Karolina Gerlich, Chief Executive of The Care Workers’ Charity, explores the hidden pressures facing care workers — from financial insecurity and burnout to risk-averse cultures — and argues that meaningful safeguarding depends on trusting, valuing and properly supporting the workforce delivering care every day.
When something goes badly wrong in a high-risk environment, the response is usually the same. New rules and tighter controls. Procedures applied to everyone, regardless of context, because the alternative, trusting individual judgement, feels too uncertain. It is an understandable instinct but it has had a cost that the sector has not been honest enough about.
A series of serious, high-profile failures has shaped how the sector thinks about risk, and accountability for those failures matters. But the response has hardened over time into something broader than any single incident warrants: a culture in which risk avoidance has become the default, and care workers are treated not as skilled professionals exercising judgement but as variables to be controlled. That shift did not happen in isolation. It reflects something deeper about how society regards the people who do this work. Care work is still not widely understood as the skilled profession it is, and that misunderstanding has consequences that reach further than most people realise. It shapes pay, conditions and status. It leaves care workers navigating financial insecurity and, for many, housing pressures that would not be tolerated in professions carrying comparable responsibility. It takes a mental health toll that the sector has been slow to acknowledge. And it erodes the autonomy that good care depends on, producing a version of safeguarding that is better designed to protect the system than the person at the centre of it.The people drawing on care are not fragile objects to be kept safe from the world. They are people with preferences, relationships, appetites and agency. They are entitled to support that helps them live well, not a managed existence shaped primarily by the desire to minimise the possibility of anything going wrong. Risk, properly understood, is not the enemy. And the question the sector should be asking is not how to eliminate it but how to navigate it well, in ways that are genuinely led by the person.
That knowledge sits with care workers. They are the people with the relationships, the ones who know what matters to an individual, what a good day looks like, what brings them to life and what diminishes them. And yet decisions about what someone can or cannot do routinely get made in reviews and risk assessments, in conversations between managers and family members, with the care worker’s direct understanding treated as background information rather than the primary evidence it should be. Families, understandably anxious about the people they love, sometimes impose their own assumptions about what is appropriate, what an older person should want, who they should spend time with and where they should go. As someone who has worked in care, I know how often the care worker is left carrying the role of advocate in those moments, holding space for the person’s voice in a conversation that has already moved on without them.
The ableist assumptions embedded in some of these decisions are also sadly evident. This is seen in the way that sexual relationships or friendships outside a care setting get framed as risks to be managed rather than as aspects of a full life. In the way that activity gets restricted not because of evidence of harm but because of discomfort or an aim to be seen to be doing the cautious thing. This is an approach to risk that succeeds on paper while leaving the person it was meant to protect diminished.
Good safeguarding has to start from a different place. It has to be centred on the person, driven by their choices and their relationships, and it requires care workers to have the training, the competencies and the professional trust to make those judgements well. It also requires them to be genuinely present in the conversations where decisions are made, in MDTs and reviews, and in the neighbourhood health structures that are beginning to reshape how services are organised. Not as attendees. As the people whose knowledge of the individual cannot be replicated anywhere else in the system.
None of that is possible without adequate funding. Care workers cannot be expected to take on greater professional responsibility, to advocate effectively, to build the kind of relationships that make person-centred risk decisions possible, while working in conditions that are chronically under-resourced. The sector has asked care workers to do more with less for too long, and the human cost of that is visible in the workforce: in the stress and burnout, in the people who leave, in the ones who stay and absorb the pressure quietly. At The Care Workers’ Charity, we see that cost directly, and it informs everything we do to support, represent and elevate the workforce. If the ambition is genuinely to shift toward relational, outcomes-led care, the funding has to follow. Without it, the ask is just another burden placed on people who are already carrying too much. The move toward neighbourhood health is a real opportunity to build something better. Models of care that are relational rather than procedural, that understand risk as something to be navigated with the right people rather than managed from above. But that only works if care workers are trusted, involved and resourced to do it. The potential is there. So is the choice about whether to take it seriously.
