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The rise in employers’ national insurance contributions (NICs), which came into force yesterday (6 April 2025), risks causing harm to people with care needs and more strain for carers, care provider leader have warned.

Sector associations have claimed that many services face closure, leaving people without much-needed care, due to employers now paying a NICs rate of 15%, up from 13.8% previously, on employee earnings above £5,000 a year, down from £9,100.

But while public sector organisations had their increased costs covered, this was not applied to the adult social care sector, with the government successfully overturning an attempt by the House of Lords to enact such an opt-out.

Cost of almost £1bn to sector

Think-tank the Nuffield Trust has calculated that the change will cost independent care providers in England an extra £940m in 2025-26, alongside a further £1.85bn from this year’s 6.7% rise in the national living wage (NLW).

Councils should meet about £2bn of the combined £2.8bn cost, said the trust, because they purchase about 70% of care provided by the independent sector.

But while the government has claimed that English councils with adult social care responsibilities will have up to an additional £3.7bn in budget in 2025-26, approximately £1.2bn of this is dedicated to adult social care.

Council fee rises lag well behind cost increases, say providers

The Homecare Association, which represents domiciliary care providers, said that its members faced an average increase in costs of 10% in 2025-26; however, council fee increases were averaging about 5%, based on data it had collected so far.

It said that some councils had frozen fees, while others offering higher percentage rises were starting from a low base.

Last year, it reported that there was a £1bn shortfall between the fees paid by councils and NHS commissioners in England and the amount home care providers needed to pay staff at least the NLW, meet other costs and make a minimum profit or surplus.

Since then, the association’s calculation of the minimum price for home care in England has risen from £28.53 to £32.14 per hour. This is mainly due to the NICs and NLW rises, though it has also uplifted its minimum profit level from 5% to 7% of costs, based on recent research.

‘Risk of harm to individuals and strain on carers’

Commenting on the impact of the increased costs, chief executive Jane Townson said: “We are likely to see an increase in non-compliance with regulations, insolvencies and provider closures.

“This risks harm to individuals; greater burdens on unpaid carers; and more pressure on NHS services. We call on the government to provide adequate funding for vital homecare services.”

Care England chief executive Martin Green offered a similar message, saying fee increases from councils did not reflect the “enormous increases” in cost that providers were facing.

“[This] will drive some services into bankruptcy, and the impact on both people who are supported, and care staff will be catastrophic,” he added.

Bridging fund proposed to mitigate impact on providers

Meanwhile, the National Care Forum (NCF), which represents not-for-profit services, has written an open letter to chancellor Rachel Reeves suggesting a way to mitigate the impact of the NICs rise on providers and prepare the sector for the government’s planned fair pay agreement.

It urged the Reeves to set up a “bridging fund”, equivalent to at least the sector’s losses from the NICs rise, to enable employers to make the transition to the fair pay agreement.

Under this, an Adult Social Care Negotiating Body would be created, to make agreements about the pay, terms and conditions of adult social care workers in England, in a move designed to raise salaries across the sector.

The bridging fund – an idea conceived of by NCF member Methodist Homes – would be allocated based on an organisation’s number of employees and could be paid direct to providers or administered by local authorities, the open letter said.

‘Not too late for government to step in to safeguard services’

NCF policy director Liz Jones said it was “not too late” for the government to address the impact of the employer NICs rise on people who needed care and support.

She added: “Without action, we are concerned that hundreds of thousands of people with learning disabilities, autistic people and older people, as well as their wider communities, will not be able to access the vital services they need to live fulfilling lives as a result of the predicted shrinkage of care and support services resulting from these measures.”

Social workers are the least likely adult social care staff group to feel valued or that they are making a difference to the people they support, government-commissioned research has found.

As a result of this, and other indicators, such as how safe and autonomous staff feel in their role, social workers have the lowest work-related quality of life of any part of the adult social care workforce in England, according to the survey of 7,233 staff, including 502 social workers.

The research, by Ipsos, Skills for Care and University of Kent, was designed to help the Department of Health and Social Care (DHSC) understand levels of wellbeing in the adult social care workforce and how this was shaped by working conditions.

Though it was carried out from August to October 2023, the survey results were only released at the end of February 2025.

Measuring workforce wellbeing

The researchers designed a measure, the adult social care outcomes toolkit – workforce (ASCOT-workforce), to capture the impact on quality of life of working in the sector.

This comprised 13 questions: making a difference, relationships with the people cared for, autonomy, time to care, worrying about work, self-care, safety, professional relationships, support in the role, competency, career path, financial security and feeling valued.

The research team calculated a combined score – known as the care work-related quality of life (CWRQoL) – from respondents’ answers, and found that social workers had the lowest average score of all staff groups (20.69), compared with an overall average of 23.30.

Social workers have lowest quality of working life

Social workers’ score was slightly below nurses and nursing associates’ (20.89) and significantly lower than those for all other groups. For example, senior care workers averaged 22.67, occupational therapists 23.17, registered managers 24.72 and personal assistants (PAs) 26.82.

This was driven by social workers’ responses across several domains, with the report revealing that:

• 69% of all staff felt able to make “as much difference as I would like” or “some difference” in their roles, but 41% of social workers felt the same, the lowest of any group.
• Social workers were the most likely to say that their role was “not valued at all” or “not valued as much as I would like by others”, with 72% feeling this way, compared with 41% of all staff.
• Almost two-thirds of all staff (65%) felt they had “as much freedom and independence as I want” or “adequate” freedom, but this fell to a half (51%) for social workers, the lowest of all groups.
• Just under half of all staff (48%) said they had the time they needed or adequate time to do their jobs well, but this rose to over three-quarters (78%) for social workers, also the worst group score.
• Three in ten social workers (30%) said they did not have enough time to do their job well and this was having a negative effect on them, twice the workforce average (15%) and higher than other job roles.
• 54% of all staff said they rarely or sometimes felt unable to look after themselves at work, compared with 64% of social workers, a proportion only exceeded by nurses/nursing associates.
• 14% of all staff – but 28% of social workers – said their relationships with people with care and support needs were not good. Only nurses/nursing associates (31%) scored worse than social workers in this domain.
• Just over half of staff (52%) often or constantly worried about work out of hours, but this was true of 62% of social workers. Two groups had a worse score than social workers on this domain: registered managers (77%) and deputy or other managers, team leaders or
  supervisors (67%).
• 17% of social workers said they did not have all the skills and knowledge they needed, compared with 11% of staff overall.

Experiences of violence, bullying or harassment

Half (49%) of the workforce had experienced or witnessed physical violence from the people they cared for or supported in the previous 12 months. In this domain, social workers’ score (34%) was below average, with nurses and nursing associates (65%) and senior care workers (63%) carrying the most risk.

However, social workers were more likely than average, or any other group, to have experienced or witnessed harassment, bullying or abuse from the people they cared for or supported in the previous 12 months, with 58% reporting this compared with 46% of all staff.

Social workers were also more likely than average to have experienced or witnessed physical violence from family members or friends of people they cared for or supported (20% as opposed to 13%) or from the public (15% versus 9%).

Most social workers ‘often consider leaving employer’

Reflecting these results, most social workers (59%) reported often thinking about leaving their organisation or employer, above the average for the whole workforce (50%).

However, social workers had more positive scores in relation to learning, development and stimulation at work than other groups.

Almost nine in ten (88%) agreed that their organisation offered them challenging work, compared with 55% of all staff, while over half of social workers (54%) said there were career development opportunities within their organisations, compared with 39% of all respondents.

In addition, over two-thirds of social workers (68%), compared with 56% of the whole sample, said they had opportunities to improve their knowledge and skills, and almost half (46%) said they felt supported to develop their potential, compared with 39% of the workforce overall.

Social workers are to be allowed to opt out of the proposed assisted dying process, the legislation’s sponsor has pledged.

Labour’s Kim Leadbeater has promised to work with fellow MPs to amend her Terminally Ill Adults (End of Life) Bill to ensure practitioners other than health professionals are allowed not to participate.

While social workers were originally not part of the bill’s process for assisted dying, they have been added to it through amendments made by Leadbeater during its recently-concluded committee stage.

Social workers to be involved in assisted dying panels

Under this, a panel comprising a senior lawyer, a psychiatrist and a social worker would consider requests for an assisted death that had been already signed off by two doctors, to check whether the statutory requirements had been met. These include that the person:

• has an inevitably progressive illness and is expected not to live beyond a further six months;
• has capacity to make the decision to end their life;
• has a clear, settled and informed wish to end their life;
• made the initial declaration that they wanted to end their life voluntarily and was not coerced or pressured into making it.

However, as the bill stands, only doctors and other health professionals have the right to not participate in helping a person to die and protection from detriment from their employer should they decide to opt out.

Lobbying from BASW

The British Association of Social Workers (BASW) had lobbied for social workers to be similarly covered and welcomed Leadbeater’s pledge, given last week, to introduce an amendment to that effect.

In a debate at the committee stage on 18 March, Conservative MP and prominent bill critic Danny Kruger put forward an amendment that would have extended the so-called opt-out provision to anyone potentially involved and in relation to any part of the assisted dying process.

He highlighted social workers’ current omission and quoted written evidence from BASW.

In response, Leadbeater said: “I would like to get it on the record that I agree with him: there should be no duty on any person to take part in the Bill’s provisions if they choose not to, for whatever reason. I will struggle to support his amendment because there are other issues with it, but on that principle I wholeheartedly agree, and I would be happy to work with him in sorting it out, before report, to that effect.”

This means she will devise an amendment to extend the so-called “conscience clause” more broadly to be considered at the next stage of the bill’s passage through the House of Commons, the so-called report stage.

‘A vital step towards parity between social workers and health professionals’

In response, a BASW spokesperson said: “BASW has engaged significantly with MPs on the assisted dying proposals since they were introduced to parliament, ensuring that social work’s role and voice is understood and represented throughout the process.

“Social workers not being included in the conscience clause in the initial drafting of the legislation was a serious omission that we have been raising with policy-makers since day one. It is paramount that all professionals potentially involved should be able to opt out of work relating to assisted dying without detriment.

“We were therefore pleased that MPs on the committee listened to our calls and gave their assurance that an amendment to this effect will now be brought forward. It is a vital step toward ensuring parity of legal protections between social workers, other non-healthcare professionals, and medical practitioners.”

Experienced care workers were earning just 4p per hour more on average than newcomers to the sector as of December 2024, according to new Skills for Care data.

This is the smallest pay gap between independent sector care workers with five or more years’ experience and those with those less than a year’s service yet recorded in a data series dating back to 2016.

Then, experienced care workers earned 33p per hour (4.4%) more on average than newcomers, but the gap has fallen significantly since, dropping from 10p to 4p per hour from March to December 2024.

Shrinking pay gap between senior care workers and junior colleagues

Skills for Care’s latest report on independent sector pay also showed that the differential between care worker and senior care worker salaries had reached its lowest level yet recorded – 6%, down from 8% in March 2024 and a high of 11% in March 2017.

Median pay for senior care workers stood at £12.75 per hour in December 2024, compared with £12.00 per hour for care workers, said the report.

The squeeze in pay progression appears to have been driven by the impact of growth in the national living wage (NLW), now the wage floor for those aged 21 and over, on a low-paying sector such as adult social care. Since the NLW’s introduction in 2016, real-terms median pay has grown by 26.2% among the bottom tenth of independent sector earners and by just 14.1% among the top tenth.

Providers’ challenge in meeting living wage rises

The NLW has increased sharply over the past two years, from £9.50 to £10.42 per hour in April 2023, a rise of 9.7%, and then to £11.44 last April (9.8%). This has meant that independent care workers have received average real-terms pay rises of 5.4% and 7%, respectively, in each of the past two years, said Skills for Care.

However, it added that some employers had reported that keeping up with changes in the NLW had been challenging, alongside their other business costs.

This is likely to become more challenging still next month, when the NLW grows by a further 6.7%, to £12.21 per hour, and employers must also meet the costs of significant increases to their national insurance contributions (NICs).

Skills for Care found that 58% of independent sector adult social care workers – about 780,000 staff – were earning less than the forthcoming NLW (£12.21 per hour) as of December 2024 – meaning they would benefit from next month’s rise. This includes about 575,000 care workers.

Much of the rest of the workforce is likely to receive a pay rise too because of the need to maintain pay differentials as far as possible.

Costs of NLW and national insurance hikes

Think-tank the Nuffield Trust has calculated that the rises in the NLW and NICs combined will cost independent sector providers an additional £2.8bn in 2025-26, with councils expected to fund £2bn of this to cover the services that they commission.

However, dedicated adult social care funding for councils in England is due to rise by approximately £1.2bn in 2025-26.

“Many councils cannot cover the rise in employment costs and we are worried this will increase the risk of non-compliance with the minimum wage,” said Homecare Association chief executive Jane Townson, in response to the Skills for Care figures.

Townson criticised the government’s decision last week to overturn a House of Lords vote to exempt adult social care providers from the NICs rise.

‘A direct threat to the quality of care’

For Care England, which represents independent sector providers, chief executive Martin Green said: “Care providers are caught between rising wage costs and insufficient money to fund them. Many are already struggling to recruit and retain staff, and with further financial pressures, the situation is only going to worsen.

“This is not just a problem for the providers themselves – it is a direct threat to the quality of care that millions rely on”.

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Over three million families will lose an average of £1,720 per year in real terms by 2029-30, as a result of proposed changes to disability and incapacity benefits, the government has estimated.

This includes 370,000 people who will lose their current entitlement to the daily living allowance element of personal independence payment (PIP), said the Department for Work and Pensions (DWP), in an impact assessment published today.

A further 430,000 future claimants, who would have been entitled to the daily living component of PIP under the current rules, would not be found eligible, under the reformed system set out in last week’s welfare reform green paper.

£4,500 average annual cut to PIP

On average, the two groups would lose out on £4,500 a year on average without PIP, which is designed to compensate people of working-age for the additional costs of disability.

To restrict eligibility, the DWP plans to bar people from receiving the daily living component if they do not score at least four points on any one of the 10 assessed activities, a policy that would apply to new applicants from 2026-27 and existing claimants, at the point of review.

To be eligible for the daily living component of PIP, you must score at least eight points across all 10 activities, which include preparing food, washing and bathing, dressing and undressing and communicating verbally.

Carers face benefit cuts too

The tightening of eligibility will also affect unpaid carers, as PIP is one of a set of disability benefits that a person has to claim in order for their carer to be able to obtain carer’s allowance or the carer element of universal credit (UC). The DWP said 150,000 would not receive one of these benefits as a result of its changes to PIP.

The department also set out the impact of its proposed measures to reduce the value of incapacity benefits.

This includes freezing the health element of universal credit at £97 per week until 2029-30 for existing claimants and halving the rate to £50 per week for new claimants, from 2026-27. In today’s spring statement, the government said that the £50 per week rate for new claimants would also be frozen until 2029-30.

Losses from incapacity benefit reductions

In its impact assessment, published alongside the spring statement, the DWP said 2.25m current recipients of the health element of UC would lose £500 per year as a result of the freeze in the rate.

A further 730,000 future recipients of the UC health element would lose out on an average of £3,000 per year due to the halving of the rate for new claimants.

However, the department added that 370,000 people would now be eligible for the UC health element, gaining £2,600 per year, as a result of its decision not to go ahead with the previous government’s plan to tighten the work capability assessment, which determines eligibility.

Losses outweigh gains from policy

Overall, it said 3.8m families would benefit from its reforms, including through its plans to increase the standard allowance of UC by more than inflation from 2026-27.

However, the projected gain for these families – £420 a year in real terms by 2029-30 – is considerably less than the £1,720 that the 3.2m families who will lose out are set to see their incomes reduced by.

Also, while just under half of the families due to benefit have a disabled person in their household, 96% of those set to lose out do, with the latter group accounting for an estimated 20% of all households with a disabled member.

Quarter of a million more in poverty

Based on its estimates, it calculated an extra 250,000 people – including 50,000 children – would be in relative poverty after taking account of housing costs in 2029-30 as a result of the measures.

It stressed that the assessment did not take account of the potential impact of its plan to increase spending on employment support for disabled people by £1bn a year by 2029-30.

It also did not take into account government plans to pay an additional premium on the health element of UC for those with severe, life-long health conditions, who would never be expected to work.

Rationale for benefits cuts

The government’s justifications for the cuts are to address the significant increases in the numbers claiming disability and incapacity benefits since 2019 – along with the resulting costs – and get more disabled people into work.

According to think-tank the Institute for Fiscal Studies (IFS), spending in Great Britain on these benefits grew from £36bn to £48bn in real-terms from 2019-20 to 2023-24 and are projected to hit £63bn in 2028-29 (in 2024-25 prices).

On the back of its proposed changes, spending on both disability and incapacity benefits will rise, but more slowly. By 2029-30, spending on PIP and disability living allowance (DLA) for working-age adults would reach £31bn, compared with £34.5bn without the reforms, said the DWP.

Measures ‘will make people more ill and less able to work’

However, charities and campaign groups renewed their severe criticisms of the measures in response to the impact assessment.

“Restricting eligibility for PIP and freezing the health element of universal credit will do nothing to help people get into work,” said Centre for Mental Health chief executive Andy Bell.

“They are more likely to make people more ill, more isolated, and less able to work. For many people living with long-term mental health problems, PIP is what enables them to carry on working.”

“MPs need to consider the consequences of plunging their disabled constituents into poverty, with little prospect of plans on employment support meaningfully mitigating this disastrous situation,” said Mencap chief executive Jon Sparkes.

Carers ‘deserve so much more’

In relation to the impact on carers, Carers UK cited research that found that 9% of carers – about 400,000 people across the UK – were in “deep poverty”, meaning their level of resources placed them 50% below the poverty line. This compared with 6% of the non-carer population.

Chief executive Helen Walker said many more carers were now in danger of further financial hardship and poverty, adding: “They deserve so much more. The repercussions of today’s changes will be felt deeply by those who for too long, have been our last line of defence – providing vital support which simply can’t be found elsewhere.”

The British Association of Social Workers (BASW) also joined the criticism, dubbing the cuts “unacceptable”.

“Any moves to balance the books must not damage living standards or make our communities and public services poorer,” said chief executive Ruth Allen. “This will add to demand for adult and children’s social work and other care services, as well as stretching community and charitable support systems.”

Think Ahead has raised concerns about cuts to mental health social work job numbers as it launched a campaign for the government to invest in thousands more roles.

The fast-track social work training provider said it had seen “trends of mental health social work roles disappearing in some NHS teams”, while some employers were pulling out of its programme on budgetary grounds because they could not commit to providing salaried jobs for trainees on qualification.

Under Think Ahead’s two-year programme to train people as adult mental health social workers, participants spend a qualifying year placed with an NHS or local authority employer, who then takes them on as a salaried employee in year two.

Cutbacks in mental health social work roles

The charity said that, of employers who partnered with it in 2024, 35% were unable to do this year for financial reasons, up from 20% of partners who pulled out last year for similar reasons. It said this was affecting NHS trusts more than councils.

“What we are experiencing in terms of the development of our programme is that where budgets are squeezed, non-clinical roles, like mental health social workers, seem to be first to take the hit – perhaps because they are seen as non-essential to mental health,” said Think Ahead chief executive Philippa Mariani.

Cutbacks to mental health social work numbers would mark a turnaround from the 20% growth in NHS mental health trusts seen from 2019-22, which left 3,576 whole-time equivalent (WTE) practitioners in post.

Despite the growth, this accounts for just 2% of England’s NHS mental health workforce, which numbered about 143,700 in 2023, according to think-tank the Nuffield Trust, with about twelve times as many mental health nurses (about 45,000) as social workers.

Also, the profession was not mentioned at all in the 2023 NHS workforce plan, prompting criticisms from Think Ahead and the British Association of Social Workers.

Call for 24,000 more practitioners

The plan is due to be refreshed this year and Think Ahead said it wanted to see a sevenfold rise in the number of NHS mental health social workers, to almost 28,000, over the next 10 years.

This is based on everyone with severe mental illness in England – of whom there were about 624,000 in 2024, according to an NHS estimate – having a social worker, and practitioners having a caseload of 20-25. The latter is based on a proposed limit for adults’ social workers set out in a 2022 report for Social Work Scotland.

Think Ahead said recruiting many more social workers would help tackle the social issues that were associated with mental ill-health, including those related to housing, poverty, employment, relationships and social connections.

Mariani said that, besides working in community mental health teams, social workers could be used more in inpatient settings, to support people’s recovery and discharge.

Think Ahead’s ambition would involve the recruitment of a net additional 2,400 social workers annually over the next decade, which the charity said would cost £130m in year one, including salary, oncosts and recruitment.

Social workers ‘a vital lifeline’ for tackling inequalities

Its Social Work Matters campaign was backed by charity the Centre for Mental Health, whose chief executive, Andy Bell, said social workers were “a vital lifeline” for tackling the inequalities faced by people with severe mental illness, including in relation to income, employment and life expectancy.

The NHS Confederation, which represents healthcare bodies, was also supportive, with its mental health director, Rebecca Gray, saying: “We welcome Think Ahead’s call to invest significantly more in mental health social workers in the NHS.

“They play a crucial role as part of multidisciplinary mental health teams – for example, in supporting patients who are leaving hospital, to finding suitable accommodation and working with parents who have mental health issues. This is so important as parental mental health is a significant risk factor for child mental health.”

Call for Casey Commission to address mental health social work

She said the Confederation hoped that Baroness Casey’s government-appointed commission on adult social care, due to start work shortly, “will present an opportunity to properly address the role and contribution of mental health social workers”.

In response to Think Ahead’s campaign, a Department of Health and Social Care spokesperson said: “Mental health social workers provide an invaluable service, and the workforce is critical to our reforms.

“We will publish a refreshed long-term workforce plan that ensures we have the right people, including mental health staff, in the right places, with the right skills to deliver the care patients need when they need it.”

MPs have overturned an exemption for adult social care providers from the forthcoming increase in employer national insurance contributions (NICs), in what leaders have described as a “devastating blow” to the sector.

In a vote today, they rejected House of Lords amendments to the legislation introducing the NICs rise that would have exempted regulated care home and home care providers in England and Wales, along with charitable social care services and health bodies, from the rise.

From April 2025, the rate of employer NICs will rise from 13.8% to 15% and the employee salary threshold at which firms start paying the tax will drop from £9,100 to £5,000 a year.

Public sector organisations, such as councils, are receiving grants to cover the costs of the rise for them, and the Lords amendment was designed to provide similar protection for health and social care providers.

However, the House of Commons overturned peers’ main amendment to the National Insurance Contributions (Secondary Class 1 Contributions) Bill, by 307 votes to 182, today, courtesy of the Labour government’s huge majority in the elected chamber.

Cost of national insurance rise for adult social care

Think-tank the Nuffield Trust has calculated that the NICs rise will cost England’s 18,000 independent adult social care providers £940m in 2025-26.

The government has said that councils with social services responsibilities will be able to help commissioned providers meet these costs through an increase of up to £3.7bn in their funding in 2025-26. This includes an £880m increase in the social care grant, 60% of which has been spent on adults’ services historically, and licence for authorities to raise council tax by up to 5%, with up to 2% ring-fenced for adult social care.

However, this amounts to only £1.2bn in dedicated extra resource for adult social care and, in addition to the NICs rise, providers must also fund the implications for their workforce of a 6.7% increase in the national living wage (NLW) next month.

The Nuffield Trust has calculated that the two measures combined will cost providers £2.8bn in 2025-26, with £2bn relating to council-commissioned care – significantly more than the increase in dedicated resource for adult social services departments in 2025-26.

‘Devastating blow that seals fate of thousands of providers’

Provider leaders reacted angrily to today’s vote, with the Homecare Association and Care England describing it as “a devastating blow that seals the fate of thousands of care providers across our nation”.

The Homecare Association has calculated that its members face a 10% increase in their costs in 2025-26, chiefly due to the rises in employer NICs and the NLW.

Its chief executive, Jane Townson, said: “The government’s refusal to exempt care providers from the [employer NICs increases], while simultaneously failing to provide adequate funding to local authorities, threatens the existence of regulated home care services across Britain. The government is forcing home care providers to choose between breaching regulations or insolvency.”

For the National Care Forum, director of policy Liz Jones said: “In choosing to vote down the amendments that would have protected care and support providers from the devastating impact of the employer’s national insurance contribution changes, the government inflicts a devastating blow on already fragile, underfunded and undervalued essential public services which millions of people, and their families, depend on for vital support.”

‘Funding available to meet social care pressures’

Defending the government’s position in the House of Commons today, Treasury minister James Murray said it could not support the Lords amendments because they would put at risk the funding that ministers intended to raise through the employer NICs rise and put further pressure on the public finances.

“On social care, the government have provided a cash increase in core local government spending power of 6.8% in 2025-26, including £880m of new grant funding provided to social care—funding that can be used to address the range of pressures facing the adult social care sector.”

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Many disabled people are facing benefit cuts in a government plan to save over £5bn a year by 2029-30 and get more people with health conditions into work, announced yesterday.

Access to personal independence payment (PIP) – the main disability benefit for people of working-age – would be restricted, while incapacity benefit rates for those out of work would be frozen for existing claimants and halved for new recipients.

At the same time, the Department for Work and Pensions (DWP) would invest an extra £1bn a year in employment support by 2029-30 in order to help get more disabled people into work.

Disabled people would also get a new right to try work without immediately losing access to benefits, while those whose lifelong conditions mean they will never be able to work would be given a benefits premium and spared reassessments.

‘Helping people who can work to do so’

Work and pensions secretary Liz Kendall, who launched the Pathways to Work green paper in a statement to Parliament, said the proposals were about “helping people who can work to do so, protecting those most in need, and delivering respect and dignity for all”.

The DWP will not publish an impact assessment of the reforms until next week, so it is not known as yet how many people will have their benefits cuts. However, charities warned the proposals would drive many disabled people into deeper poverty.

Scope said the changes would be “catastrophic for disabled people’s living standards”, while the Centre for Mental Health warned that they would worsen mental health, a concern also raised by NHS leaders.

Rising benefits caseload and cost

The green paper is the government’s response to the significant increase in the number of working-age people claiming disability benefits (mainly PIP) or incapacity benefits (employment and support allowance or the health element of universal credit) in the wake of the pandemic, and the ensuing rise in costs.

According to think-tank the Institute for Fiscal Studies (IFS), spending in Great Britain on these benefits grew from £36bn to £48bn in real-terms from 2019-20 to 2023-24 and are projected to hit £63bn in 2028-29 (in 2024-25 prices).

Annual spending on disability benefits grew by 45% in real-terms, and the number of recipients by 39%, while the inflation-adjusted cost of incapacity benefit grew by 26% and the caseload by 28%, from 2019-20 to 2023-24.

Greater levels of disability in population

The government has admitted that this has been, in part, caused by rising levels of disability, with 36% of people of working-age now having a long-term health condition, up from 29% a decade ago.

However, it said that this was being outstripped by the rise in the number of successful claims for disability or incapacity benefits. According to DWP figures, the number of disabled working-age people in England and Wales increased by 17%, but the numbers receiving an incapacity or disability benefit increased by double that amount (34%), from 2019-20 to 2023-24.

The DWP said this meant that the “structure of the benefits system” was partly responsible for the rise in cases.

In particular, the green paper said there was a “perverse” incentive within the incapacity benefits system for people to be found to have “limited capability for work and work-related activity” through the work capability assessment (WCA).

As a result, they are put on the health element of universal credit (UC) and receive £97 per week, in addition to the standard universal credit allowance, which is worth £91 per week for single people aged over 25. The difference in what they receive and what is given to those just on the standard allowance has grown over time due to a freeze in the standard allowance from 2015-19.

Changes to out-of-work benefits for disabled people

To address this issue, the DWP said it would:

• Scrap the WCA, meaning people would no longer be assessed on how far their disabilities or health conditions limited their ability to work. In future, the health element of UC would only be available to people assessed as eligible for the daily living component of PIP (see below). This is expected to come into force in 2028-29.
• Freeze the health element of UC at £97 per week until 2029-30 for existing claimants and halve the rate to £50 per week for new claimants, from 2026-27. In the spring statement on 26 March 2025, the government said that the £50 per week rate for new claimants would also be frozen until 2029-30.
• Increase the standard allowance of UC – for new and existing claimants – from £91 to £98 per week, from 2026-27. Combined with the cuts to the health element, this would significantly narrow the gap between payments to people without health conditions who only receive the standard allowance and those with a condition who receive both the standard allowance and health element.
• Consult on raising the minimum age for the UC health element from 18 to 22, with the savings reinvested in work support for young people. This would be to “remove any potential
  disincentive to work” and support the government’s “youth guarantee”, to give those aged 18-21 access to education, training or help to find a job.
• Enhance investment in employment support for people who are out of work who have a work-limiting health condition or disability, with an extra £1bn a year provided by 2029-30.

To protect those with the highest needs, the DWP said it would pay an additional premium on the health element of UC for those with severe, life-long health conditions, who have no prospect of improvement and will never be able to work, and ensure that they would not have to have to be reassessed.

Restricting access to PIP

Despite the government’s emphasis on getting more disabled people into work, one of the biggest measures in the green paper is restricting access to PIP, which is designed to compensate people for the costs of disability and is paid regardless of work status.

The DWP said spending on PIP was “becoming unaffordable” and needed to be focused on those with higher needs.

To restrict eligibility, it plans to bar people from receiving the daily living component if they do not score at least four points on any one of the 10 assessed activities, a policy that would apply to new applicants from 2026-27 and existing claimants, at the point of review. To be eligible for the daily living component of PIP, you must score at least eight points across all 10 activities.

Under the plans, you would not be eligible if you needed assistance to wash your hair or wash below your waist (two points) or needed assistance getting in or out of the shower (three points), under the washing and bathing activity, unless you scored four points or more in one of the other activities.

The DWP said it was “mindful of the impact this change could have on people” and so would consult on offering a review of disabled people’s health and eligible social care needs should they lose access to PIP.

Loss of benefit

The IFS said the impact of the reforms to PIP was uncertain because the consequences of changes to eligibility criteria were hard to predict. However, it added that:

• People who received the health element of UC but were not eligible for PIP would lose access to the health element through entitlement being based on the PIP assessment. This would make them worse off by £2,400 a year (in today’s prices), from 2028-29. Currently, 600,000 people qualify for the health element of UC but do not receive PIP.
• About 2.4m families would be worse off by £280 a year by 2029-30 due to the freeze in the health element of UC.
• New claimants for the health element of UC would be worse off by £2,500 a year than were the green paper changes not introduced.

The proposals sparked widespread anger from disability and anti-poverty charities.

Government ‘choosing to penalise some of society’s poorest’

With almost half of families in poverty having at least one disabled person, Scope said the government was “choosing to penalise some of the poorest people in our society”.

While welcoming the increased investment in employment support, the charity’s executive director of strategy, James Taylor, said this would be undermined by the benefits cuts.

“These cuts will be a catastrophe for disabled peoples’ living standards and independence,” he added. “The government will be picking up the pieces in other parts of the system with pressure on an already overwhelmed NHS and social care, as more disabled people are pushed into poverty.”

Impact on carers and child poverty

The End Child Poverty Coalition and Child Poverty Action Group warned that the measures risked deepening child poverty – which the government is developing a strategy to tackle – while the Carers Trust and Carers UK flagged up the impact of the proposals on carers.

Access to carer’s allowance is dependent on the person caring for someone who receives one of a set of disability benefits, and Carers UK said half of awards are tied to the person being cared for receiving PIP. It also pointed to the fact that disability rates are higher among carers than in the general population, with about 150,000 people receiving both PIP and carer’s allowance.

“1.2 million unpaid carers in the UK are living in poverty, (with 400,000 in deep poverty),” said its chief executive, Helen Walker. “Raising the qualifying threshold for support could mean even more carers will struggle to afford essentials like food and heating.”

Risk of deterioration in mental health

The Centre for Mental Health, meanwhile, warned of an adverse impact of the policy changes on people’s mental health.

While welcoming the planned increase in employment support funding, chief executive Andy Bell said: “Evidence shows that when governments tighten benefit rules, people’s mental health gets worse. If more people fall into poverty, both the prevalence and severity of mental ill health is likely to rise.”

This issue was also picked up by health trust representative body NHS Providers, which warned that the proposals risked increasing pressures on mental health services.

“Mental health trust leaders previously told us that changes to universal credit and benefits were increasing demand for services, as were loneliness, homelessness and wider deprivation,” said its interim chief executive, Saffron Cordery.”

“With poor mental health the leading driver of ill-health related economic inactivity, they will also be worried that today’s announcement could lead to worse mental and physical health for patients and shift further costs and pressures onto the health and care system, including overstretched emergency departments and mental health services.”

The Care Quality Commission (CQC) has set out lessons from the first tranche of assessments of local authority adults’ services since it resumed performance checks in December 2023.

It said that support for carers was in need of improvement, while authorities also needed to enhance their understanding of population equality and diversity issues and use of data, though reablement was an area of strength.

CQC deputy directors Amanda Stride and Lella Andrews made the comments in a presentation to a Local Government Association webinar on its assessment system for councils in England.

Need to improve support for carers

Stride and Andrews said support for unpaid carers was an area of improvement identified by the CQC’s assessments to date.

This included improving the identification of carers, the range and capacity of services for them, the timeliness of assessments and the personalisation of support, based on the age and needs of the person being cared for.

The conclusion reflects the results of a recent Carers UK survey, which found that over half of carers felt they required more recognition of their needs from councils, with some reporting long waits for assessments or support.

The CQC officials also pointed to understanding of population equality and diversity issues as an area for improvement, and said councils’ inconsistent use of data made it harder for them to effectively plan and monitor services.

Challenges with recruitment and transitions

Transitions for young people to adults’ services were often challenging, especially if they did not start early, while councils faced ongoing recruitment pressures, particularly in relation to occupational therapists.

However, reablement was an area of strength, with the CQC having seen good practice in its use to support people to regain independence, said Stride and Andrews.

They added that, while the CQC’s assessment methodology would not change, it was working with sector bodies to make improvements, including in how it gathers evidence of lived experience and collects provider views.

Councils ‘want to work with the CQC to improve process’

In response to the findings, the chair of the LGA’s community wellbeing board, David Fothergill, said: “Councils are keen to learn and improve services. Identifying common themes is essential not only for addressing challenges but also for sharing what works well.

“We want to work with the CQC to ensure the assurance process is productive and valuable, helping councils build on strengths as well as tackle areas for improvement.”

He pointed to the LGA’s work, with the Association of Directors of Adult Social Services (ADASS), through the Partners in Care and Health sector-led improvement initiative, which “plays a key role in supporting the sector to continually drive progress”.

Partners in Care and Health has published guidance for councils on learning from CQC assessments carried out to date, including reflections on the process from adults’ services directors in authorities that have been assessed and an analysis of what it takes to get a good rating, based on the first set of reports.

By Tim Spencer-Lane

The Mental Health Bill, which would amend the Mental Health Act 1983 (MHA), has now passed through committee stage in the House of Lords after five days of debate.

This stage allows peers to scrutinise the detail of a bill, although by convention no votes are taken on tabled amendments.

Committee stage normally provides an important indicator of which issues peers are interested in and may revisit at third reading, where amendments are likely to be put to a vote. It is important to remember that the government does not have a majority in the Lords and could be defeated on particular votes.

Principles

The bill does not insert principles onto the face of the MHA. Instead, it sets out four principles (choice and autonomy, least restriction, therapeutic benefit, and the person as an individual) to be included in the MHA code of practice.

Baroness Tyler (Liberal Democrat) was concerned that “placing the guiding principles in the code leaves a loophole in which they can be deviated from”. She also proposed that “equity” should be added to the principles to “provide additional momentum towards the goal of addressing the racial disparities in the Mental Health Act”.

Lord Bradley (Labour) supported a principle based on identifying and supporting “the communication needs of the individual”.

In response, Baroness Merron (parliamentary under-secretary of state, Department of Health and Social Care), argued that, in respect of statutory principles “the real concern is about making very complex legislation even more complex”.

Unlike the Mental Capacity Act 2005 (MCA), the MHA “has not been designed or structured around statutory principles”. She also argued that “it feels unnecessary to include equity as a specific principle because it is already a requirement of the Equality Act 2010” and that the code of practice will give guidance for practitioners “on how to support individuals with communication needs to make sure that their voices are heard”.

Learning disability and autism exclusion

A topic that dominated debates in the Lords was the position of people with learning disability and autistic people. The bill would prohibit people being detained for treatment under the MHA solely on the basis of learning disability or autism.

Baroness Browning (Conservative) welcomed “the removal from the Mental Health Act of the presumption of mental illness in people with autism and learning difficulties”.

However, she was concerned that “once it is removed the Mental Capacity Act will be used more frequently” to deprive autistic people and people with learning disabilities of liberty. In relaition to this, she pointed to the widespread difficulties associated with the Deprivation of Liberty Safeguards.

Baroness Berridge (Conservative) argued “there is the other danger that – when there is no co-occurring mental health condition – you end up with people coming through the criminal justice system”.

In response, Baroness Merron stated that “the number of people with a learning disability and autistic people in mental health hospitals is indeed unacceptable”. She argued that the government did not want the MCA to “be a loophole, back door or anything of that nature”.

She also pointed to the bill’s duty on integrated care boards (ICBs) to establish and maintain a register of people with a learning disability and autistic people who are at risk of detention. ICBs and local authorities must have regard to the register and the needs of the local ‘at risk’ population, when carrying out their commissioning duties.

Baroness Merron said the intention of these provisions was that “people with a learning disability and autistic people are not detained but supported in the right way”.

Professional roles and responsibilities

Amendments were tabled by the former prime minister, Baroness May (Conservative), intended to “widen the definition of those who can attend a mental health incident and act to detain an individual in a variety of circumstances”.

These aimed at extending the powers given to police officers to remove a person suffering from a mental health crisis to a place of safety, to health and social care professionals (including social workers and paramedics). The proposals were supported by several peers, who argued it would lead to the reduction of police attendance at mental health incidents, in line with the Right Care, Right Person concordat.

However, Baroness Merron argued that “extending the ability to health and social care professionals to enter someone’s home without their permission would be a major shift in their roles” and “it would impact on relationships between patients and health and care staff”.

She committed to look at reducing police time in health settings and to update the code of practice to clarify the handover process between police and health, including in A&E.

Community treatment orders (CTOs)

The bill proposes to tighten the criteria for the use of CTOs and limit how often they are used. A range of views on CTOs were expressed in the debates. Baroness Fox (non-affiliated) referred to their “spiralling and increasing use”. She noted that “CTOs are necessary when community care is under huge strain, because the idea of voluntarily accessing a wide variety of support in the community is a myth in today’s circumstances”.

Baroness Berridge (Conservative) felt that CTOs should be “in the last chance saloon”. On the other hand, Baroness Parminter (Liberal Democrat) felt that CTOs “can be valuable for people with eating disorders – and for forensic patients”. Lord Kamall (Conservative) called for more data on why a disproportionate number of black people were subject to CTOs.

Baroness Merron restated the government’s position that “CTOs can be valuable for certain patients” but “reform is needed so that they are used only when appropriate and for the shortest possible time”.

She also confirmed that “officials are working with NHS England and others to understand what additional data should be collected to understand the impact of the reform”, adding that the government was “committed to ongoing monitoring of CTOs as we implement the changes”.

Children and young people

Many of the safeguards in the bill are linked to a determination of capacity (for those aged 16 and over) and competence (for those aged under 16); for example, the rights for a child to appoint a nominated person or make an advance choice document depend on their competence to make this decision.

However, Baroness Tyler (Liberal Democrat) raised concerns that “there is also no clear and consistent approach for determining whether a child is competent. Although the concept of competence is generally understood, how to assess a child’s competence is not.”

Consequently, she argued, children may not benefit from the reforms in the bill that depend on competency.

Several peers called for a statutory test of competency to be inserted onto the face of the MHA. Lord Meston (crossbench) tabled an amendment which adopted the MCA’s functional test but without the need to consider if the inability to make the decision is caused by an impairment of or disturbance in the mind/brain.

Peers were concerned about how the nominated person role, which replaces the nearest relative, would work for children and young people. Baroness Berridge (Conservative) called for a prescribed list of people that an approved mental health professional could appoint as the nominated person for children and Baroness Butler-Sloss (crossbench) called for greater rights for parents to be consulted and challenge appointments in the court.

The bill does not provide any reforms aimed at addressing the position of children placed on adult mental health wards and those placed in hospitals out of area. Earl Howe (Conservative), therefore, called for procedural safeguards for children placed on adult wards and Baroness Berridge (Conservative) wanted a new notification process for out-of-area placements.

For the government, Baroness Merron rejected the amendment for a statutory test of competency, pointing out that the courts had rejected the proposed definition.

She added: “To introduce a statutory test for under-16s only under the Mental Health Act is likely to risk undermining Gillick, which remains the accepted competence test for under-16s across all settings, including reproductive health and children’s social care, and the wider legislative framework on matters related to children.”

The minister also said detailed guidance would be provided in the code on how the nominated person role would work for children and young people, and confirmed that people who were a risk to a child could not be the nominated person.

Baroness Merron said that additional guidance would be provided “on the process to determine, and review throughout a child’s detention and treatment, that the environment in which they are accommodated continues to be in their interests”.

Racial disparities

The bill does not include any reforms expressly aimed at reducing racial and ethnic inequalities in the use of the MHA. However, there was depth of feeling amongst peers when debating this area.

Baroness Whitaker (Labour) highlighted the discrimination faced by the Gypsy, Roma and Traveller communities and their lack of access to services. Baroness Tyler (Liberal Democrat) felt that the bill “still does not go far enough to address that deeply entrenched inequity”. Lord Kamall (Conservative) probed the government “to understand what they know and what research they are aware of, so we can understand the reasons for these racial disparities and put in place measures to tackle them”.

Some peers called for the creation of a “responsible person” in each hospital who would be responsible for driving change

Baroness Merron acknowledged the need for better data and argued that the patient and carer race equality framework (PCREF) “will improve data collection on racial disparities over the coming year, and the [Care Quality Commission (CQC)] has existing duties to monitor and report on inequalities under the Mental Health Act”.

She also said the department “will continue to monitor racial disparities in the use of CTOs”. But the minister rejected the creation of a responsible person role as “it would duplicate existing roles and duties”, including the public sector equality duty under the Equality Act 2010 and the monitoring role of the CQC.

Implementation of the reforms

Many peers called for greater clarity and specific guarantees over when the bill would be implemented.

Lord Scriven (Liberal Democrat) tabled an amendment to “create an obligation for the government to lay a costed plan for sufficient services before Parliament within four months of the passage of the bill”. Baroness Tyler (Liberal Democrat) called for a costed plan for community care to support the reforms in the bill and Lord Stevens (crossbench) advocated for a statutory backstop for implementing the bill.

Baroness Merron set out an indicative plan for implementing the bill. The first priority would be the code of practice (which would take a year) and the secondary legislation. There would be training of the existing workforce in 2026-27 and commencement of the “first major phase of reforms in 2027”. It would take up to 10 years to fully implement the bill.

Mental health commissioner

The joint committee on the draft bill had recommended the post of a statutory mental health commissioner should be created to provide an independent voice advocating for mental health service users and act as a watchdog to oversee the implementation of the reforms. This was not included in the bill.

Baroness Tyler (Liberal Democrat) called for the creation of a statutory commissioner to provide “sustained leadership for mental health”, transform mental health services and drive forward the reforms.

Lord Bradley (Labour) disagreed with claims that the commissioner would duplicate the functions of the CQC, pointing to the example of the Children’s Commissioner for England, which functions alongside Ofsted. Lord Kamall (Conservative), however, expressed some concern about the creation of a new bureaucracy.

Baroness Merron repeated that a commissioner would duplicate existing functions of the CQC and Healthcare Inspectorate Wales, as well as NHS England. She also claimed that the Children’s Commissioner was operating in a much broader landscape than that proposed for the mental health commissioner and was therefore less duplicative.

The ‘human rights protection gap’

In the months leading up to the publication of the bill, the High Court handed down its judgment in Sammut v Next Steps Mental Healthcare Ltd [2024] EWHC 2265 (KB). This decision confirmed that private care providers commissioned by local authorities and NHS to deliver services under section 117 of the MHA were not public authorities for the purposes of the Human Rights Act 1998, so were not bound by its provisions.

Consequently, Baroness Keeley (Labour) raised concerns about the ongoing gap in protection for those receiving care from the private sector and tabled an amendment to extend the protection of the Human Rights Act to include all section 117 service users, informal patients and those being deprived of their liberty in any setting. The amendment was strongly supported by ‘legal’ members of the Lords – Lord Pannick (crossbench), Baroness Chakrabarti (Labour) and Baroness Butler-Sloss (crossbench).

In response, Baroness Merron confirmed the government was “actively considering” this matter.

What was not debated at committee stage

It is noteworthy that several important areas of the bill received little mention in the debates.

These include the new powers to enable restricted patients, who have capacity to consent to their arrangements, to be discharged from hospital with conditions amounting to a deprivation of liberty. Stakeholders have raised concerns that the reform crosses the Rubicon by allowing the detention of people with capacity in the community and argued that greater safeguards are needed.

The part 4 reforms concerning consent to treatment also provoked little debate, no doubt in part because of their complexity. But there was little discussion of matters such as the  increased right for mental health patients to refuse medication and urgent electroconvulsive therapy, as well as the new clinical checklist to guide decision makers.

There was also no mention of the reforms to the meaning of ordinary residence for the purposes of section 117 aftercare services, including the introduction of new ‘deeming rules’. These will have a significant impact on local authority funding of section 117 services.

What happens next?

The next stage for the bill will be the report stage, which is an opportunity for the whole House of Lords to consider what has been done during the committee stage. This will be followed by the third reading which is the final opportunity for peers to consider the whole bill. Amendments will be tabled, debated and voted on during these stages.

The bill will then be considered by the House of Commons.

Tim Spencer-Lane is a lawyer specialising in adult social care, mental capacity and mental health and legal editor of Community Care Inform.