Voices of Homecare: Workforce

The Homecare Association regularly surveys its members to provide robust evidence on the state of the workforce and inform policy change. In 2025/26, the sector faces some of its most pressing challenges yet. Vacancies remain stubbornly high, pay and conditions lag behind competing sectors, commissioning and contracting practices continue to undermine providers’ attempts to improve terms and conditions for their careworkers, and providers are being asked to take on new responsibilities with limited support. Without action, people who rely on homecare risk going without vital services, and providers risk closure.

This year, rather than duplicating new data collected by the Department of Health and Social Care, we focused our survey on four areas of immediate concern to providers: the closure of international recruitment routes, changes in the Employment Rights Bill, the expansion of delegated healthcare tasks, and the growth of unregulated care. These issues cut to the heart of workforce stability, safety, and the sustainability of homecare businesses.

Between 17 June and 22 July 2025, we collected 450 responses from homecare providers across the UK, serving over 186,000 clients and employing over 135,000 careworkers. The sample includes small, medium, and large providers, working with both self-funding clients and state commissioners.

Our report shows that:

• Commissioning drives workforce outcomes. The public sector funds 80% of homecare. Purchasers’ reliance on lowest-price contracts fragments hours across many providers, increasing travel time, creating irregular schedules, and undermining job security. By contrast, locality-based commissioning with volumes of 1,000 to 2,000 hours per provider allows shift-based rotas, reduces turnover, cuts carbon emissions, and improves continuity of care.
   
• Fair funding and fair working practices are the foundations of sustainable services. It is within the Government’s power to deliver these. A national contract setting a minimum fee rate, combined with sustainable funding and neighbourhood-based outcome-focused commissioning, would provide the foundation of a stable workforce.
   
• Ending international recruitment does not resolve exploitation issues and will exacerbate recruitment challenges. Hyper-fragmentation and zero-hours commissioning create instability, leaving workers underemployed and vulnerable. A key solution is for the NHS and local authorities to commission blocks of guaranteed hours within tight geographic zones. This gives providers the stability to offer secure, legal contracts and makes it easier to distinguish responsible employers from those cutting corners.
   
• Addressing the funding shortfall is key. The Health Foundation has estimated the sector needs £8.7 billion to meet demand, cover rising costs, improve access, and boost pay in 2028/29. By 2034/35 this rises to £15.4bn. At a minimum, the sector needs £3.4 billion by 2028/29 to stop services from declining.
   
• Investment in homecare offers a compelling return for people, communities, and the NHS. The Health and Social Care Committee has recently identified in its inquiry into adult social care reform: the cost of inaction, every £1 invested in the sector would generate a £1.75 return to the wider economy
   
• With political will, change is both possible and urgent.

Uncompetitive wage rates, unsociable hours and insecure contracts, all shaped by commissioning styles, drive domestic workforce turnover.

A Fair Pay Agreement could help set a foundation for improvement, but it will only succeed if matched by sustainable funding for providers, reforms to commissioning and realistic local authority and NHS budgets. Without this, attempts to improve pay and conditions may push more careworkers into unregulated parts of the market and providers into further deficit.

Other reforms add to the complexity. Measures in the Employment Rights Bill on sick pay and zero-hours contracts will have a disproportionate impact on homecare, where part-time working is high and personalised care requires frequent rota changes. Delegated healthcare tasks are growing, yet NHS support and funding for training and oversight remain limited. Unregulated models of care also pose new risks, threatening both public safety and the viability of responsible providers. 

Our message is simple. The Government must fund, plan for and include social care in reforms from the Fair Pay Agreement to employment rights, and from NHS integration to immigration. Local authority and NHS commissioning practices must evolve to support the Government and the sector’s ambition for improved working conditions, sustainable services and high-quality care. Without this, the sector faces an erosion of employment standards, business sustainability, and quality of care driven by government policy decisions.

 

Voices of Homecare: Workforce