“Resilient care is built, not hoped for.” Dr Jane Townson OBE, Homecare, June 2026
Every care package in the UK starts at a kitchen table. A cup of tea, an assessment form, and one question, asked thousands of times a day: what help do you need?
It is a kind question. It is also the most expensive one in the sector. Whatever the answer, the result is a package of hours, and hours only ever grow.
We have watched that question from three countries: Denmark, the Netherlands and, since 2023, the UK. This is what we think it costs, and why we think the UK is closer to changing it than it realises.
The invisible bill
The cost of that first question does not disappear when a council declines to fund the answer. It moves. First to the person and their family, who pay for care themselves when the council does not. Jane Townson has called it the care tax: paid in nursing home fees, in careers cut short, in a generation caring for parents and children at once. Carers UK estimated in 2019 that 2.6 million people had given up work to care. Employers pay. The NHS pays, in every avoidable admission.
Most of the technology sold to homecare providers this year does nothing about that bill. Rostering, records, planning, compliance. Valuable work, and every stretched service needs it. But technology in homecare is an instrument, and the question is what it serves: the rota, or the person. Serving the rota makes the same hours cheaper to deliver. It leaves the demand exactly where it was.
The question Denmark asks
Denmark changed the question by law. Since 2015, municipalities have been required to offer a short, goal-directed rehabilitation course before granting ongoing home care, wherever function can realistically improve. At a Danish kitchen table the first question is not what help you need. It is what you could regain.
DigiRehab is what that question looks like on an ordinary Tuesday: twelve weeks of strength and balance training at home, twice a week, delivered by the care worker who is already there and guided by a tablet. According to DigiRehab, nearly half of Denmark’s 98 municipalities use it, and more than 25,000 training programmes have been completed. About seven in ten people finish the course. Municipalities judge it on their own care records, every year, and those results are why they continue.
The story we find hardest to forget is not a number. In Stevns, south of Copenhagen, a training assistant tells of a woman of 93: a wheelchair, four visits a day. Her answer to the question was her garden. Four weeks in she was mowing her own lawn and walking the kilometre to her hairdresser. Today she receives a few visits a month.
Stevns has gone a step further. There, DigiRehab is paid on results: payment depends on whether the measured need for care actually falls. Stevns is the first municipality with a contract like this, others are preparing one, and it is not yet common practice.
The Netherlands, without a law
Does the question travel without a law behind it? We tested that ourselves in the Netherlands: different funding, different assessment rules, nothing in legislation to lean on.
The numbers travelled well. At a large Dutch care group serving more than 10,000 clients a year, we followed 121 clients who completed the programme. In the year before they started, 82 per cent had needed steadily more care. In the 52 weeks after starting, they received on average 25 fewer hours of care. Measured against each client’s own rising trend, the difference is 78 hours. Other Dutch projects show the same pattern.
The harder lesson was not in the numbers. The training travelled easily. The question did not. As long as the conversation opens with “what help do you need?”, people ask for help, and staff give it. The change only began when the first question turned to what someone could regain, and not as an exercise target. Nobody trains to improve a score. People train to walk to the shops, to climb their own stairs, to mow a lawn. Learning to ask that well was the real work in the Netherlands. It will be the real work here too.
The UK head start
Here is the part we did not expect. The UK starts further along than either Denmark or the Netherlands did. Reablement is already a familiar word. Most providers know the six-week service, and most commissioners have bought one. The gap that Denmark closed by law, and the Netherlands closed by learning, is smaller here than it was for us.
Funded reablement in England usually stops at week six, while the Danish experience suggests the second six weeks are where gains settle in. A provider able to keep asking the question past week six offers commissioners something the system cannot currently buy.
A provider paid by the hour will read “fewer hours” as lost income, and that is a fair first reaction. But where a provider cannot staff all the hours it is already asked for, an hour a client no longer needs is not lost. It goes to the next person waiting, delivered by a care worker the provider already employs. For clients who pay for themselves, the course is also a service in its own right: it has a beginning, an end and a result, and it sits next to hourly care rather than replacing it.
Two questions
Back to the kitchen table. Same person, same cup of tea, same form. One question produces a package of hours that will quietly grow for years. The other produces twelve weeks of work towards a goal the person actually wants, and often a smaller package at the end of it.
The care tax is real, and it is already being paid. A different first question will not abolish it. In Denmark and the Netherlands it has made it smaller. We would like to find out, with providers here, how far it can go in the UK.
By Arend Roos and Dr Robert Stewart
Arend Roos is UK Lead and Director of DigiRehab UK. Dr Robert Stewart is a retired GP, former Senior Lecturer in Innovation in Healthcare at Kent and Medway Medical School, and clinical adviser to DigiRehab UK. DigiRehab is a twelve-week strength and balance programme for older people, developed in Denmark and delivered by care workers during their visits. In the UK since 2023: digirehab.uk.