Care is seen as a valuable economic activity

This is the eighteenth piece in a series about the future of Adult Social Care in England.

Photo by AhmadArdity on Pixabay

The challenge, if you remember, is to think about how we could turn ‘Adult Social Care’ from something you’re given, into a network of care and support in your own community that you’d choose to use.

So, I’ve created a logic model with the intention of showing how we might create an environment in which “people think that our community is a good place to live — we are a resilient community.”

I’ve completed the inputs and activities on my Logic Model and now it’s time to look at the proposed outputs.

In this piece, I’m looking at the outcome: “care is seen as a valuable economic activity”. The contributing outputs are:

1. Carers have greater balance in their lives;
2. More carers are able to remain in work; and
3. Poverty decreases.

I’ve used the term ‘outputs’ rather than intermediate outcomes, as I think that these are things that could be tracked. And, they’re not targets. [1]

I discussed the inputs and activities for this outcome in two earlier pieces:

1. There’s a bend in the road ahead. How to make prevention ‘real’; and
2. Is employment the root of all evil?

So why do I think that these outputs are important?

I think they’re important because for me, they are indicators of ‘honesty’. Because, we have to acknowledge that most of the caring in England isn’t done via the state with our taxes. It’s done by approximately 4.7m[2] people who help approximately 6.4m people; [3] their loved ones and friends with their day-to-day lives.

And just to take the ‘bigger picture’ for a moment, FrameWorks UK [4] were recently able to identify a new mindset: health as a national resource. This is the assumption that national and personal health are linked — and that the health of the nation depends on the health of its people. Health, self-care and care, go hand-in-hand.

On 12th April 1976, the forerunner of Carer’s Allowance was introduced: Invalid Care Allowance. Married women weren’t eligible to claim until Jacqueline Drake took the UK government to court. In 1986, the European Court ruled that excluding married women was unlawful.

In Jacqueline’s case, she gave up work to care for her mother who had dementia. She was initially refused support because she was married. The assumption was that she was being supported by her husband. [5]

In April 2026, Carer’s Allowance is worth £86.45pw. In the example cited by Frances Ryan, this equates to 65p ph. [6]

And let’s not forget that the value of care provided by unpaid family carers, in England, is estimated to be worth over £152bn, per annum. [7] [8] That’s broadly equivalent to the NHS budget. And, then we get stories like this:

“Unpaid carers have been issued with demands to repay thousands of pounds for allegedly breaking benefit rules even though officials knew the decisions were based on unlawful and discredited policy guidance.” [9]

For many people, caring is a positive and rewarding experience, others do it as part of the ups and downs of married life, but for some it’s accompanied by emotional blackmail, fatigue and poverty. So, for me, one of the important things has to be support for carers, so that they can continue to be ‘willing and able’ to care. [10]

From a personal perspective, I’ve worked with carers and carers’ services for many years. But it wasn’t until very recently that I realised that my mother had been a carer. My Nan needed help (help that she could not manage without [11]) dressing and undressing and my parents had sold their newly-wed bungalow and had moved in with her. So, throughout my childhood, Nan wasn’t living with us, we were living with her. And, that’s how I learned to cook.

These are the reasons why I think that it’s important to monitor these outcomes.

Carers have greater balance in their lives

As I’ve said before, we need to reflect upon the fact that we live in a society in which being an adult and a citizen is aligned with the ideals of independence and autonomy; there are no ‘good’ dependencies for adults. And, because being dependent is shameful, by extension, caring for those who are dependent is not seen as ‘real’ work, especially if undertaken without pay, within families. [12]

And because we’re content that this all goes on within families and it’s expected, this has given rise to an identification issue — ie people identifying themselves as a ‘carer’ in addition to wife, husband, good neighbour.

The 2021 Census tells us that of the 4.7m unpaid carers in England, 1.4m were already providing more than 50 hours of care a week. For the majority, there will have been a point in their lives when being a full-time carer had never entered their head.

But, the vicissitudes of life direct many, many people onto the path of caring everyday. But these transitions occur largely unseen. And that gives rise to real issues. As part of their Moving Mindsets work, Frameworks UK identified that:

“when asked about barriers to health, participants talked about a lack of green spaces and rising food prices — alongside caring responsibilities [my emphasis] and the demands of working multiple jobs — as unfair societal constraints on healthy behaviours.”

In my view, caring should not be a detrimental experience.

But to achieve this, perhaps we need to recognise our own prejudices:

“Everyone is ageist and everyone is ableist. Although much bias is unconscious, prejudice is learned. From childhood on, we’re barraged by messages about how awful it is to grow old and how tragic it is to be disabled. Unless we stop to challenge them, such messaging becomes part of our identity and warps our sense of self and our place in the world.” [13]

And, our own view of ourselves means that accepting support and care from ‘others’, paid carers or local organisations is unthinkable and therefore the responsibility for our care rests on the person/people closest to us.

We’ve created this warped space and therefore we can, with effort and determination, create a different view of ourselves. A view that says “it’s still me, even though I can’t do all the things that I used to.” There is no place for shame, just courage.

If we’re strong ourselves, then our community can see us and can recognise their part to play. If our community can take a role, then actually our family and friends won’t have the sole responsibility for us and their lives will have greater balance.

Allowing ‘others’ to take a role in our lives also means that caring and support become opportunities within the local economy, outside of the statutory sector and the large providers. I believe that this is a way to re-weave caring — in its broadest senses — back into community life, to make it visible again, to make it part of ‘village’ life.

So, what I would really like us to do, is to be honest with ourselves. Admit to ourselves how we might be willing to accept our place in the ‘village’ as someone who might need support and care.

More carers are able to remain in work

The 2021 Census told us that of the 4.7m carers in England, 2.3m of them were still in work [14] — at the time of the Census, 0.4m of them were working and doing 50+ hours of caring a week.

While carers will experience challenges in juggling work and care, many reported significant attractions to working and were keen to remain in employment. In explaining their enthusiasm for work, carers cite benefits beyond the financial rewards of work, including social and health benefits, and a sense of respite from caring. [15]

Over and above considerations of having greater balance, Cambridge Econometrics published a report looking at the potential impact of enabling 520,000 carers to return to work across the UK. They calculated the opportunity costs of non-working unpaid carers to be between £5.4bn — £16.9bn, depending on whether it is assumed non-working carers could earn as much as working unpaid carers or working non-carers.

Had those earnings been received, then this would have been an increase in household disposable income and would have stimulated consumption in the economy. This additional consumption has further knock-on effects in the economy, as increased household spending increases economic activity to respond to higher demand. This was calculated to be between £2.5bn — £7.2bn increased Gross Value Added (GVA) in the wider economy, and £170m — £494m increased VAT revenue for the Exchequer.[16]

These could be real, additional, economic benefits to local communities, if we were to challenge our prejudices of ageing and disability, but also if we were to support carers in the workforce.

Managing the inevitable emergencies that arise when loved-ones have complex needs is a key challenge to remaining in work. Carers UK have identified that many working carers find they go months or even years without a real break. They will have used their annual leave to care and may have done overtime to make up hours they have had to take off for caring. Many carers leave work altogether when they feel they cannot cope any longer, and many more reduce their hours, turn down promotion or take lower paid, flexible work that can fit around their caring responsibilities. [17]

In addition, reducing working hours and taking breaks from employment altogether reduce women’s overall earning potential, as well as the potential for taking full advantage of employer contributions. The ultimate result of all this is that women’s pension incomes are on average 40% less than men’s. [18]

For many carers, the attitudes of managers and other staff were just as an important a factor in their decisions around work and care as were the formal policies in place in their workplace. Carers describe being made to feel guilty or as if they were underperforming, or feeling pressure to compensate for the flexibilities they required as a carer, by working harder. [19]

Many businesses now understand that supporting working carers is a benefit to them too, as they are able to retain experienced and skilled workers. [20]

So, what I would really like us to do, is to be honest with ourselves and ask what could we do differently, at work and in our community, to support working carers.

Poverty decreases

The amount of time spent caring also affects a family/informal carer’s ability to work. This reduced ability to work means these unpaid carers face a financial penalty from lost wages and are more likely to live in poverty than those without caring responsibilities (23% compared with 20%).[21]

In 2024, Carers UK and WPI Economics published an analysis of “Poverty and financial hardship of unpaid carers in the UK.” Using 2021/22 data, the analysis identified that a million carers in England were living in poverty. Of that million, approximately 40% were found to be in deep poverty.[22]

Carer’s Allowance, the main benefit for unpaid carers, is ineffective at replacing earnings. To exacerbate matters, Carer’s Allowance also has stringent earnings limits, with earnings over a defined number of hours at the National Minimum Wage, triggering an immediate end to entitlement. It is not surprising therefore, that 27% of families receiving Carer’s Allowance are living in poverty. [23]

All people living in poverty, whether they have existing health conditions or not, suffer extra stresses that can cause or exacerbate existing health conditions. However, for the purposes of this discussion, 1m people living in poverty are actually delivering care — they are the frontline of the nation’s informal prevention response.

So, what I would really like us to do, is to be honest and ask ourselves how we can make care be understood as a valuable economic activity.

How does this help make ‘Adult Social Care’ into a network of care and support in our own community that we’d choose to use?

The list of issues confronting Adult Social Care in England is long and complex. And, I believe that:

• there is a lack of a shared understanding of ‘care’;
• there is reluctance to approach ‘care’ as a consumer;
• we do show disrespect toward the activity of ‘caring’;
• poverty can’t be an enabler; and
• many local authorities won’t be able to accept this challenge in the foreseeable future.

We don’t know who will need care and support during their lifecourse. But, if we allow these resources to remain within rationed statutory siloes then many of the people who might benefit will actually miss out.

We’ve done this before, during COVID when statutory services withdrew.

And, without asking permission, we are able to occupy this space again, we just need to shift our gaze, to consider our own potential needs and who might satisfy them. Shall that be a commissioned agency, or should it be our own community?

My starting assumption is that most communities haven’t thought about how they might build their own better health.

Many people will have assumed that it’s the NHS’ job to keep us all healthy. But as we know the Social Determinants of Health, [24] indicate that there are a group of social and economic factors that contribute 40% to our health outcomes.

There is also evidence to suggest that a resilient community creates the conditions within which individuals and families are supported in achieving personal resilience. Just as this healthy pattern leads to individual benefits, the overall result is a community that itself is healthier. This yields higher levels of community physical and emotional health. It also results in greater productivity and abundance because more of its resources are available for positive development. [25]

So, I would suggest that our nascent ‘collective’, a number of people, similar but different, who will discuss any number of ideas and approaches, begin to think about an audit of the building blocks of health in their community. [26]

In “UBI and Health”, Anna-Carin Fagerlind Ståhl states that “wellbeing as well as illness depends on the demands and resources available in the psychosocial environment.” [27]

I think that a commonality between well-being and illness is useful. It’s useful because we tend to see health as the absence of illness [28], which leaves us poorly equipped to understand how to build or maintain our own, or our communities’, good or better health.

And, to keep everything ‘real’, here’s a piece from the Guardian about parenting:

“…I don’t think society is honest about the reality of care work. The old lie is that care work is wholly fulfilling (for women), when of course it isn’t, even when you love the recipient of that care more fiercely than all others. We have such trouble detaching care from love, or admitting that care work is hard work, and that in becoming a parent you are signing up to many, many years, possibly a lifetime, of care work, and that sometimes you would rather read a book or go for a walk or swim in the sea. That it’s OK to miss these things, regret your loss of freedom, even.” [29]

So, I’m going to take this as an opportunity to reflect upon the ‘Foundational Economy’. This is a concept created in 2013 by the Centre for Research on Socio-Cultural Change (CRESC):

“What we will call the foundational economy is that part of the economy that creates and distributes goods and services consumed by all (regardless of income and status) because they support everyday life”. [30]

CRESC argued that policy-makers had neglected the “mundane production of everyday necessities,” as their attention had been drawn by the allure of high-tech, next-generation industries. It contended that, as a result, the foundational economy was pervasively mismanaged and that this has led to it being characterised by low-wage, low-skilled jobs.

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The Asset-Based Community Development Institute at DePaul University have identified the seven functions of the foundational economy [31] :

1. Enabling health;
2. Assuring security;
3. Stewarding ecology;
4. Shaping local economies;
5. Contributing to local food production;
6. Raising our children; and
7. Co-creating care.

Raising our children and caring are both foundational activities. And I wonder if this isn’t the best way to embed a preventative approach.

But, before we do that, I’ll refer you to a very interesting report that was published in October 2021: “The value of adult social care in England. Why it has never been more important to understand the economic benefits of adult social care to individuals and society.”

In terms of the overall economy, this study calculated that the adult social care sector was, at the time, equivalent to energy supply and water supply but significantly bigger than agriculture forestry and fishing. It was a quarter of the size of the construction sector. [32]

The report identified that there were five notable features that make social care’s economic contribution, and potential future contribution, worthy of note[33]:

1. Adult social care is highly labour intensive;
2. The publicly funded demand for adult social care is driven by long run demographic factors that are independent of the business cycle;
3. Adult social care is undertaken everywhere in England rather than being concentrated in particular regions or centres;
4. Adult social care will be an increasing employer of labour for the foreseeable future, when other sectors may be reducing their employment; and
5. Adult social care has potential for immediate growth to:

• meet current unmet need;
• improve the quality and outcomes of care; and
• innovate in service delivery and improve productivity.

The study also calculated the economic value of adult social care in England. [34] The Gross Value Added (GVA) of a sector of the economy is the measure of the value of the goods and services produced in that sector. The GVA of adult social care is an indication of its direct impact on the economy via the employment of inputs such as labour, premises and equipment to produce something that has value to buyers. This creates productive employment and businesses, but it also has indirect benefits via its supply chain and second-order effects arising from the spending power of the people employed in the sector. These are known as the indirect and induced effects.

Each year, Skills for Care publish the aggregate figure in their “The state of the adult social care sector and workforce in England” report. In their latest report, the figure for 2024/25 was estimated to be £77.8bn.

So, yes, the numbers are big.

But, we should also take notice of the extractive practices employed by some of the larger care providers. I first came across this in a report from our friends at the Centre for Research on Socio-Cultural Change (CRESC) in their report “Where Does the Money Go? Financialised chains and the crisis in residential care” and more recently in work by Reclaiming our Regional Economies “Ending extraction in the UK care system.”

But, in their (partial) defence…the big companies are the ones building new care homes. [35] They’re literally the only people with access to sufficient capital to build. And for care in the home, they’ve created systems which allow 10,000s of people to receive care at times throughout the day. In one large county, this meant that the commissioning function had to be able to find a way to get almost 50,000 hours of care, per week delivered to 4,100 people across the county. This was costing (2024/25 prices) £1.3m per week.

Back in June 2018, Simon Duffy wrote “Self-Directed Support — if it’s so good then why is it so hard?” Many of the 153 adult social care authorities embraced self-directed support as one of their ambitions. “At its simplest: Self-Directed Support is a system to organise the help people need so the person has as much control as possible.”

However, for me, this was a journey that many authorities failed to make. Without a doubt, it was going to be a long and arduous path and there never was the promise that anyone was going to be able to afford it. So, faced with the task of delivering quality statutory care services to large numbers of people, commissioners will use contracts and frameworks. This means that the individual is left with rigid commissioned services and the commissioner is left with no alternative local market to provide that care — an ultimately self-defeating cycle.

So, how do we break that cycle?

If we’re honest about wanting to create a community life that can sustain us and our neighbours, then actually, we do need to think about running it ourselves.

So, let’s return to ‘prevention’. From an adult social care perspective, ‘prevention’ is defined as “…the care and support system actively promoting independence and wellbeing. This means intervening early to support individuals, helping people retain their skills and confidence, and preventing need or delaying deterioration wherever possible.” [36]

Prevention is a key element of the national agenda. In “Fit for the Future: 10 Year Health Plan for England,” you might have seen that one of the three fundamental shifts for the NHS is ‘from sickness to prevention’.

But the thing to remember is that local authorities and the NHS don’t know what the prevention ‘answer’ is. And local authorities (and the NHS) will of course, continue to think in terms of “…a wide range of activities…” or “…services…” [37] Which is a bit of a shame…

This reminded me of “What if we ran it ourselves?” Getting the measure of Britain’s emerging community business sector”.

Literally, what if we did it ourselves? If the services that we pay our taxes for, aren’t in a position to do anything effective about prevention, we are the only alternative!

And, I’m not suggesting that there should be fewer unpaid/informal carers. In fact, I expect that there would be many more as we transition away from the need for the label of ‘carer’. In fact, you might be, or might become a carer. You might have ideas about the support you and your friends might need, or might be able to provide, making care and support truly local.

Or you might know people who want to challenge the warped messaging about how awful it is to grow old and how tragic it is to be disabled. If you know people who want to say, “it’s still me, even though I can’t do all the things that I used to,” there’s no place for shame, just courage and you might be able to build that courage.

As I said at the beginning, I see these three outputs as indicators of ‘honesty’.

And, as I’m writing this, the latest report from Carers UK tells us that many unpaid carers balancing work and care are at breaking point, with nearly half (47%) of those in employment thinking about cutting their hours or leaving their job completely. [38] So, in my view, changing our approach isn’t without urgency or importance. It is time for us to build our community response.

Because if we could be honest about the care that is being provided behind many, many doors in our community, then we could offer support, not only to our neighbours who need support, but also to their friends and loved ones who are providing it. If support was available and freely accepted, then people could make real choices about how work fits into their lives and real financial hardship could be avoided.

If there was a network of care and support in their own community that they could use, then I honestly think that we will have taken important steps to helping people to see care as a valuable economic activity.

In this way, we can take real steps to turn ‘Adult Social Care’ from something you’re given, into a network of care and support in your own community that you’d choose to use.

In my next piece, I will outline my proposed outputs for the outcome of “people who may need some extra support can find it easily and play an equal role in our community”.

[1] “Goodhart’s Law tells us that ‘when a measure becomes a target, it ceases to be a good measure.’” — “Goodhart’s Law” — Model Thinkers. Accessed 12th January 2026.

[2] “Facts about carers (last updated December 2024)” — Carers UK,

[3] “Facts about carers (last updated March 2025)” — Carers UK

[4] “Moving Mindsets: Emerging opportunities to shift culture on health, wealth and government” — Tamsyn Hyatt & Dr Jen John, FrameWorks UK, June 2025.

[5] Katy Styles, LinkedIn, April 2026

[6] “Britain’s shadow workforce is paid as little as 65p an hour. Who cares for the carers?” — Frances Ryan, The Guardian, April 2026

[7] “Key facts and figures about caring” — Carers UK

[8] “Valuing Carers 2021/22: the value of unpaid care in the UK” — Dr Maria Petrillo, Dr Jingwen Zhang & Professor Matt Bennett, Carers UK, November 2024.

[9] “Unpaid carers ordered to repay benefits despite DWP knowing rules were unlawful” — Patrick Butler, The Guardian, March 2026

[10] Para 6.15 — “Care and support statutory guidance” — DHSC, Updated 18 February 2025

[11] “could not manage without” is the key element of being a carer.

[12] “Care, capitalism and politics” — Kathleen Lynch, Social Europe, November 2020

[13] “Ageist? Ableist? Who, Me?” — Ashton Applewhite, American Society on Aging, January 2023. Accessed 2nd July 2024

[14] “RM022 — Economic activity status by provision of unpaid care by general health” — NOMIS, 2021

[15] “Walking the tightrope. The challenges of combining work and care in later life” — Kate Jopling, Employers for Carers, July 2016.

[16] “The hidden cost of unpaid care: The economic price of locking carers out of work” — Vaidehi Maheshwari, Daniel Seymour, Tony To & Shyamoli Patel, Cambridge Econometrics, October 2025

[17] “State of Caring 2015” — Carers UK, May 2015

[18] “Let’s talk about how unpaid care is affecting people’s pensions” — Pheonix, June 2024

[19] “Walking the tightrope. The challenges of combining work and care in later life” — Kate Jopling, Employers for Carers, July 2016.

[20] “The Business Case for Supporting Working Carers” — Employers for Carers, March 2026

[21] Page 95 — “UK Poverty 2026” — JRF, January 2026.

[22] A person is considered to be in deep poverty when the resources they have available are so scarce it places them more than 50% below the poverty line

[23] Page 115 — “UK Poverty 2026” — JRF, January 2026

[24] “Social Determinants of Health 101 for Health Care: Five Plus Five” — By Sanne Magnan, October 09, 2017. Accessed 4th March 2021.

[25] “What Defines a Resilient Community and Why Strive for It?” — Stephen Sideroff Ph.D., Psychology Today, November 2020. Accessed 29th June 2025

[26] “What builds good health? An introduction to the building blocks of health” — Louise Marshall, The Health Foundation, July 2024

[27] The psychosocial environment is defined as the interaction between psychological and social aspects of the environment, the opportunities that are available to an individual to meet needs of wellbeing, productivity and positive self-experience.

[28] “Seeing Upstream: Mapping the Gaps between Expert and Public Understandings of Health in the United Kingdom.” — Emilie L’Hôte, Marissa Fond & Andrew Volmert, FrameWorks Institute, 2018

[29] “Am I a happier person for having a child? It’s the wrong question to ask” — Rhiannon Lucy Cosslett, The Guardian, April 2026

[30] Quoted from “What is the ‘foundational economy’?” — Institute of Welsh Affairs, February 2019

[31] “The Four Essential Elements of an Asset-Based Community Development Process. What Is Distinctive about an Asset-Based Community Development Process?” — Prof. John L. McKnight & Cormac Russell, Asset-Based Community Development Institute at DePaul University, 2018.

[32] Page 7 “The value of adult social care in England”

[33] Page 10 “The value of adult social care in England. Why it has never been more important to understand the economic benefits of adult social care to individuals and society” — Skills for Care, October 2021. Accessed 25th October 2021.

[34] This has been subsequently updated “Economic and social value of the UK adult social care sector: England” — Alma Economics, July 2024

[35] In March 2021, the National Audit Office (NAO) published a report which noted that “the Department [DH&SC] does not monitor the condition of current care accommodation itself…” and “local authorities do not have a duty to collect data on the adequacy of current accommodation.” It deduces that “at current rates, it will take several decades to modernise the care home estate.” — “The adult social care market in England” — NAO, March 2021. Accessed 4th November 2022

[36] “Prevention in social care” — SCIE, May 2021.

[37] “Key facts and figures about adult social care” — The King’s Fund, July 2024

[38] “The ‘tipping point’. When unpaid carers can no longer combine caring with paid employment. An analysis of the key factors leading to carers giving up work to care” — Carers UK, May 2026