The Care Association Alliance brings together local and regional care associations from across England, representing thousands of independent and voluntary providers of residential, nursing and home care. Our first paper argued the money. This one argues the people.
Adult social care fills around 1.71 million posts across close to 19,000 employers. Few parts of the economy match that scale. Yet it is one of the only workforces of its size with no nationally recognised professional framework, no consistent career ladder, and no shared understanding of what a career in care looks like.
We reconstructed the experience premium directly from twelve editions of Skills for Care’s own pay reports rather than take a secondary source on trust. A care worker with five or more years’ experience earned 33p an hour more than a new starter in 2016. Today it is between 6p and 10p.
Wound care, catheter and stoma care, PEG feeding, insulin. A 2026 survey by The Care Workers’ Charity found 67.9 per cent of care workers are asked to carry out delegated healthcare activities, and 93 per cent of those have never received additional compensation. Voluntary guiding principles exist. A binding framework, tied to competence and pay, does not.
A care worker with five years’ experience now earns a few pence more an hour than someone who started last week. In 2016, the gap was 33p.
Almost a million young people are NEET, and the number crossed one million earlier in 2026 for the first time since 2013. Care has tens of thousands of unfilled posts. Do the two sit in the same places? Across nine regions the answer looked decisive (r = −0.89). Across 149 local authorities the relationship all but disappears, and without London it is indistinguishable from zero. We report the correction, not just the first result.
The right conclusion is not to abandon the idea, but to design it nationally rather than as local geographic targeting: a national care-sector Youth Guarantee pathway within Get Britain Working, built on the CAA’s existing Pathway into Care programme, and an explicit second recruitment pool in midlife career switchers, who already make up over a quarter of the workforce.
Not a new bureaucracy. Not a single national employer. Not the end of the diversity that makes adult social care what it is. Five components, built on the Skills for Care Care Workforce Pathway that already exists.
Parity, competency, portability, diversity, progression, professional identity.
Leading to social work, OT, physiotherapy, nursing and a new Care Technologist role.
Governance, competence, supervision, accountability, remuneration.
Funded through commissioning and fee-setting reform; competence, not just a floor.
National in design, with explicit recognition of midlife career switchers.
Government has committed to a social care T Level for first teaching in 2028, and is defunding the Level 4 qualification immediately above it from 1 September 2026. A young person completing the T Level would have no funded route onwards. That is the objection a careers teacher will raise, and the reason a parent will steer their child elsewhere.
The Level 4 practice qualification, carrying delegated healthcare and Care Technologist specialisms, is the step from doing the work to being accountable for it. Reinstating it costs £9–14 million a year, less than the sector spends in a single week replacing the people who leave.
Built on architecture the sector has already started, not a replacement for it.
Four costed lines, every input published and every step of arithmetic shown in Appendix A.4. The sector loses around 335,000 people a year at a replacement cost of £1.2–2.0 billion. Taking a single percentage point off the turnover rate returns £52–87 million, annually, before counting quality, continuity or the £2.7 billion the NHS spends on delayed discharges.
Five things cannot wait, because in each case a window is closing rather than opening. The rest is sequenced so that portability arrives before accountability, and pay reform arrives with the framework it is meant to reward.
The five immediate items need no commission, no primary legislation and no new institution. They need a decision, and several of them need it within weeks. Three things, though, are exactly what a commission is for.
This paper is published and submitted to the Commission at publication, not circulated privately in advance. Our arguments should be tested in the open, and Appendix A.4 exists so that the parts built on our own arithmetic can be checked rather than taken on trust.
The mechanism to build one already exists in the Skills for Care Care Workforce Pathway. What has been missing is not evidence, but the decision to complete it. This paper sets out exactly how, and what it costs to start now.
The CAA is the national umbrella body for local care associations in England, a member-led organisation with no paid officers. All its functions are carried out by its member associations, which collectively represent over 10,000 independent care providers across every English region.
The CAA works locally, regionally and nationally, partnering with government, commissioners and health bodies to advocate for a sustainable, properly funded adult social care system. It is a founding participant in the Care Provider Alliance.
Globe House, Park Lane, Halesowen, B63 2RA · info@caa.care · www.caa.care