"He'd Exposed Himself To Our Care Professional": Inside The Unregulated Care Sector
Illustration: Tracy Worrall
12 min read
Finding care for a loved one is often difficult and expensive. Sophie Church explores the unregulated sector and its darker corners. Illustrations by Tracy Worrall
It’s a nightmarish revelation: finding out the carer looking after your vulnerable loved one – helping them wash, eat and take their medicine – is not who they say they are.
But when Louise Woollam hired Rachel Goodman to look after her husband Richard, who suffers from Alzheimer’s, little did she know she was inviting a thief into her home.
Goodman would go on to steal Woollam’s gold and diamond engagement ring, inherited from her mother. She’d also take the silver earrings Woollam had been given by her husband. Other items were never found.
Woollam had completed a basic Disclosure and Barring Service (DBS) check before hiring Goodman. However, this failed to reveal Goodman’s 13 prior offences, including theft and obtaining property by deception.
When Woollam approached the Care Quality Commission (CQC, the social care regulator) to voice her concerns, she was told that as she had hired Goodman independently, there was nothing it could do. She was on her own.
Welcome to the dark corner of Britain’s social care sector, where self-employed ‘personal assistants’ (PAs) are gaining employment in social care with no prior experience, or any guarantee they are who they say they are.
According to data from Skills for Care, there are 123,000 non-CQC unregulated carers operating in England and Wales today. This figure is likely an underestimate, however, as it is based on people paid directly by councils and excludes PAs working privately.
For some, being able to choose their own carer is beneficial. Working-aged disabled people, for example, often value being able to choose someone as their own personal assistant – even if they don’t have some skills.
Critics worry, however, that this autonomy leaves some vulnerable to abuse. “You could go out this afternoon, Sophie, and stick a note on a lamp post and say, ‘Sophie’s care: call me up’, and off you go without any training, oversight or anything and get money,” explains Dr Jane Townson, chief executive of Homecare Association.
Nothing’s being done because adult social care is broken
“It’s a modern-day ‘cash in hand’ option,” says Tim Wilson, managing director of home care provider Assist Care Group, which operates in West Sussex and Surrey. “Carers are moving from a regulated, protected environment to an unregulated, self-employed, environment where they can self-declare their income.”
Wilson says his industry is seeing a lot of undocumented workers, which includes migrant workers operating outside the conditions of their visa, as well as those who have entered the UK illegally.
“We’re seeing a lot of people who are wanting to protect their housing benefits and their universal credit, and a lot of people who are unsuitable for a caring role, but they’re choosing self-employment for those reasons,” he adds.
Online ‘introductory agencies’ offering unregulated care work are springing up as the UK gig economy – renowned for encouraging dubious working practices – evolves, offering cut-price care to vulnerable families.
To drive prices down, such agencies mandate that care workers signing up to their websites are self-employed (although critics argue that by working through an introductory agency, these workers are not technically self-employed). This means the agency does not have to register with the CQC. It also allows them to avoid paying employer’s National Insurance and VAT, as well as the fee for CQC registration. As a result, they can offer their services at well below the market rate – undercutting registered care services in the process.
TrustonTap, one such introductory agency, states on its website: “Quality care for 25 per cent less than most traditional agencies.” Where traditional agencies charge £23.56 in fees and taxes, TrustonTap only charges £7 – and can then pay its carers £19 an hour compared to £13.44.
“We’ve now got this dark economy – this underground economy of falsely self-employed workers looking after the most vulnerable people in our society and all the dangers that false self-employment brings,” says Wilson.
HMRC are failing to police this practice as they “don’t want to be going after a vulnerable person trying to buy care services for themselves”, he claims. HMRC declined to comment.
William Cotton, chief executive officer and founder of TrustOnTap, tells The House he has “learnt to be disliked” because he is trying to change things. “It’s very tempting for people to hurl bricks at us and say, ‘but you don’t do this, this is unfair’, he says.
“But hang on, we are offering an alternative model to care that might not be right for everyone and definitely isn’t right in certain circumstances, but actually before you criticise it, acknowledge that this is an alternative which saves people significant amounts of money.”
Illustration: Tracy Worrall
Agencies like Cotton’s are not only presenting an affordable option for care – unheard of in the traditional care sector – but giving families more choice over who they employ.
“Eighty-five per cent of the time, we’re dealing with family members who are seeking some degree of help for their elderly relatives,” Cotton says. “They value being introduced to one or more carers who are professional, and experts in what they do.
“We’re doing something that we are actually quite proud of – the fact that we’ve got almost 1,100 reviews, and that on quality of care, value for money and reliability, [clients] like what we’re doing,” he adds.
Cotton disagrees that TrustOnTap is employing those who are technically self-employed.
“We’re setting standards on behalf of the customers, on a number of checks, but that’s not to do with self-employment,” he says. “We’re offering professional carers of a high standard, and we need to make sure that’s maintained every year.”
While not regulated, TrustOnTap demands its carers go through training every year for first aid, infection control, and moving and handling. Carers must also have an up-to-date DBS. The agency also takes references and interviews carers, with fewer than 10 per cent of carers who apply eventually accepted.
TrustOnTap upholds its own standards because “it’s the right thing to do”, Cotton says. He admits other agencies may be less scrupulous. “Other introductory care agencies could set themselves up and not apply the same standards we apply,” he says.
“There are hundreds of thousands of self-employed, independent carers who advertise their services through local networking groups, through newsagents’ windows – ‘PA for hire at £20 an hour rather than £23 an hour’ – no DBS checks, no safeguarding processes, no oversight, no training. I probably don’t really want to emphasise that, but there’s no regulation there.”
Now, many families seeking carers are being drawn to services which on the surface appear to be regulated – but aren’t in reality. This is having devastating consequences for those in care.
He’d exposed himself to our care professional
Without regulation, a carer’s suitability for the job may not be checked. Once employed, there may be no quality control over their work. This means a carer may be crossing professional boundaries, delving into their client’s finances, getting involved with family politics or administering medication incorrectly – with no regulatory oversight.
Ian Cottrell is managing director of Home Instead, a home care provider in Eastbourne and Hailsham in East Sussex. He recounts how, a year ago, one of his carers was ending her shift looking after a 97-year-old woman with dementia, and handing over to a male carer from an introductory agency.
Before she left, the male carer asked Home Instead’s carer to hoover his bedroom. When she went in, he was lying on the bed naked. “He’d exposed himself to our care professional – a guy who has one-to-one interaction with someone that’s incredibly vulnerable in their own home,” says Cottrell.
“How do I know that guy’s not just gone out and joined another introductory agency that hasn’t done the checks and just got put in with another woman?”
One care advocate, who prefers to remain anonymous, tells The House that of the 60 vulnerable people on their client list in their last job, around 50 had safeguarding incidents relating to PAs raised by their families, friends or GPs.
“PAs were changing things typically, whether it was a catheter, stoma bags or whatever, and they didn’t have the equipment – they didn’t have the gloves, they didn’t have the bags. Or they weren’t following process because they hadn’t had the training,” they say. “There were scenarios of people getting multiple infections, so it was identified as a pattern.”
In another instance, a 19-year-old man with Down’s syndrome, who lived independently, employed a PA through Facebook. The PA would help with the man’s shopping, encouraging him to draw out cash and letting him pay at the till. However, when the care advocate visited the house, they could see the carer had been pocketing the change. “I was like – hang on a minute,” they say. “You’ve come back with some super noodles, some cake, a loaf of bread and a pint of milk. That’s not £50.”
Illustration: Tracy Worrall
While vulnerable people are being exploited, unregulated care may also be feeding the type of labour exploitation that Labour’s landmark Employment Rights Bill – lauded as “the biggest upgrade to workers’ rights in a generation” by the government – is designed to stamp out.
With 156,110 people granted a work visa since 2021 becoming care or senior care workers according to Migration Observatory figures, in certain areas supply for social care work outstrips demand.
As the number of unregulated providers has risen, councils, particularly in London and the South East, are spreading out allocated hours between as many as 300 providers. This has left individual agencies struggling to give sponsored workers – who cannot access benefits – full-time work.
“They’re destitute because they’re not earning enough money, and they’re afraid of whistle-blowing about their employers, because they will then have their licenses revoked and they’ll get deported,” says Townson.
To supplement their income, many care workers are turning to other ‘cash-in-hand’ jobs – in nail bars or car washes, for example.
“Some of the unscrupulous employers, we’ve been told by some sponsored workers, are making them give them the cash that they’ve earned in all of these side-jobs to put through a payroll to make it look like they’re employing legitimately,” says Townson.
“The whole idea of the Employment Rights Bill is to enhance employment rights of workers, but they might actually end up with fewer workers with any employment rights at all.”
Care providers accuse local authorities operating to tight budgets of fuelling these bad practices.
Currently, 27 per cent of local authorities are paying fee rates below direct employment costs at the National Living Wage, according to research carried out by Homecare Association in April this year.
This leaves care home providers – who have to pay statutory employment costs such as pension contributions, employer’s National Insurance, sick pay and travel reimbursement – in a race to the bottom.
At Hampshire county council, for instance, care providers were told to bid for work at an hourly minimum rate of £21.76 and a maximum rate of £25. However, the Homecare Association found that the only way to adhere to National Living Wage and legal and regulatory requirements would be to set a minimum rate of £32.14 per hour for 2025/26.
While some homecare providers bid at £25 per hour or more in Hampshire, they have not won work for over 18 months.
“If you paid carers at least the living wage, and you paid agencies, what I think is a reasonable minimum sum of £32 an hour, then you could stop these abuses. But someone’s got to pay for it, and local authorities don’t have the money,” Labour peer Lord Wills, who is the main carer for his wife, tells The House. “It all comes back to the money.”
A spokesperson for Hampshire county council says: “We are committed to sourcing care responsibly, balancing cost-efficiency with ethical employment and quality. We only commission home care from providers regulated by the CQC. To support a sustainable care market, we have set a minimum rate of £21.76 for standard care.”
Now, campaigners are backing calls to create a legal requirement for private carers to be qualified or registered. After her experiences, Woollam has started a petition to create a professional register for care workers.
Townson also says she had raised her concerns with Angela Rayner (before she departed to the backbenches). Rayner had introduced the Employment Rights Bill at a recent meeting around Fair Pay Agreements, a form of sectoral bargaining allowing employers and worker representatives to negotiate pay and terms and conditions.
The House understands the Casey Commission could be exploring improved regulation of private carers. The government is also creating an Adult Social Care Negotiating Body to try to improve pay and conditions within the sector.
Baroness Jones of Whitchurch, former business minister, announced in July that the government would publish a consultation on employment status “by the end of this year”.
However, with adult social care in crisis, campaigners fear the explosion of unregulated care is simply another issue that will lie at the bottom of government’s in-tray.
“I have got friends that work in different areas, and they just say it’s all we’re dealing with, but nothing’s being done because adult social care is broken,” says the care advocate. “But the problem is only getting worse.”
A Department of Health and Social Care spokesperson said: “It is unacceptable for people to take advantage of families in vulnerable situations. Care workers play a vital role in society caring for our most vulnerable. We have launched an independent commission into adult social care as part of our critical first steps towards building a National Care Service.”
The Care Quality Commission declined to comment.
