What’s happening in homecare? - Quarterly Members’ Meeting

Crisis in UK Homecare

The homecare sector in the UK, which supports vulnerable adults to live independently at home, is under severe strain in early 2026. A major policy shift came in July 2025 when the government banned recruitment of overseas care workers under the Health and Care Worker visa route. This ended reliance on international staff, who had comprised a growing share of the workforce and helped stabilise vacancy rates temporarily.

Vacancies in homecare remain far above the wider economy average, with rates around 9.7% in late 2025 and recruitment difficulties reported by most providers. Domestic workers continue to leave for better-paid roles elsewhere, while pay in the sector hovers near the National Living Wage, offering little incentive or progression.

Compounding this, providers face escalating costs. The National Living Wage rose significantly in April 2025, with another increase slated for 2026, alongside changes to employer National Insurance thresholds and new rights under the Employment Rights Bill. Yet local authorities and NHS commissioners pay hourly rates—often around £24 or less—that fail to cover these costs, let alone overheads like travel, training, or compliance. The Homecare Association's analysis shows many public bodies pay below even the direct cost of employing workers at minimum wage levels.

The funding gap for England alone exceeds £2.6 billion for 2025-2026, with longer-term estimates from bodies like the Health Foundation pointing to needs of £8.7 billion by 2028/29 to meet demand, cover costs, and improve pay. Without adequate uplifts, providers struggle to sustain services, leading to closures, reduced capacity, or refusal of new packages.

Real-world consequences are stark. Hospital discharges are delayed—nearly six in ten patients faced issues in early 2025 due to homecare shortages—prolonging NHS pressures and bed blocking. Vulnerable people face longer waits or reduced support, increasing risks of hospital admissions or reliance on family carers. The government's push toward neighbourhood health and community-based care, including through the Better Care Fund, depends on a viable homecare sector, but current funding and workforce dynamics undermine this shift.

Tensions abound: efforts to improve domestic worker conditions and pay (via a planned Fair Pay Agreement from 2028) clash with immediate fiscal constraints and immigration controls aimed at reducing net migration. Sector leaders warn of a 'knife-edge' situation, where short-term restrictions risk long-term decline unless central government provides direct funding to bridge gaps.