The Homecare Association welcomes the Big Conversation on Care and the Prime Minister's commitment to reform

The Homecare Association has welcomed the Prime Minister's speech on the need to reform adult social care, and the launch of the first phase of the Big Conversation on Care, posing the question: "When we are old or disabled, or have a serious illness, who should support us and how?"  

Every one of us is affected by the state of social care, directly or indirectly. When older and disabled people cannot get adequate care and support at home, they and their families risk harm – and pressure on the NHS grows. At least three-quarters of hospital beds are occupied by older people, corridor care is rife, and 42% of hospital inpatients are waiting for services provided mainly through social care, at £400 or more per bed per night. Supporting people well in their own homes keeps them independent and out of hospital – and frees up the GP appointments and hospital beds every family relies on.

The Homecare Association supports the government's ambitions for quality, choice and control, and integration around the person. Engaging the public directly in shaping how we prepare for an ageing society is vital, as is cross-party consensus if reform is to outlast electoral cycles.

The Prime Minister has talked about personal care free at the point of use, which would reduce financial stress for individuals and families and end the fear of a long illness consuming everything a lifetime has built. The Association has long advocated for pooling risk and making care free at the point of delivery, like most NHS treatment.

But free personal care on its own does not improve the other outcomes that matter to people – the quality of care, people's wellbeing and independence, and fairness for careworkers – because the way the state purchases care shapes everyone's experience of it. Some parts of the UK already provide free personal care, yet they still buy careworkers' minutes at less than the lawful cost of employment, and there’s no evidence of better outcomes for the people drawing on care or the workforce.

The Association believes the longer-term direction of travel should be from a purely commissioned wholesale model towards a more consumer-directed system, in which funding follows the person and people choose from a curated network of quality-assured providers. Countries as different as Australia and the United States, through its public Medicare programme, have converged on this approach despite having almost nothing in common fiscally or politically. But such a system cannot be introduced at scale overnight: it depends on infrastructure that Britain has yet to build – fair prices, more secure payment mechanisms, geographic density, up-to-date quality ratings, shared data and a stable, trained workforce – which is why reforming how care is commissioned now is the route to that destination.

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

“We warmly welcome the Prime Minister's determination to reform social care and to build public understanding and cross-party consensus. Fix care at home and you free up the GP appointment you cannot get and the hospital bed your family may one day need.

“Anyone who has seen a well served self-funder knows what quality care looks like: a trusted local provider chosen by the family, a careworker you know arriving when they said they would, and visits shaped by need rather than a stopwatch. Our ambition is for every citizen to have that opportunity, whoever pays.

“The state's role then changes from purchaser of minutes to guarantor of the system: it assesses, funds, prices, licenses, rates and holds to account, while the citizen chooses.

“We cannot move to that at scale overnight. The countries that deliver it built the foundations first, and so must we. That is why reforming how care is commissioned now matters so much – and why free personal care, on its own, is not enough. Free at the point of use must be funded at the point of delivery.

“We stand ready to work with the Prime Minister, the government, the Casey Commission and all political parties to build a care system worthy of the people it serves.”

The Homecare Association continues to call on the government to:

• Legislate: introduce a statutory National Contract for Care requiring commissioners to pay cost-reflective rates calculated through an agreed national method.
• Invest: ring-fence social care budgets and invest at least £2.64 billion for England to ensure homecare workers receive equivalent wages to NHS Band 3 healthcare assistants with 2+ years’ experience.
• Reform: replace competitive minute-by-minute purchasing with funding that follows the person and pays for outcomes, so providers are rewarded for keeping people well and independent, and careworkers can be offered secure employment, fair pay and training.

ENDS

Notes to editors

• The Homecare Association is the UK's leading membership body for homecare providers, with over 2,100 members nationally. Its mission is to ensure society values and invests in homecare, so we can all live well at home and flourish in our communities. The Homecare Association's members agree to abide by the Association's Code of Practice.
• Every £1 invested in earlier, preventative support saves £3.17 – £11.1 billion if scaled across England (Local Government Association).
• On average, public bodies pay about £25 per hour for homecare against the £34.42 needed in England for safe, lawful, sustainable services (£38.69 in London); nearly a third pay less than it costs simply to employ a careworker legally (Minimum Price for Homecare 2026-27; Homecare Deficit 2025).
• 83.5% of registered community social care services in England have no current CQC quality rating (Unseen and Unrated, Homecare Association, June 2026).
• The number of British people working in adult social care has fallen by 130,000 since 2020/21 (Skills for Care, 2026), and the careworker visa route has closed.
• Hammersmith & Fulham Council, which provides free homecare currently pays £19.29 per hour – around half the £38.69 needed at the London Living Wage; its CQC local authority assessment rating is ‘Requires improvement’.
• Northern Ireland provides free personal care, yet every Health and Social Care Trust pays below the direct cost of employing careworkers at the National Living Wage, and it has the UK's highest proportion of 15-minute visits.
• Australia's Support at Home programme (implemented from November 2025) and the US Medicare home health programme both provide a single national assessment, needs-based budgets rather than payment by the minute, citizen choice from quality-assured providers informed by public ratings, and payment adjusted for outcomes achieved.
• The US Medicare programme is publicly funded and free at the point of use for those who qualify.