Recently the BBC published an article and released a documentary exposing abuse and poor care provided at a care home in Inverness. Catriona MacPhee, a BBC journalist, went undercover as a cleaner at the Castlehill care home in Inverness, to understand the experiences of the residents at the sharp end of the crises faced by the care sector throughout the UK.
The documentary and article were yet another example of the damaging effects of bad care. In the documentary, residents with dementia were shown being threatened, pinned to beds, left unwashed and lacking in vital medications. It was evident in this case that inadequate levels of staffing were the cause of some of the issues, compounded by a management culture that tolerated unsanitary conditions and unsafe care.
Unlike England, Scotland has a register of care workers. This means that the people working in the Castlehill care home were registered and they were working for a service that itself has to be registered and inspected. Although it is only one case, it does highlight the limits of registration and regulation alone in keeping people safe. As the case for care worker registration is explored in England and the English care regulator – the CQC – struggles to deal with an enormous backlog of inspections, it is important to keep in mind the limits of what registration and regulation can achieve.
Systemic patterns of underfunding/underresourcing of care services and a lack of consideration for the suitability of care provided for people with different needs are resulting in poor outcomes in care home services across the UK – despite efforts made to regulate the care sector.
The current state of care
In the BBC expose, it’s clear that care homes face multiple challenges in delivering their services. Firstly, there is increasing demand for care as the UK faces an ageing population that is projected to rise, with rates of dementia predicted to increase – we will live longer but with more complex health needs (Wittenberg et al, 2019).
Most care provided is unpaid care by family and friends. Too often this also has to fill the gap where formal care is inaccessible, inadequate or unaffordable. There is a vast amount of unpaid care given by friends and family to their loved ones across the UK, recent data estimates the amount of people providing this care at around 5.8 million with the monetary value of this care estimated at 184 billion pounds – the equivalent of a second NHS (Petrillo and Bennett, 2023). Unpaid care is often provided from a place of love and respect but can often have complex impacts on the carer, with many carers experiencing worse health outcomes than non-carers and being far more likely to experience poverty (Watkins and Overton, 2024). Many people may have to take on caring responsibilities when they aren’t able to meet the costs of professional care (Watkins and Overton, 2024; Carers UK, 2025).
For those who seek care from care homes when they may be unable to provide care at home, they are faced with high costs, a high demand for beds and unequal standards of care provided across different services (Burns, Hyde and Killet, 2016). Equally, for people working in the care sector, they face systematic issues around understaffing (caused by depleting funds to care homes) leading to a poor quality of work and high demands on their skill and time in inadequate conditions (Daly and Fisher, 2023). Research also suggests that care work is not considered highly skilled by UK policymakers contributing to little motivation to improve poor pay conditions (Daly and Fisher, 2023). The quality of care provided and conditions of care work may also be in tension with profit-driven incentives which can sometimes lead to extractive practices and poor care (Fisher and Foster, 2025).
Underfunding of care homes and the impact on quality of work
The BBC expose discusses the understaffing of care homes resulting in inadequate care, partly a result of the underfunding of care home services.
Research by Diane Burns, Paula J.Hyde and Anne M.Killett first reported how measures to save costs by reducing funds to labour in nursing homes across 12 case studies impacted the quality of work for care workers and could have an adverse effect on the quality of care provided. Their research identified that nursing homes in their sample faced cost pressures for a number of reasons, including: reduced payments from Local Authorities (LAs), increased operational costs and (at the time of the research in 2016) reduced income from decreasing occupancy rates (Burns, Hyde and Killett, 2016).
As a result, care workers faced a negative impact on the quality of their job, as defined by a number of factors: level of work intensity, degree of autonomy, contract specifications, task diversity etc (Burns, Hyde and Killett, 2016; Findlay, Kalleberg and Warhust, 2013; Holman, 2013; Osterman, 2013). As these features of their work were impeded, this caused, in some cases, a decrease in the quality of care provided.
Conditions of care work have long been a topic of international concern. Research suggests that paid care work is undervalued in the UK and contributes to difficulties in retention and recruitment (Daly and Fisher, 2023). Duncan Fisher and Liam Foster’s research has highlighted that paid care work has been considered ‘low pay’ work since 1988 with a high rate of zero hours contracts (Fisher and Foster, 2025). Care workers in the UK report a normalised culture of low pay endemic to the industry. There are attempts to justify this by classing the work as ‘low skilled’ or ‘not professional’ with minimum requirements for training to enter the sector (Fisher and Foster, 2025). However, workers feel their roles increasingly demand them to have specific knowledge and skills to deal with the complex needs of residents, an example of which is people with dementia (Fisher and Foster, 2025).
Adult social care does not perform well in consistency of training for its workers, with early training seen as patchy and not standard (Fisher and Foster, 2025). Additionally, training is hard to access for adult social care workers amid insecurity in their contracts and lack of paid time to complete training (Fisher and Foster, 2025).
This is only a handful of examples of how poor conditions at work for adult social care workers would create barriers to providing high standards of care.
Types of care, staff resilience and the ability to meet need
However, it’s not the case that underfunded care home services are the sole cause of poor quality of care provided. Research suggests that a proportion of care workers often place high value on their work, feeling a sense of personal responsibility to deliver good care to residents through a desire to help others (Fisher and Foster, 2025).
Burns and colleagues’ research showed that while job quality for employees in care homes was always impacted by reduced funds to labour, (increased working hours, lower pay, less training, lower staffing levels and fewer job benefits) quality of care was not universally impacted (Burns, Hyde and Killett, 2016). Their research showed that for care homes which took a custodial approach to care, standards of care weren’t maintained when employees faced a decrease in their job quality. Custodial approaches to care are defined here as a focus on meeting the physical needs of a resident where the resident is assumed to be incapable of determining how their care should be delivered and are passive recipients of care (Burns, Hyde and Killett, 2016).
However, for care homes providing a person centred approach to care, standards of care were maintained despite a decrease in quality of work for care home workers. Person centred care is understood here as care that enables flexibility in the conception of care to meet the needs of the individual, however changeable and complex (see, e.g., Institute of Medicine 2001; Edvardsson, Winblad, and Sandman 2008; Banaszak-Holl, Castle, Lin, and Spreitzer 2013).
The Centre for Care spoke to Claire Rintoul, the CEO of SheffCare, who told us that they strive to provide person centred care, with staff members committed to caring in the best way they can. She explained for the quality of care to be sustained in difficult circumstances, (reduced staffing etc) person centred care was the only way to do so in terms of how care is administered. While there shouldn’t be an argument to validate low support from central systems (e.g. local authority spending, government policy) by consistently providing person centred care – it’s clear that the culture and attitude to care administration is equally as important as material resources.
System change – what’s being done?
It’s clear there are a multitude of issues in the care sector resulting in the poor conditions of care demonstrated in the BBC article and documentary – but what is being done about it?
The Labour government has committed to an independent review by Baroness Louise Casey, gathering insights from people with lived experience and other stakeholders across the care sector with a view to reform adult social care. The Centre for Care hopes that this work will enable further progress to be made in the provision of care within care homes and across adult social care, as pre-existing challenges will only be further exacerbated if action is not taken.
References
Banaszak-Holl, J., Castle, N.G., Lin, M. and Spreitzer, G. (2013). An assessment of cultural values and resident-centered culture change in U.S. nursing facilities. Health Care Management Review, 38(4), pp.295–305. doi:https://doi.org/10.1097/hmr.0b013e3182678fb0.
BBC Disclosure (2025). Disclosure – Care Home Undercover. [online] Available at: https://www.bbc.co.uk/iplayer/episode/m002k175/disclosure-care-home-undercover.
Burns, D.J., Hyde, P.J. and Killett, A.M. (2016). How Financial Cutbacks Affect the Quality of Jobs and Care for the Elderly. ILR Review, 69(4), pp.991–1016. doi:https://doi.org/10.1177/0019793916640491
Carers UK (2025). State of Caring 2025: The cost of caring – the impact of caring across carers’ lives. London: Carers UK.
Edvardsson, D., Winblad, B. and Sandman, P. (2008). Person-centred care of people with severe Alzheimer’s disease: current status and ways forward. The Lancet Neurology, [online] 7(4), pp.362–367. doi:https://doi.org/10.1016/s1474-4422(08)70063-2
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Holman, D. (2013). Job types and job quality in Europe. Human Relations, 66(4), pp.475–502. doi:https://doi.org/10.1177/0018726712456407.
Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. [online] PubMed. Available at: https://pubmed.ncbi.nlm.nih.gov/25057539/
MacPhee, C. (2025). I went undercover as a cleaner at a failing care home. BBC News. [online]. Available at: https://www.bbc.co.uk/news/articles/c4g78yj2v2go.
Osterman, P. (2013). Introduction to the Special Issue on Job Quality: What Does it Mean and How Might We Think about It? ILR Review, 66(4), pp.739–752. doi:https://doi.org/10.1177/001979391306600401.
Petrillo, M. and Bennett, M.R. (2023) Valuing Carers 2021: England and Wales. London: Carers UK.
Watkins, M., & Overton, L. (2024). The cost of caring: a scoping review of qualitative evidence on the financial wellbeing implications of unpaid care to older adults. Ageing & Society, 1-28. https://doi.org/10.1017/S0144686X24000382
Wittenberg, R., Hu, B., Barraza-Araiza, L. and Rehill, A., 2019. Projections of older people living with dementia and costs of dementia care in the United Kingdom, 2019–2040. London: Care Policy and Evaluation Centre, London School of Economics and Political Science, 79.
About the authors
Lucy is an Impact Associate in the Centre for Care, working closely with Fay Benskin and academics to improve the impact of research in decision making processes for key stakeholders across government policy and third sector organisations.
Catherine Needham is Professor of Public Policy and Public Management at the Health Services Management Centre, University of Birmingham. Her research focuses on adult social care, including personalisation, co-production, personal budgets and care markets.
