Skip to main content

Where the heart is ... a review of the older people's home care market in England

With an expanding older population, changing health and social care needs and expectations, and a wide recognition that acute care services are not the best place to support older people, the question about what kind of home based care services are needed in future might be expected to be at the heart of public care debate. We hope that this report will encourage wider discussion about this question and ultimately a clearer view about what home care is for, and how it can be best delivered.

Currently, home care services are struggling. A wide range of different services are delivered or commissioned through health, housing or social care, and the catch-all title of home care includes many different activities, with different purposes and very different results. The evidence-base to show how effective home care can be is limited and inconclusive. A major employer across the country, home care is generally a low wage sector with low status and profile, and has been susceptible to further cost-cutting in recent years as a result of reduced local authority budgets due to the economic downturn.

It is a sector still characterised mainly by small private employers running small or medium sized businesses, but larger providers also see opportunities for responding to potentially increased demand as the population ages. Self-funders and personal budget holders are becoming increasingly important purchasers of care and some providers are developing new and very different ways of approaching this market.

This report offers a picture of the current home care market, some of the challenges it faces, and a model for its future development. It aims to provide a basis for dialogue between commissioners, consumers and providers about what home care services might look like in the future. It is written during the period of consultation on the proposals put forward by the Government in the 2012 Care and Support White Paper.