Domiciliary care has its roots in early charitable and community-based health support, evolving significantly over the past century.
Early 20th Century: Informal and Charitable Care
Pre-Welfare State: Care was largely provided by family members, religious organizations, or charitable institutions.
District nurses and health visitors: These roles emerged in the late 19th and early 20th centuries, offering limited medical support at home.
1948 – Creation of the NHS & Welfare State
The National Health Service (NHS) was established in 1948, but social care (including home help services) remained the responsibility of local authorities, not the NHS.
Home help services were introduced for tasks like cleaning, shopping, and some personal care, mainly to help older or disabled people stay at home.
1960s–1970s – Formalization and Expansion
Increasing demand led to more structured home help services.
Care was typically provided by local authority-employed home helps.
Services remained basic, non-medical, and task-focused.
1980s – Market Forces and Changing Roles
Rising costs and an ageing population increased pressure on social services.
The role of home helps began shifting toward personal care (washing, dressing) in addition to domestic tasks.
Voluntary and private sector involvement began to grow.
1990 – NHS and Community Care Act
This was a pivotal moment: it shifted responsibility for arranging care from the NHS to local authorities.
Introduced means testing for care and encouraged private sector provision.
Led to rapid growth of independent domiciliary care agencies.
2000s–2010s – Regulation and Commissioning
2002: The Care Standards Act introduced regulation of domiciliary care providers by the National Care Standards Commission, later replaced by the CQC (Care Quality Commission) in 2009.
Local authorities increasingly commissioned care from private and voluntary providers rather than delivering it directly.
Recent Developments (2010s–2020s)
Personalisation agenda and Direct Payments gave service users more control over their care.
Rapid growth in complex care at home, supported by advances in technology and workforce skills.
COVID-19 highlighted the importance and resilience of domiciliary care, leading to more public and governmental attention.
Summary
Domiciliary care in the UK evolved from informal support systems into a regulated, commissioned, and diverse sector involving public, private, and voluntary providers. It now plays a critical role in supporting people to live independently, reducing reliance on hospitals and residential care.