Home Care is Hiding in Plain Sight – and Local Government Holds the Key

Sharon Lowrie

Chief Executive – Be Caring

Arguing that the NHS’s ambitions will fail without serious reform of home care, Sharon Lowrie, Chief Executive of Be Caring, sets out why local government must overhaul commissioning to unlock better outcomes with the money already available.

The NHS Fit for the Future: Ten Year Health Plan for England is built on the compelling premise that care must shift from hospital to community, from treatment to prevention, from analogue to digital. Ministers are right to champion it. But there is a stubborn gap between that ambition and the funding, commissioning culture, and political will needed to make it real, and nowhere is that gap more visible than in home care.

The Overlooked Backbone of Community Care

Home care keeps older and disabled people independent, reduces hospital admissions and, when it works well, delays or prevents the need for far more expensive residential placements. Yet it remains, in political terms, the sector nobody wants to own. The NHS talks about community services but rarely means home care specifically. Local government funds it but rarely shapes it. National policy mentions it in passing. The result is a service that is simultaneously essential and overlooked, bearing enormous systemic pressure while receiving disproportionately little strategic attention.

This is a problem that local government has both the power and the responsibility to fix.

The current commissioning model for home care is broken in ways that are structural, not incidental. The dominant approach, commissioning care in rigid time blocks, with travel time bundled invisibly into an hourly rate that has not kept pace with real costs, creates a system that rewards volume over quality and punishes investment in people. 

Staff turnover in the sector ran at 24.7 per cent in 2024–25, costing providers an estimated £500 million annually. Care workers routinely spend less than 70 per cent of their paid time actually delivering care. Families report late visits, rushed calls, and a revolving door of unfamiliar faces. These are not failures of individual providers. They are the predictable consequence of commissioning that treats care as a commodity rather than a relationship.

The tragedy is that we already know what works. Be Caring, the UK’s largest employee-owned care provider, has spent seven years building and evidencing an alternative. 

A Better Way

Our neighbourhood prime provider model assigns care workers to compact geographic areas, paying them a full block shift that includes travel, training, and gaps between visits. The results are not marginal. In Manchester, care worker productivity increased by more than 25 per cent following adoption of the model. In Leeds, the service achieved an Outstanding CQC rating. Retention improved. Client satisfaction improved. Under-delivery fell. The same funding, organised differently, delivered materially better outcomes.

None of this happened by accident. It required commissioners willing to move beyond rigid time-block contracts and engage with a genuine partnership model – one based on planned time, guaranteed volumes, and a shared commitment to outcomes rather than minutes. It required investment in digital infrastructure – in Be Caring’s case, a bespoke platform called CAREVIEW 360 – that provides real-time visibility of care delivery, enables smarter scheduling, and supports a trusted assessor model that reduces delays in care package reviews. And it required a provider with the values and workforce culture to sustain it. The technology does not replace the human; it makes the human possible.

This is Directly Relevant to the Government’s Three Shifts Agenda. 

Moving care from hospital to community requires community services that can actually absorb demand. Right now, fragmented home care cannot. 

Moving from treatment to prevention requires consistent, relationship-based care where workers know their clients well enough to notice change; rushed calls from temporary staff cannot deliver that. 

Moving from analogue to digital requires investment in care management systems that are fit for purpose; most of the sector is still using tools designed for a different era.

The ask of ministers and councillors is not to spend more money. It is to spend existing money differently. Smarter commissioning – neighbourhood-based, outcome-focused, with sufficient contract stability to enable genuine workforce investment – can deliver more care of higher quality with the funding already allocated. The evidence exists. The model has been tested, refined and independently validated. What is missing is the political will to commission it at scale.

The Political Choice Ahead

Home care has sat in the “too difficult” category for far too long. The NHS cannot genuinely move care into the community without it. Local authorities cannot ease pressure on hospitals without it. And the people who rely on it – older people determined to remain in their own homes, families who simply want reassurance that their loved ones are safe – should not have to wait any longer for the system to deliver what they need.

The solutions are there. We have already seen what works. The real test now is whether leaders, locally and nationally, are prepared to follow through.

This article features in the new edition of ChamberUK. Our parliamentary journal.

You can buy your copy here.

Photo Credit: Be Caring