Home Care
Home care isn’t broken. Strengthen it now, and it will carry the NHS this winter
As the National Care Service takes shape, one thing needs saying: the home care market isn’t broken. It needs strengthening, and that can be done with levers the government already holds, starting in next month’s Budget. A thriving home care market will support the NHS this winter, not in ten years’ time. Providers are ready and waiting to prove it before the general election.
A working class family built on care
Thirty years ago my mum left her NHS midwifery job to start caring for people in their own homes. My dad was a paramedic. There were five of us boys.
When I hear the Prime Minister talk about what his family’s journey made possible, I recognise it. Home care gave our working class family the same thing: a chance to build a better life through hard graft.
I was able to go to university and study business management, then come back and join the business Mum started. Today Premier Community employs more than 600 people across the East Midlands and South Yorkshire. We’re still locally rooted and still family-run.
A National Care Service is an exciting moment
I want to be clear from the start: a Prime Minister putting social care at the centre of his agenda is a massively exciting moment for our sector. I don’t want to undervalue his approach, or the raw emotion he clearly brings to it.
There are two things we completely agree on.
Care workers are undervalued. Care is a skilled, vocational profession. As a business we stretch every budget to put as much as we can back into the front line, so our teams have the environment they need to do their jobs well. But it doesn’t go far enough, and we both know it. A Fair Pay Agreement that sets a proper standard for how care staff are treated is something we’d welcome.
The system is unfair on people who pay for their own care. Too many families spend their life savings on care that should be treated as essential. If the National Care Service ends that injustice, it will have done something generations of politicians have failed to do.
The misconception about private providers
Where I think the debate is going wrong is on what “private” actually means in home care.
Baroness Casey has spoken about large, often overseas-owned organisations profiteering from care, and quoted margins of 12 to 15%. There are operators that fit that description, and she’s right to call them out. But that picture comes largely from care homes and specialist services. It isn’t what home care looks like on the ground.
There are around 12,000 registered home care providers in England. Most are small and independent, and many are family businesses like ours. Some people call that fragmented. I’d call it choice. People and councils can pick a provider that suits them, and that provider is accountable locally, to the families it serves and the commissioners who can take their contracts elsewhere.
The reality since 2024
Our costs have risen far faster than the fees councils can pay. Since 2024, employer National Insurance changes and National Living Wage rises have pushed social care workforce costs up almost 10% in a single year. That’s about £2.8bn, against £880m of extra funding. Council home care fees rose by an average of 5.3%.
I don’t blame councils for that. They’re squeezed too, and overspent their social care budgets by an estimated £774m in 2024/25. They have very little choice but to hold rates down.
The result is a system that only works because families paying for their own care help keep providers viable. That’s the same unfairness the Prime Minister wants to end, and it’s why fair funding has to come first.
Talking about the next election and a long-term mission is right. But the system doesn’t need tearing up to get better. The pressure on providers is happening now, and so is the opportunity.
From coal fires to crisis care
When I joined Premier in 2006, the job looked very different. Our carers lit coal fires, took people out on social trips and did the everyday preventative work that kept people well at home for longer.
Even then, local authority in-house services were overwhelmed. We existed because we could help them: we could recruit, we could employ and we could deliver efficiently.
Today, most of what we’re asked to do is last-minute crisis care. People come to us later, with higher needs, often straight from a hospital bed. The market is far more complex than it was 20 years ago.
So I say this with respect for the ambition: it would be a fantasy to think a national service could run home care directly. The delivery capacity, local knowledge and workforce already sit with thousands of independent providers. The market isn’t broken. It needs strengthening.
Home care can help the NHS this winter
We don’t have to wait ten years to see what a stronger home care market can do. We’ve already done it. In spring 2020, as hospitals battled Covid, our local authority put extra resources behind hospital discharge. We used it to set up a dedicated new-starter team for emergency discharges. In May 2020 we took on more than 70 new clients, a record for us at the time and roughly double what we’d normally onboard in a month.
We were one small part of something much bigger. Up and down the country, care workers were visible and kept going into people’s homes when everyone else was told to stay in theirs. The public remembers that. That workforce and those providers are still here, and they’re waiting for the right backing to do it again this winter, and to be the backbone of the National Care Service that follows
In early 2026, an average of 13,750 people a day were stuck in English hospitals despite being well enough to leave. Winter always pushes that number higher. More than 400,000 people are waiting for a social care assessment, care or a review.
Many of those people could be at home, with the right care around them, if councils could commission it at a price that covers the cost. On average, councils across the UK are paying £25.05 an hour for home care this year. The Homecare Association puts the minimum sustainable price at £34.42.
Close some of that gap, and providers like us can take people home sooner. That frees beds for the patients who need them, and it gets in early enough to stop the next admission. Every week we pick up the calls, from discharge teams asking us to find care today.
Prove it before the election, with levers that already exist
The National Care Service’s mission is to fund care fairly, set a common standard for good care alongside CQC, and make sure care staff are treated properly. That is everything we want as a business. The Prime Minister has said he wants to fund reform from existing budgets. I agree, and I think the Budget on 28 October is the place to start.
None of these needs a new institution:
- Fund councils to pay the real cost of care. Channel money through the existing social care grants so fee rates move towards the £34.42 an hour it costs to deliver care legally and well.
- Treat care providers like public bodies on employer National Insurance. The NHS and councils were compensated for the 2025 rise. Care providers doing the same publicly funded work were not.
- Use winter and discharge funding to buy home care capacity up front. Guaranteed hours for discharge, agreed before the winter peak, get people home instead of leaving them waiting on a ward.
- Bring the Fair Pay Agreement forward. £500m is already set aside for 2028–29. Starting some of it now, ring-fenced for care worker pay, would show carers they’re valued this year.
- One framework for every provider. Public, private, family-run or not-for-profit, everyone works to the same standards and is judged on quality, not ownership.
If there’s political capital to spend, spend it now. Don’t wait for a mandate in 2029. Prove it this winter.
Do that, and by the next election the public won’t have to take a National Care Service on trust. They’ll have seen what a strengthened home care market does for their parents, their neighbours and their local hospital. Providers are ready and waiting. Let us prove it.
Dan Isterling, CEO, Premier Community
Sources: Nuffield Trust (cost pressures) · Nuffield Trust (delayed discharges) · Homecare Association · Nursing in Practice (Fair Pay Agreement) · Homecare.co.uk
