The Care Quality Commission (CQC)’s new State of Care report reveals systemic issues and inequalities in the homecare sector. These threaten to undermine the new Labour government’s 10-year plan for health and their ambition for a National Care Service. The Homecare Association welcomes Labour's commitment to "Home First". Homecare is well-placed to support the three shifts: from hospital to community; illness to prevention; and analogue to digital. The government must recognise and address the barriers to delivering this vision.
While CQC reports homecare services have grown by 34% since April 2020, reaching nearly 13,250 registered services, this expansion masks deeply concerning regional inequalities. The northeast has just one-third of the registered homecare agencies per 100,000 people aged 65+ compared to London. Our research showed the northeast had one of the lowest hourly rates at £19.82 per hour, second-lowest in England's nine government regions (1).
Dr Jane Townson OBE, CEO of the Homecare Association, said:
"Homecare plays a vital role in enabling us all to live well at home and flourish in our communities. Investing in homecare helps to enhance wellbeing; increase healthy life expectancy; reduce pressure on the NHS; save money for the health and care system; and support economic growth.
"Our research on fee rates for homecare has consistently shown that the lowest fee rates cluster in areas of higher deprivation. The State of Care report now confirms that these same areas have significantly lower access to homecare services. This is no coincidence - providers simply cannot operate sustainably under current commissioning practices. Data show those without access to homecare are at higher risk of falls and emergency hospital admissions.
"Zero-hour commissioning at low fee rates leads to zero-hour, insecure employment at low wage rates. This creates conditions ripe for labour exploitation and, potentially, modern slavery. Currently, 38% of homecare workers are on zero-hour contracts, driven by commissioning practices of councils and the NHS. Implementing the new Employment Rights Bill won't be enough to improve recruitment and retention; the government must also address funding and commissioning.”
The quality assurance system also requires urgent reform. CQC reports 86% of homecare services as Good or Outstanding. Our work, however, highlighted that 60% of homecare locations have no ratings (23%) or received their last rating 4-8 years ago (37%) (2). This, along with poor local authority oversight, raises concerns about the quality of services.
The Homecare Association calls on the government to implement the seven principles outlined in our 2024 Manifesto (3):
- Put homecare and support at the heart of health and care policy
- Empower partnership working across sectors
- Drive innovation in preventative care
- Transform care into a valued career with fair pay
- Invest £18.4bn by 2032/33 to meet future demand
- Commission for value rather than lowest price
- Strengthen regulation to protect both workforce and care recipients
Dr Jane Townson OBE added,
"The new government's transformation agenda cannot succeed without addressing these fundamental issues. We need between £1 billion and £1.4 billion extra annually just to ensure homecare workers receive pay equivalent to NHS Band 3 Healthcare Assistants. The current average fee rate of £23.26 per hour falls well short of the £31.51 needed to ensure fair pay and sustainable services."
[ENDS]
(1) https://www.homecareassociation.org.uk/resource/the-homecare-deficit-2023-pdf.html
(3) https://www.homecareassociation.org.uk/resource/homecare-manifesto-for-the-general-election.html
Contacts
Dr Jane Townson OBE, CEO, Homecare Association
Email - [email protected]
Mobile number - 07970 881840
Notes to editors
The Homecare Association is the UK’s membership body for homecare providers, with over 2,200 members nationally. Our mission is to ensure that homecare receives the investment it deserves, so all of us can live well at home and flourish within our communities. The Homecare Association acts as a trusted voice, taking a lead in shaping homecare, in collaboration with partners across the care sector. It also provides hands-on support and practical tools for its members. The Homecare Association's members agree to abide by the Association's Code of Practice.
