Once again, we are very grateful to Lucy Buxton, who has over 32 years’ experience of working in social care and the NHS, for this thought provoking blog.


Will self-employed carers ever be regulated?

Before I start, I want to point out that this article is just my thoughts, and my opinions based on my knowledge and experience.

Recently, the lovely Emma from Pocket Carer asked me whether I thought that self-employed carers would ever become regulated. Not a straight answer I thought. I sat with those thoughts for a minute and found myself wandering down a lane full of ‘if and buts’, with plenty of ‘maybes’ and ‘not likely’ answers.

Why should self-employed care work become regulated?

I found myself going to one of my favourite questions; for what purpose? And yes, for what purpose would self-employed carers ever become regulated? Well, the obvious reason is to ensure safe care is provided, and to provide independent feedback with the view to providing an individual with some insight into the service they are purchasing or about to purchase and there’s the thing, the person or their loved one will be purchasing the service directly so isn’t that in their responsibility to do their due diligence? A bit like when I need a tradesperson to do work on my home.

Talking of those tradespeople, there are places and facilities where individuals like myself can go to read reviews and do my due diligence such as Trust Pilot, but what about carers? Let’s just sit with that for a minute.

Now, what other service would regulation provide? A level of safeguarding maybe, and we have a local authority system set up for this, so on such a  small scale would it be needed?

Self-employed carers and due diligence 

Let me go back to due diligence. For me, there is an element of ensuring that if we are going to look for a self-employed carer, we need to educate ourselves on the right questions to ask. Such as:

  • Do you have an enhanced DBS and can I see it please?
  • Do you have insurance?
  • What happens if you are ill?

Let’s admit it, if we are placing someone with a loved one, or even for ourselves, we do have to take some responsibility in the decision-making process if we are not passing it onto a third party to implement for us.

We then have to think about time. Go with me here… If I am a self-employed carer, I’m not going to be able to look after a large number of people; 2 – 5 – maybe, depending on call times, the types of care needed, and also the days required. So, would the financial outlay of regulating such a small service be financially viable for a regulator? Also, for the carer, would I choose to go down this route if I knew I had to pay annual fees? Probably not, due to the ability to earn what I needed versus what the business as a whole would need.

Let’s go back to the tradesperson I have a contract with. If they turn up late, I will have a word. If they start to do the job wrong, I will have a further word. Now, this can go one of two ways, either very well or very badly for them. The very bad options cause them financial damage and impact their reputation. So, replace my tradesperson with a carer. Many self-employed carers get work through recommendation and the last thing they want is bad press. My point here is that when engaging a private carer, the person purchasing the service has a direct line of communication with that person, so the role of a third party isn’t really there, and if it were, it would be for safeguarding purposes which the local authority fulfil.

Now, this is where things get interesting. What if the self-employed carer doesn’t want to be self-employed and they want to be a limited company? Then the simple answer will be that you need to be registered in England with the CQC.

We know that a self-employed carer cannot be directly commissioned by the local authority or NHS yet an individual can use direct payments to purchase care directly which gives them more autonomy and empowers them with their choice.

Could regulation lead to a lack of self-employed carers? 

There is another point here to consider with regard to supply and demand. We know that there is a big hole in the social care recruitment and retention bucket at the moment, which means a lot of people are having to go without essential care. If, all of a sudden, we start regulating self-employed carers, that balance of supply and demand changes even further. There would be many self-employed carers that would just stop and find work elsewhere – meaning more people are left without support and care.

I know I still haven’t answered the question, I’m getting there, I promise!

I mentioned earlier Trust Pilot, and no I don’t get money for ad placement 😉 and yes, I can see how services that have a database of carers can support an individual to find a self-employed carer. We also know that in different areas of the UK, carers may or may not have to be registered. So, is this the way I can see things changing? Yes. For two reasons, one because we really need to raise the perspective/opinion of caring as a career choice, and two, because ultimately carers look after people for one reason or another who are vulnerable, and we have a moral duty to keep folk safe.

As a nurse, I have an active PIN number. I have to prove every three years that I have kept my knowledge and skills up to date and that I have enough experience that is relevant to being a nurse so that I can continue to practice.

And there we have it. You’ve wandered around my brain with me and reached my destination. So, do I think it will happen? No, not soon anyway, but I won’t say never.

Do I see a register for carers both employed and self-employed across the UK, I hope so! Why? Well after nursing my own mom and going down the rabbit warren of care agencies and carers out there, as a family we chose to provide care ourselves because it was the only way we could be sure that mom would receive the person-centred care that she so rightly deserved, and, I have to say, enabled and supported the most dignified, peaceful death I have ever seen.

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