The History of Home Care in the UK

Relief in the parish

From the Poor Relief Act 1601, responsibility for people who could not support themselves sat with the parish. Much of that help was “outdoor relief”: money, food or fuel given to people in their own homes, often older people who could no longer work. Care at home, in other words, is older than the institutions that later came to define welfare.

The workhouse era

The Poor Law Amendment Act 1834 tried to end outdoor relief for the able-bodied and pushed those seeking help into workhouses. Older and infirm people were still often supported at home, but the workhouse infirmary became, for many, the only place to be cared for in old age. The fear of “the workhouse” shaped attitudes to institutional care for a century, and still echoes when families say a parent “would hate to go into a home”.

The early twentieth century

The Old Age Pensions Act 1908 gave some older people a small income for the first time, and local health authorities began employing visiting nurses and, from the 1920s, “home helps”, initially to support mothers after childbirth. These home helps were the direct ancestor of the modern care worker.

The post-war settlement

The National Assistance Act 1948 formally abolished the Poor Law. It gave county councils a duty to provide residential accommodation for older people in need of care and powers to promote the welfare of disabled people. In the same settlement, the National Health Service Act 1946 allowed local health authorities to provide domestic help for households where someone was ill, pregnant, elderly or disabled. Home help became a public service, provided by council employees, usually part-time local women, visiting to clean, shop, cook and keep an eye on people.

From power to duty

The Health Services and Public Health Act 1968 turned the power to provide home help into a duty. The Chronically Sick and Disabled Persons Act 1970, promoted by Alf Morris MP, required councils to find out how many disabled people lived in their area and to provide practical assistance in the home where it was needed. The Local Authority Social Services Act 1970, following the Seebohm Report, brought the scattered welfare functions together into single social services departments, which is where home care sat for the next twenty years.

What the service looked like

Through the 1970s and 1980s the council home help was a familiar figure. Visits were often long, the same person came each week, and the work leaned towards housework rather than personal care. Demand grew faster than the service: the population aged, hospitals discharged people sooner, and the long-stay geriatric wards and large institutions were closing under the policy of “care in the community”. By the late 1980s the gap between what councils could provide and what people needed was obvious, and the Griffiths Report of 1988 recommended a different model.

The NHS and Community Care Act 1990

Implemented in April 1993, the Act made councils responsible for assessing need and arranging care, but expected them to buy that care rather than always provide it themselves. The government required that most of the money transferred to councils be spent in the independent sector. The effect was rapid. Private and voluntary home care providers multiplied, the council home help service shrank, and the visit changed shape: shorter, task-focused, and increasingly about personal care rather than housework. Almost every home care provider operating today, including Starling Homecare, exists because of this Act.

The Care Standards Act 2000

Until 2003 a domiciliary care agency in England needed no registration at all. The Care Standards Act 2000 created the National Care Standards Commission and, through the Domiciliary Care Agencies Regulations 2002, required agencies to register, to have a registered manager, and to meet national minimum standards from April 2003. In 2004 regulation passed to the Commission for Social Care Inspection.

The Health and Social Care Act 2008

This Act created the Care Quality Commission, which took over regulation of health and adult social care in England from April 2009. Under the regulations made under it, “personal care” became a regulated activity from October 2010, which is why a home care provider must today be registered for personal care before it may help anyone wash or dress. The CQC’s framework of five key questions (safe, effective, caring, responsive, well-led) and four ratings followed in 2014.

The Care Act 2014

In force from April 2015, the Care Act consolidated sixty years of piecemeal law into one statute. It placed a duty on councils to promote individual wellbeing, set a single national eligibility threshold, gave family carers their own right to assessment and support, and set out how care is paid for, including the means test and the right to arrange care through Direct Payments. Our care funding guide explains how those rules work in practice today.

Where the sector is now

Home care in England is delivered almost entirely by independent providers, from national franchises to small family businesses, all registered with the CQC and most contracted by councils as well as serving private clients. The pressures are workforce, funding and the visit length, and the policy direction, through hospital discharge and “home first”, keeps pushing more care into the home. How that regulation works today is explained on how home care is regulated.