Challenges in delivering domiciliary
care:
issues for employers, carers,
and the state
Sue Yeandle
Professor of Sociology
University of Leeds
Director
Gender and Employment in Local Labour
Markets Programme 2003-2006
Background
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Local Challenges in Meeting Demand for
Domiciliary Care – study in Gender and
Employment in Local Labour Markets Research Programme
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ESF award with additional funding from partners
– 12 local authorities, EOC and TUC
Study carried out in 6 local authorities:
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2 county councils – Somerset and West Sussex
2 large cities – Birmingham and Newcastle
2 smaller districts – Thurrock (Essex) and
Sandwell (West Midlands)
Challenges in meeting demand for
domiciliary care: study approach
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Analysis of official statistics for England and for 6 LA
districts in England
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A new survey of independent sector domiciliary care
providers in the 6 districts
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Census 2001 data
Population projections
88 completed questionnaires from providers of
domiciliary care
46% response rate
Follow-up interviews with 42 of these employers
Further interviews with 25 key stakeholders
Documents and information supplied by respondents
to our survey and by 6 SSDs
Employment in the care sector
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445,000 people, 90% of them women, are
employed as care workers
Care workers are 1 in 25 of all employed
women in England
55% of female care workers, and 22% of
male care workers, work part-time.
A large minority of all care workers had no
formal qualifications at all in 2001 – 29% of
all women care workers, and about 19% of
all male care workers.
Source: Census 2001
Policy Context
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LA role - commissioning & purchasing social
care services
Some still provide specialist services
Care packages ‘more intensive’
73% of care supplied by independent
providers in 2005
CSCI, Skills for Care, GSCC
Direct payments and individualised care
budgets
Developing agenda re supporting carers
Home care delivery in selected localities
2005
Locality
Contact hours of
domiciliary
care per week
Number of
households
where
domiciliary
care was
provided
% of hours of
domiciliary
care provided
by the
independent
sector
providers
Birmingham
60,810
5,840
67%
Newcastle
39,050
3,360
82%
Sandwell
22,380
2,160
82%
Somerset
50,420
3,390
50%
Thurrock
8,880
800
81%
39,740
3,620
77%
3.6 million
354,500
73%
West Sussex
England
Source: Community Care Statistics 2005: Home Help and Care Services for Adults, England
Recruitment issues
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Demand outstrips labour supply
Regulation and accreditation
LLM conditions and competition for labour
Traditional labour pool shrinking
Need for workforce diversity to meet
changing service needs
Recruitment processes cumbersome and
lengthy
Costs of recruitment unacceptably high
Job Design and Job Content
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‘Home help’ image of the job outdated – role
more technical, professional and intimate
Career routes and progression under active
development
‘Flexible working’ and ‘hours of choice’
widely offered as enticement
Training and accreditation valued by most
staff – despite implementation difficulties
Working Conditions
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35% of sample used zero hours contracts for
some staff
Only 57% paid travel costs of staff attending
clients
Only 61% paid mileage allowances
Only 59% gave staff paid study time to
prepare NVQs
Low pay widely recognised as an issue
Workforce Development Issues
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More than half reported problems with
the availability or quality of training
Well over half reported problems funding
staff training
68% had problems releasing staff for
training
72% said some staff lack confidence
needed for training
48% said some staff lack basic skills
Employment challenges: providers’
views
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Most felt they were moving towards achieving NMS targets,
but had concerns about:
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Covering the workload when staff were released for
training
Retaining staff once they had completed their training
Limited scope to pay staff for time spent on job training
Costs of training
Addressing the basic skills & confidence issues of some
staff
Rates of staff turnover varied: some had acute staff
shortages and high staff turnover
Most were experimenting with new recruitment
arrangements
Most helped their staff with training costs
Pay rates were low in most cases
Sources of demand for social care…
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Every year….
10,000 people have a stroke (Eng & Wales)
36,000 people are seriously injured in a road
accident (GB)
(Dept for Transport 2002)
27,000 children are born or diagnosed with a
serious disability or rare syndrome (Contact a
Family)
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220,000 are diagnosed with cancer
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2,500 people are diagnosed with MS
(www.mstrust.org.uk 2006)
(HSQ 2000)
Stressful lives and mental health
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1 in 10 people have a 'disabling anxiety
disorder' at some stage in their life.
20% of women, and 14% of men, have some
form of mental illness
18% women, and 11% of men, have anxiety,
depression, phobias/panic attacks
6% boys, and 16% of girls, aged 16-19 have
a mental health problem.
15% of people over 65 have depression.
Up to 670,000 people in the UK have some
form of dementia.
Source: Mental Health Foundation 2006
Life expectancy and health
Life Expectancy
Males (at birth) 75.0 59.1 years
Most deprived 71.4 49.4
Least deprived 77.4 66.2
Average
years
in poor
health
15.9 years
22.0
11.2
61.4 years
51.7
68.5
18.6 years
26.3
12.7
by sex and
level of deprivation
Females(at birth) 80.0
Most deprived 78.0
Least deprived 81.2
Average
years in
good
health
Source: Bejekal, M 2005 Health Statistics Quarterly
Living circumstances of people
aged 85+
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Living alone
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Men 70%
Women 78%
Health ‘not good’
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Women 55%
With a limiting long-term illness
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Men 37%
Men 32%
Women 36%
Themselves a carer
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Men 8%
Women 3%
Carers and employment
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Over 1.5 million carers are in fulltime employment (58% are men)
Over 660,000 carers are in parttime employment (89% are women)
Most working carers are aged 30-59
10% of all male employees and 14% of all
female employees are carers
A quarter of all early retired men and
women are carers
Figures here/ on next slide are for England & Wales, Census 2001,
Crown copyright, reproduced with permission
Employees and caring
responsibilities
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Already, 12% of men and 16% of women
employees aged 30+ are carers
About 232,000 working carers live with a
disabled person under age 60
Over 110,000 working carers live with a
sick or disabled person aged 60+
Among working carers who care for
20+ hours per week, many are the sole
earners in their household - over half of
men and 40% of women
Options for delivering future care
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Carers (unpaid care) need…
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Domiciliary care services
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a last resort for many
Technology-assisted care services
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but delivered by whom?
key issues: user/carer independence/choice/control
Residential care services
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employment based support (for working carers)
respite and support services (for all carers)
income support (for non-employed/ lower income carers)
payment?
crucial but cannot meet all needs
Most service users/carers need a combination of
all the above
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calls for integration / complementarity / flexibility
Logic for a new social contract on care
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Caring/needing care happens to almost everyone
Vulnerable, sick and disabled people need carers
The economy needs carers
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Social care policy needs carers
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Well over 10% of the workforce - often experienced
employees their organisations cannot afford to lose
Replacing all unpaid care with formal care services not a
viable option; cost = the NHS; inadequate labour supply
Carers are crucial partners in delivering care policy
Carers provide most ‘out of hours’ care – the system would
collapse without them
Carers need independence, income and life choices like
everyone else
Care is part of the ‘social contract’ – over the life
course we all need to give and receive care- implications
for government, employers, service providers, families
Reports and publications
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Local Challenges in Meeting Demand for
Domiciliary Care: Synthesis Report (2006)
Sue Yeandle, Lucy Shipton and Lisa Buckner
GELLM Research Programme Series 7: Part 1
Centre for Social Inclusion, Sheffield Hallam University.
6 Locality Reports of this study are also available:
GELLM Research Programme Series 7: Parts 2-7
Centre for Social Inclusion, Sheffield Hallam University. These
are detailed reports relating to the 6 study areas.
www.shu.ac.uk/research/csi

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Cash for Care in Developed Welfare States (2007)
edited by C Ungerson and S Yeandle, London, Palgrave
Macmillan Future of Work Series
Who Cares Wins: the social and business benefits
of supporting working carers (2006) Yeandle, Bennett
et al London, Carers UK (with separate statistical annex
by Buckner & Yeandle)
Thanks to
 Dr Lisa Buckner, University of Leeds
 Lucy Shipton, Sheffield Hallam University
For their contribution to the research reported in this
paper
Contact details
Professor Sue Yeandle,
Co-Director, CIRCLE
School of Sociology and Social Policy
University of Leeds
LEEDS
LS2 9JT
email s.m.yeandle@leeds.ac.uk
tel +44 (0)113 343 4442
www.leeds.ac.uk/sociology/