Homecare Association Manifesto 2024


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; and save money for the health and care system.
A quarter of us will be 65 or older in 25 years. Our health and care system is not coping now. To meet this challenge, we must transform how we fund, provide, and ensure access to care. Early support and preventative approaches in the community will help to shift the dial on demand. We must harness the power of innovation while cherishing the irreplaceable human elements of hands-on care. With smart strategies, collaboration, and investment, we can build a future where more of us remain healthy for longer. Supporting people at home must be at the heart of government policy.
Our manifesto for homecare highlights seven areas of focus for an incoming government.

1. Home at Heart

Older and disabled people prefer to draw on support and care at home rather than in hospitals or care homes. They value their independence, autonomy, and community connections. We need increased public awareness of the value of homecare and for “home first” to become the default option. The government, NHS, and councils must provide accessible information to help people know what choices they have. When assessing needs, it’s crucial to focus first on supporting individuals at home. Assessors must evaluate if the home environment is suitable and suggest any adaptations or technology to assist. Commissioners must work together to develop integrated care pathways that promote homecare. The government must find new and fairer ways to cover the costs of care, ensuring universal access regardless of ability to pay.

2. Power in Partnership

Collaboration across social care, health, housing, and voluntary sectors is crucial for addressing people’s complex needs efficiently and effectively. Developing integrated care pathways, promoting joint training, and sharing data, supports team-working. Homecare providers must have a voice in Integrated Care System (ICS) discussions and decision-making at all levels. ICS leaders must involve homecare providers in developing plans and listen to their feedback. To empower people needing and giving care, we must create advisory groups and share accessible information to help them shape services.

3. Innovate to Improve

Social factors such as where we live, our education, lifestyle, social support, and financial stability strongly influence our health and well-being. With the use of data and predictive analytics, we can now identify those at higher risk and take action early to maintain health. We need to create models of homecare that prioritise prevention and address social factors to extend healthy lifespan. ICBs should commission homecare as part of proactive care and public health services. By combining technology, data analysis, and in-person care, we can enhance the quality and efficiency of homecare services.

4. Care as a Career

To meet rising demand for care, Skills for Care estimates the sector will need 440,000 more care workers by 2035, a 25 percent growth from 2022-23 . Growth in the older population is happening more in peripheral, rural, and coastal areas than in urban centres. This requires systematic planning and resource allocation to meet workforce requirements in the future.
Recruitment and retention of care workers is, however, a challenge. In 2022-23, the vacancy rate was 9.9 percent and the staff turnover rate was 28.3 percent. Factors associated with higher turnover include younger age of workers; lower pay; fewer contracted hours; zero-hour contracts; less training; and lack of relevant qualifications.  While international recruitment is helping to address immediate shortages, it is not a long-term solution. We need urgent government action and a workforce strategy to attract and retain a skilled homecare workforce within the UK. This must address recruitment, retention, training, working conditions, recognition, collaboration, workforce planning, and funding. Crucially, there must be investment to ensure care experts at all levels receive fair and secure pay and terms and conditions of employment. 

5. Invest in the Future

We need a multi-year funding settlement for social care to meet future demand, improve access to care, and cover the full costs (£18.4bn by 2032/33). We must pool risk and find new ways to fund care. Suggestions include a cap on lifetime care costs; a social care insurance scheme; private insurance; or public-private partnerships, to create a simpler, fairer system that protects individuals and families. To support providers in improving their services, VAT on welfare services should be zero-rated. This would allow them to reclaim VAT on operating expenses and invest in staff, technology, and infrastructure.

6. Commission for Value

Councils and the NHS must commission for long-term value and outcomes, not short-term price, which risks substandard care. Investing in early support and prevention helps reduce future costs. Shifting from time-and-task-based models means adjusting payment systems to offer greater security of income. This helps to improve employment conditions for the workforce. It also encourages innovation.
Central government must fund councils to pay a fair cost of care. Detailed cost analyses and stakeholder consultations are required to inform this. The government must legislate to ensure public bodies cover the full cost of quality sustainable care services.

7. Regulate to Protect

Effective regulation is essential for protecting the rights and well-being of those who draw on homecare services. By ensuring all providers of personal care meet rigorous standards and dealing swiftly with poor performance, regulators can drive up the quality of care and give people confidence in the services they rely on. The government must ensure regulators are well-led and resourced to fulfil their responsibilities. The government must set performance standards and hold regulators accountable. All providers of personal care should be subject to oversight. A professional register for care experts should recognise their skills and maintain standards.
With smart strategies, collaboration, and investment, we can build a future where more of us remain healthy for longer. Supporting people at home must be at the heart of government policy.

Homecare Association

The Homecare Association is a national membership body for homecare providers, with over 2,200 members across the UK. Our mission is to ensure society values homecare, and invests in it, so all of us can live well at home and flourish within our communities. We lead the way in shaping homecare and provide practical support for our members.

Facts & Figures

*Over 950,000 people per year in the UK supported at home by professional careworkers, compared with up to 487,485 in care homes, and fewer than 150,000 in UK hospitals at any one time.
*4.6 million hours per week of homecare delivered in the UK, or 237 million per year.
*c. 10.6m people providing informal unpaid care at home
*700K jobs in homecare in England (555K in CQC regulated providers; 130K unregistered personal assistants)
*43% care experts on zero-hour employment contracts, driven by zero-hour commissioning of homecare by councils and the NHS
30.6% staff turnover
*Median pay £12.14 per hour, although this figure might be higher than actual pay per hour when all working time, including travel time, is accounted for.
*£21.56 per hour, weighted average price paid by public bodies in the UK for homecare for people aged 65 years and over in a sample week during April 2023
*£2.08 billion p.a. The additional money needed to ensure that homecare workers in the UK can be paid the same as NHS healthcare assistants at Band 3 with 2+ years’ experience
*£30.31 per hour. Fee rate needed to ensure care workers receive pay of £12.45 per hour, equivalent to NHS Band 3 Health Care Assistant with 2+ years’ experience.

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