What is the social care sector?

The social care sector is part of the wider healthcare industry. Healthcare is one of the largest industries, including a wide range of different roles and labour processes. Within this, ‘social care covers all aspects of personal and practical support and services for children, young people and adults. Helping to support their independence, improve their quality of life and ensure they have the necessary assistance in their daily lives to stay at home or to be in a homely setting.’¹ This is a narrower definition than both health and care, but still requires thinking through where the social care sector starts and ends. Many of these activities have previously been undertaken as part of domestic labour, reproductive activities that were not previously organised by capital as a form of paid work. This leads to a blurriness around the edges of any definition of “social care” work.

If we take the definition above as a starting point, this involves roles supporting people across their lives in their homes or home-like settings. This differentiates it from roles that might be found in hospitals or typical NHS settings. These kinds of social care roles are likely to be familiar. Many of us have looked after family or friends in a home setting, often without any payment. As Marx reminds us in Chapter Sixteen of Capital Volume One, ‘capitalist production is not merely the production of commodities, it is essentially the production of surplus-value.’ The organisation of the social care sector is therefore another important example of the way that capitalist production reorganises labour-power (in this case, the capacity to care) in order to produce surplus value. As Marx continues, using an example from education, ‘a schoolmaster is a productive labourer when, in addition to belabouring the heads of his scholars, he works like a horse to enrich the school proprietor. That the latter has laid out his capital in a teaching factory, instead of in a sausage factory, does not alter the relation.’ The political economy of the social care sector is one in which capital is laid out in a “care factory”, not with the aim of providing care, but for the proprietors of care companies to make a profit, which requires the organisation of care labour in order to achieve this.

The sector is built around these direct care roles, with job titles like “care worker”, “care assistant”, “foster care worker”, or “personal assistant”. These are all jobs that this issue mostly focuses on. Broadly speaking, social care is delivered in two settings. First, in care homes, which are developed for the purpose of providing care for multiple recipients. Second, through domiciliary care, which involves workers visiting sometimes up to 10 people per day in their own homes. Each of these comes with different pressures and methods of managing the labour process of care workers. In addition to administrators, supervisors, and managers, there are numerous supporting roles, including housing support officers, welfare rights officers, and activities workers, among others. Especially in residential settings, ancillary roles are incredibly important, including chefs, laundry services, maintenance, and cleaning. Each of these roles facilitates the care of an increasing number of people receiving care. In addition to these, there are “regulated professions”, job roles that the government sets apart from other direct caring jobs. Often working in tandem with care workers, but elevated above in status, are social workers, occupational therapists, nurses, therapists, counsellors, and other healthcare workers. These roles require specific degrees and training and are regulated through councils tailored to their job role. Despite this elevation in status over care assistants, they are still underpaid and underfunded. Whilst nurses typically work directly for nursing homes, many of the other regulated professions work for the NHS and dip in and out of the social care sector as their patients do the same.

This overview of social care and the roles involved might give a sense of a system developed to ensure support for those who need it. However, the organisation of this “care factory” is in crisis. This crisis has been going on so long that it no longer really makes sense to talk of a crisis - this implies that it is new, or some sort of break from the norm. The multiple crises of the sector have been going on so long now that the idea of a “crisis” has all but lost its meaning. If we imagine the social care sector as a factory, it is one in which there are far too many inputs than the factory can manage, there is no investment in the factory, and far too few workers. More specifically, there are four structural factors that are deeply shaping social care: first, funding is drying up, falling far below what is necessary for even maintenance of the sector; second, demand is increasing, both with an ageing population and more people in need of care; third, the state is increasingly shirking responsibility, as well as changing which duties fall within health or social care; and fourth, a labour shortage due to an inability to recruit or retain workers, combined with an aging workforce. The system is underfunded and seriously failing its recipients of care and care workers. The health and social care sectors are in a constant tug of war over social care duties, which are deeply intertwined and interdependent, yet equally underfunded. As the need for social care increases, more workers are also pulled into the orbit of the social care sector. Returning to the definition of social care above, it is easy to see how many jobs play a social care function, especially and increasingly teachers, doctors and, unfortunately, the police and other repressive arms of the state.

The structure of social care

Unlike much of healthcare in Britain, social care is not free at the point of use. This structures the provision of social care in important ways. Those who request care from local authorities have a needs assessment and means test. Only those with assets of less than £23,250 qualify for any support on a sliding scale. The sector is mostly funded at the local authority level, with some support coming from the government via the NHS. Councils across England spend on average 65% of their entire budgets on children’s services and adult social care, up from 57% in 2014. Despite this, provision remains far below what is needed. Social workers are under constant pressure from their managers to provide the minimum possible “care package”, that is, the amount of care a social worker determines that someone needs.

In care homes, the set rate that local authorities pay homes has not risen in line with inflation. This draws a distinction between recipients of care who pay for it themselves (so-called “self-funders”) and those whose care is paid for by a local authority. In practice, this means that many companies (having laid out their capital in order to make a profit) prioritise places for “self-funders”, as they receive more funding. These material interests lead to care homes holding out for the higher-paying customers. Companies move to areas where there are more “self-funders” and, in the process, create “care deserts”, often in places where the need for care is most acute. In domiciliary care, this translates into specific management practices to make care work profitable. For example, private companies routinely charge local authorities for an hour of care, whilst stacking rotas in a way that the person can only get 30 minutes or less. In both cases, there is huge downward pressure on funding, with workers both squeezed in terms of work intensity and working conditions. A relentless downward pressure on wages is created due to obstacles to productivity gains.

There is also a third dynamic that is shaping the care workforce. As part of a push for greater autonomy for people with disabilities over their own care, the government introduced personal budgets for those deemed eligible. After a successful needs assessment, recipients can decide that the money assigned for their care can be paid directly to them. These direct payments give recipients of care flexibility and control in arranging their own care, often resulting in them directly employing workers known as personal assistants. Two care workers, writing in issue #20, describe how the person receiving direct payments is then pushed into the, often awkward, role of employer, both being reliant on their personal assistant for daily tasks but also in a position of power over them and burdened with becoming a full-time, unpaid manager. A personal assistant is a very broad role. They can help with intimate personal care, such as washing and using the toilet, but also with household tasks, paperwork, and transport. There are 67,000 individuals employing 123,000 workers using direct payments in England. The huge majority of these workers are part-time (85%).

The government in England has invested significant funding into developing adult social care workforce data, attempting to understand the workforce crisis. This provides us with some data that can be used to understand the sector. Data is much more patchy for child social care, or in Scotland, Wales, or the North of Ireland. We have therefore focused on the England data here as an indicator of trends. In 2023/24, there were 1.84 million posts in adult social care in England. 1.705 million of those posts were filled by 1.44 million workers. This makes the adult social care sector almost as large as the NHS, the biggest employer in Europe, with 1.5 million workers. While there is an increasing presence of big companies, backed by venture capital and making huge profits in the sector, the majority of social care provision is organised by small to medium-sized companies or charities. This is a peculiar dynamic, in which it remains an industry in which small companies can enter into the market, which has not already been monopolised.

This dynamic of small providers can be seen starkly in domiciliary care. There are 13,733 domiciliary care companies employing 580,000 workers. These companies typically operate in one or two geographic areas, employing an average of 42 workers. Companies compete for contracts with local authorities, sometimes bidding for individual care plans. The number of care recipients a company has on their books can fluctuate easily, and domiciliary care workers have the highest rate of zero-hours contracts (38%), reflecting the desire for flexibility from the employer. In domiciliary care, workers typically visit homes for 30 or so minutes at a time, aiding people with personal care, preparing meals, ensuring medication is taken and any other household tasks. The job requires driving between houses, and typically, workers aren’t paid for their travel time, so despite working a 12-hour shift, the pay can reflect much less than that. As well as chronically low pay, workers also complain of a lack of training, workplace bullying and favouritism, and changeable rotas that don’t give enough time off. Unsurprisingly, there are a huge number of vacancies for domiciliary care roles (12%), with lots of companies perpetually recruiting.

There are almost the same number of workers in residential care settings. In England, there are 300,000 workers working in 10,112 adult residential care homes. A further 290,000 workers work in 4,191 nursing homes, which house people who need care from nurses as well as care assistants. Many domiciliary care workers aim to move into care homes to work, due to the slightly better pay and the prospect of working for what are sometimes viewed as more “legitimate” companies - rather than the smaller businesses in domiciliary. However, despite getting paid (mostly) for all hours worked, pay in care homes is still averaging around minimum wage.

Care homes have become an attractive investment opportunity for financial capital. There has been the entry of REITs (Real Estate Investment Trusts) into the social care sector. As one investor report notes, REITs are ‘tax-efficient vehicles that own and manage income-generating property while distributing most of their earnings to shareholders, also reduc[ing] their capital deployment.’ Care homes, like other parts of healthcare, have become an attractive investment opportunity due to the underlying land and property. Essentially, they allow investment vehicles to buy the property and charge the care home rent, while also owning a large portfolio that can also be sold off. From 2024 onwards, there has been a ‘surge’ of investment with ‘US capital playing a prominent role.’ In 2024, cross-border capital investment was 48% and in the first five months of 2025, it was 85%. In Britain, the two investors, CareTrust REIT (which acquired 137 properties for £690 million) and Omega Healthcare (acquired 60 properties for £305 million) are both US based companies.² This increased financialisation of care homes is introducing new pressures. As one report has noted, ‘some of the largest for-profit care home providers operate in a way which hinders accountability of their true profitability; increases their financial fragility; and crucially locks in high future costs for care home beds.’³ In particular, there is significant spending on debt repayments, with significant further debt being taken on. In some cases, this can mean gearing ratios of 600% (the rate of debt to assets). This introduces new risks, particularly with ‘sale and leaseback’ agreements being used to leverage the sale of care homes to expand by building or buying more. When investments cannot be repaid and firms collapse, this has very serious consequences for the recipients of care, as was seen with the Southern Cross and Four Seasons collapses, in 2011 and 2019 respectively.

Who are care workers?

The data can also provide a rough picture of who works in care in England. The average worker is 43 years old, predominantly white (64%) with British nationality (72%), and they are overwhelmingly women (80%). They earned an average of £11.23 per hour across 2023/2024, effectively minimum wage. Black people are disproportionately represented in the sector (18%, compared to 3.71% of the general population). Care workers are split between working full-time (55%) and part-time (45%). On average, workers spend 4.4 years in their role and 8.4 years in the sector. There are many care workers who frequently change jobs, with a turnover rate of 24.2%, resulting in approximately 350,000 job leavers per year. Only 57% of those stay within the sector. Additionally, 29% of the workforce is aged over 55, which means around 550,000 people are likely to retire in the next 10 years.

The percentage of women in the sector has been declining since 2022, when the Health and Care Worker visa scheme opened to care workers, as these workers are more likely to be men (32%, an increase from the historic 20% in the sector). Since the scheme opened, an estimated 205,000 workers from abroad have joined the adult social care sector. However, in 2025, the government closed the scheme, reportedly due to concerns about unacceptable exploitation. In the same breath, they discuss their desire to bring down net migration and create long-term plans to “train homegrown talent”, pandering to the far right at the expense of a social care system on its knees. The Home Office revoked the sponsorship licenses of 470 companies, leaving 40,000 workers without jobs and visas.

While recruits are desperately needed, the scheme was flawed from the outset. As with most working visas in Britain, the government gave licenses to companies, allowing them to sponsor workers’ visas. The government handed employers a certain number of certificates of sponsorship, which they then could hand on to workers. This effectively tied workers to their employers, giving employers the ability to say, “if you complain, I will cancel your visa”, and be able to carry through on that threat. This creates fear of being a “troublemaker”, providing a way for employers to get away with abusive working practices. It is also common for workers to pay high fees for the visa, travel arrangements, and accommodation in Britain. The result is that many workers arrive in debt, paying it off to predatory lenders or even directly to the employer. This can create a relationship of debt bondage with the employer. There are also twin dynamics of overwork and underwork present in the sector. Either workers are expected to work very long hours, or have to in order to pay their debts, or they find the promised hours are not available, falling into further debt. These situations can amount to the government definitions of “modern slavery.”

High turnover among new recruits, an aging workforce, limited career progression, and successive governments’ pandering to the far-right on international recruitment have together created a systemic labour shortage, even as demand for social care continues to rise. Yet, despite this tight labour market, employers continue to exert downward pressure on workers through wage squeezes, stricter labour discipline, and employment deregulation. As a result, many newer workers are moving out of the sector entirely, into less demanding, low-paid jobs in retail and services. Those who remain in the sector longer-term tend to be those on better pay and with more secure conditions, those with training or qualifications and international recruits. It is this latter group - qualified workers, migrant labour, and those who have secured relative stability - that will form the backbone of any future political and organisational capacity within the sector. The question moving forward is whether this composition can find a common political language and leverage the tightening labour market to push for higher wages and better conditions, or whether it will remain trapped in defensive struggles against increasingly authoritarian management practices and the persistent fragmentation of employment relations in social care.

The state of organising in the sector

Despite the sheer size of the sector, union activity is comparatively low. No one collects the data on union density in the sector but it’s fair to assume it’s also low. However, while the headline figures may make it seem like there is not much militancy in the sector, it is always important to look behind the data. This issue covers some of the organising efforts by workers and unions that are trying to change this. These offer a glimpse into the underlying struggles of workers in the sector, many of which go unreported.

Three important dynamics are beginning to unfold in the sector. First, there has been an important wave of Health Care Assistant organising in hospitals (see A Hospital in Crisis in issue #20). UNISON branches are finally waking up to the untapped potential of organising social care and putting significant staff time into organising the sector. This is a large and well-resourced union, which could generalise the experiences of successful organising quite widely. Second, some of the newer unions have had notable successes organising with care workers. For example, the IWGB has had a Foster Care Workers Branch since 2016. They have successfully argued that foster carers in Glasgow were workers (rather than having no employment status) and have been part of a case arguing that foster care workers should have rights to union recognition. Across local and national campaigns, they have fought to increase fees and allowances for foster care workers. In 2022, care workers, domestic, and maintenance workers at a nursing home organised through UVW, won a pay rise after several strike days. Third, Zimbabwean migrant care workers formed the Pan-African Workers Association (PAWA). This was formed in 2022 in response to the exploitative conditions of the Health and Care Worker visa scheme. Now affiliated to the IWW, the group has connected hundreds of workers online and supports migrant workers organising in unions.

It is important to understand the changing political economy of the sector, as this continues to have an important impact on the opportunities and challenges that workers face, whether in care homes or domiciliary care. Across each of these three dynamics, there is huge potential for future organising. The larger unions are poised to enter into national sectoral bargaining in adult social care, with the introduction of Fair Pay Agreements. It remains to be seen how this will pan out in practice, but it could create new opportunities for grassroots organising, both within and beyond these unions. The care sector is ripe for new organising, as the contributions to this issue demonstrate.