Falling short: How far have we come in improving support for unpaid carers in England?

People who provide care unpaid for a family member or a friend due to illness, disability, or mental health provide a vital role bridging gaps in state-funded support. But despite the laudable policy statements in support of carers, this Nuffield Trust report looking at the policy history and latest data shows that the reality for unpaid carers has been one of diminishing help over time.


Published: 10/10/2022

Download the report [PDF 727.6KB]

Unpaid carers play a crucial role in providing essential care for people who need help because of ill-health, frailty, disability, a mental health condition or an addiction. This care, provided by both adults and children and worth billions of pounds a year – is often not visible but has become an essential part of the health and care system, bridging gaps in state-funded support.

Over the past decade and a half there has been a strong policy focus on improving the support available to unpaid carers in England. Bold commitments detailed in policy documents such as the 2008 Carers Strategy (Carers at the Heart of 21st-Century Families and Communities) and the 2018–20 Carers Action Plan set out to better support carers, recognise their value and improve services for carers. This report seeks to assess the extent to which these policy commitments have been realised.

Despite the laudable policy statements in support of carers, and the additional pressure put on unpaid carers during the Covid-19 pandemic, this report shows that the reality for unpaid carers has been one of diminishing help over time:

  • Evidence reveals an 11% drop between 2015/16 and 2020/21 in the numbers of carers in receipt of ‘direct support’, meaning that at the end of this six-year period 13,000 fewer carers were being given the choice and personalisation that this type of support is designed to offer. Access to breaks for carers – funding for ‘carer support involving the cared-for person’ – also declined during this period, by 42%.
  • At the same time local authority gross expenditure on services for carers has also reduced: the latest data detail an 11% drop in 2020/21 compared with 2015/16. This has translated into a reduction in the support offer available to carers, with local authorities providing fewer direct support payments and directing 36,000 more carers to information and advice only. Carers report finding it harder to access adequate advice and support, and satisfaction with carer support services is declining.

Key to explaining this mismatch between the promises of better support for carers and the reality for the rising number of unpaid carers are:

  • a lack of accountability and agreement on who is responsible for policy success and failure
  • a lack of clarity on who is responsible for what within local systems
  • a failure to set out how policy success might be measured
  • a false assumption that legislation alone can secure change
  • the invisibility of carers in wider policy decision-making
  • funding pressures and budgetary constraints
  • a lack of data needed to support service commissioning, and to evaluate policy success.

To tackle this, we make a series of recommendations aimed at parliamentarians, policy-makers, local commissioners and data organisations. These include improving accountability within government for achieving success in better supporting carers; committing to ensuring that councils and organisations delivering support to carers are adequately funded; requiring all integrated care boards to develop an action plan to support carers and to include carers in health inequalities impact assessments at a local level; and having an explicit focus on unpaid carers within data policy to drive better-quality data at national and local levels.

Suggested citation

Paddison C and Crellin N (2022) How far have we come in improving support for unpaid carers in England? Research report, Nuffield Trust.