Homecare Association welcomes National Care Service commitment: “free at the point of use must also mean fair at the point of delivery

The Homecare Association, the UK’s leading membership body for homecare providers, has welcomed the Prime Minister’s commitment at the Labour Party Conference to build a National Care Service that is free at the point of use, fully funded, and starts in the home.

The Association has long supported pooling the financial risk of care across society. Free personal care would protect people from the potentially catastrophic costs of developing a condition requiring years of support. It would also end charges that fall heavily on disabled people’s benefits, remove a charging boundary that can delay hospital discharge, and enable people to seek support earlier, when it can do most good.

But making care free to the individual will not, on its own, solve the problems facing social care.

In England, the direct cost of employing a homecare worker lawfully at the National Living Wage in 2026-27 is £26.17 per hour, before any contribution towards the other costs of delivering and managing a safe, sustainable service. The Homecare Association calculates that a minimum of £34.42 per hour is needed for sustainable homecare provision.

Experience from areas where personal care is already free illustrates the risk. Hammersmith & Fulham Council, the only council in England to provide free homecare, pays some providers only £19.29 per hour, compared with £30.18 needed simply to employ a careworker lawfully at the London Living Wage. Northern Ireland, where personal care is also free, pays a regional tariff of £22.13 per hour, below the direct cost of employment, and has the highest proportion of 15-minute homecare visits in the UK.

Dr Jane Townson OBE, Chief Executive of the Homecare Association, said:

“The Prime Minister is right to put social care at the heart of his programme, and right that care should start in the home, where most people want to live for as long as possible. Nobody can sensibly plan for years of care, and nobody should lose their home or savings because of the illness they happen to develop. We support the direction of travel and want to help make it work.

“But ‘free’ describes what the citizen pays, not what the state buys. Where care is already free, removing charges has not always been matched by sufficient funding for the care itself. The result can still be rationed minutes, insecure work and unmet need. A promise made to the public must not be paid for by the workforce, or by the people whose visits are cut short.

“The Prime Minister has promised that the National Care Service will be fully funded. That must mean funding the real cost of good care, including fair pay, travel time, training, supervision and sustainable provision, rather than transferring the cost from individuals to an underfunded commissioning system.

“He also said care should be about people, not profit. We agree that people must come first. In homecare, the immediate threat to quality is often not excessive profit but public bodies purchasing care at prices below the cost of lawful employment. A provider paid £19.29 per hour has no profit to extract, and a council-run service paid the same would face the same arithmetic.

“Reform should therefore start with people, not systems: what people need to live fulfilling lives, the support that will help them achieve that, what they should be entitled to, how we pool the cost fairly, and how people can exercise genuine choice and control over their support.”

Building the National Care Service

The Homecare Association argues that a National Care Service should combine nationally consistent entitlements with individual choice and local delivery.

Its proposed model is simple: need sets the budget; the person directs it; the provider has flexibility over delivery; and outcomes, experience and quality help determine whether the system is working.

A nationally consistent assessment would create a portable entitlement, which people could direct towards a provider of their choice within a quality-assured local network. Providers would be funded for assessed need and planned capacity, rather than retrospectively for contact minutes, enabling services to be organised around people’s needs and outcomes.

The Association’s recent report, Homecare: commissioning is the key to quality, fair work and better outcomes, sets out how commissioning could move towards this model.

The transition must begin now, rather than waiting until the National Care Service is introduced in the next Parliament.

A national contract for care services should provide a consistent framework for commissioning and delivery across the country, setting clear expectations for quality, workforce standards, transparency, continuity and outcomes. Crucially, it must come with the funding needed to meet those expectations.

Three foundations can be put in place now:

• A national price floor for homecare, below which no council or NHS body can purchase care, based on the lawful and efficient cost of providing the service.
• A fully funded Fair Pay Agreement, so that improved pay and conditions for careworkers are backed by sufficient public funding rather than imposed on providers through contracts that do not cover the cost.
• Commissioning reform, moving away from purchasing care by the contact minute towards funding assessed need and planned capacity, enabling providers to pay careworkers for the whole working round, including travel time.

Dr Townson added:

“Free personal care could be a profound and positive reform, if we learn from what has and has not worked elsewhere.

“The question is not simply whether care is free. It is whether people can get enough good care when they need it, whether careworkers can earn a fair and secure living, and whether providers can sustain the capacity communities need.

“A National Care Service worthy of the name must be free at the point of use and fair at the point of delivery.”

ENDS

Notes to editors

1. The Homecare Association is the UK’s leading membership body for homecare providers, representing organisations of every type and size across the independent, voluntary and public sectors.
2. The Homecare Association's paper, Homecare: commissioning is the key to quality, fair work and better outcomes sets out four commissioning decisions that must align: price, allocation, payment mechanism and assurance.
3. The Homecare Association's paper. Responsible capital in social care: investment, profit and policy choices facing the government argues that providers should be judged on behaviour, outcomes and financial resilience rather than ownership model alone.
4. The Homecare Association’s Minimum Price for Homecare 2026-27 calculates the direct cost of employing a careworker lawfully in England at £26.17 per hour and the minimum price for safe, sustainable provision at £34.42 per hour. The equivalent direct employment cost at the London Living Wage is £30.18 per hour.
5. The Homecare Association's Homecare Deficit 2025 reports on fee rates for homecare in 2025, obtained via freedom of information enquiries to all 276 public bodies in the UK. In 2025, Hammersmith & Fulham Council reported an average hourly price of £19.53. Recent data provided by members suggests some providers are receiving £19.29 per hour. In 2025, Health and Social Care Trusts in Northern Ireland reported an average of £21.62 per hour. The Northern Ireland Department of Health's published tariff for homecare in 2026-27 is £22.13 per hour.

Contact
E-mail: [email protected]
Telephone: 020 8661 8160
Mobile: 07435 910654