Dr Jane Townson OBE, Chief Executive at the Homecare Association, examines how policy changes meet the hard limits of provider reality — and why homecare workers feel the impact first.
Too many homecare workers in England receive pay only for the minutes they spend in someone’s home. Travel between visits, waiting time, training and supervision are often unpaid or only partially recognised. Headline wage rates can appear compliant, but the pay for total hours worked tells a different story.
In much of England, councils and NHS bodies are the dominant buyers, fixing fee rates and forcing providers to compete for limited hours, prioritising price over quality and outcomes. Some providers accept below-cost fees and then “make it work” by squeezing labour: unpaid travel time, long gaps between visits, and minimum wage breaches. Worker exploitation and poor care quality are inevitable consequences.
Commissioning design also shapes job quality. When public buyers spread small volumes across dozens of providers, none have enough work to build compact rotas. This makes it hard to offer shift-based roles with guaranteed hours and predictable income. The Homecare Association’s Homecare Deficit 2025 shows 61% of councils and trusts purchase only 500 hours per provider per week – far below what providers need for workforce stability and sustainability.
Homecare is essential infrastructure. It keeps people safe at home, prevents avoidable hospital admissions, supports discharge, and enables unpaid carers to remain in work. The House of Lords Economic Affairs Committee reinforces this: care is foundational to national resilience and economic participation. The Commons Health and Social Care Committee found that every £1 invested in social care generates a £1.75 return to the wider economy. Yet government starves care of investment.
The Employment Rights Act has now gained Royal Assent. Stronger rights, better sick pay and more predictable hours are welcome. But law alone will not improve conditions if public bodies keep buying homecare by the minute at fee rates which cannot cover legal compliance costs. Our Minimum Price for Homecare sets out what lawful delivery includes: paid travel time, paid training, holiday pay, mileage, and overheads for a safe, regulated service.
The same applies to the Fair Pay Agreement. The principle is right. But who will pay for fair pay? Government estimates the 10-year cost at £6.4 billion, with a significant share expected to fall on councils, the NHS and self-funders. Without ring-fenced investment, a Fair Pay Agreement risks becoming another promise that looks good on paper but fails in practice.
So, what should change?
First, market shaping and commissioning that make decent jobs possible. We recommend neighbourhood-based contracts large enough to support stable teams – around 1,500–2,000 hours per week per provider – so providers can build compact rotas, reduce travel and waiting time, and offer shift-based pay with secure income.
Second, a national contract that sets a minimum price for homecare, backed by government funding, so public bodies cannot set fees below legal cost.
Third, ring-fenced government funding must cover the extra employment costs that come with guaranteed hours, expanded sick pay, and fair pay requirements.
Finally, fair regulation matters. Authorities do not consistently recognise compliant providers, and poor practice often eludes detection or enforcement.
When homecare struggles under funding pressures, families face crises, unpaid carers cannot work, and the NHS bears the cost through avoidable admissions and delayed discharges. Yet government prioritises NHS investment while treating homecare as discretionary spending. This is a false economy that undermines the very prevention agenda it claims to champion.
“Home first” needs more than legislation. It needs a system built to support it: intelligent market shaping and commissioning, fair price, fair pay, and fair regulation. Only then will employment rights and fair pay agreements translate into better jobs – and, crucially, better outcomes for those needing care and support.
