The UK General Election - 4th July 2024


Sleep walking off the cliff edge?

Nathan Hollow

Board Director - Head of Health and Social Care - Head of South West

For months, if not years, newspaper headlines have focused on the financial crisis in the care sector. Almost all of this has looked at elderly care provision, another issue is coming to the fore which this time predominately affects Learning Disability and specialist care services – sleep-in payments and the National Living Wage (NLW).

Guidance issued by the Department for Business, Energy and Industrial Strategy (BEIS) in October 2016 sought to clarify this complex issue, outlining that, “workers may be found to be ‘working’ whilst asleep if, for example, there is a statutory requirement for them to be present or they would face disciplinary action if they left the workplace.” This clarification has left the care sector with, according to Care Minister David Mowat MP, a “£200 million-ish headache”.

Many providers will now find themselves struggling to pay sleep-in workers the NLW given funding agreements were made six-months prior to the clarification and likely did not take account of this significant cost increase.

Worse still, HMRC are actively pursuing providers for non-payment dating back five or more years, with back-pay and fines potentially running to millions of pounds. Struggling providers are now being driven to the cliff edge, with the Voluntary Organisations Disability Group (VODG) claiming providers will “inevitably” collapse if they are not funded for the extra costs.

As we approach the Spring Budget, the challenge for providers is how to present their case to government in this highly emotionally charged area. After all, public opinion is unlikely to be on the side of private providers who haven’t paid the NLW, regardless of the fairness and nuance behind this issue.

Whilst a lot of media attention on this issue has focused on the financial headache the new guidance poses for care providers – and whilst this is undoubtedly a serious concern in boardrooms across the country – the narrative needs to change if the sector is going to achieve the result it requires from government and the HMRC. After all, the sector has for years called for more funding – what’s changed now?

Take for example David Brindle’s excellent piece in the Guardian last month – not a single quote from the sector referenced the value of care workers; how difficult their role is compared to other minimum wage jobs; how their hard work and dedication is what keeps the system operating despite the chronic funding shortfalls.

Fundamentally, if government is to fully support the care sector – as it should, and as it clearly needs to – it must hear care providers truly value the contribution of their workers, and that they are committed to paying all of them the NMW or NLW. The sector must set itself apart from the other businesses experiencing similar challenges – the Ubers, Deliveroos, and Sports Directs of the world – whose objective is purely to drive down business costs.

The debate around sleep-in payments, and care sector funding more broadly, should therefore shift from focusing on saving individual businesses or shoring up shareholder returns, and rather focus on financing social care so that our country’s most vulnerable people can receive the very best care and support, from the very best care workers. Care workers whose contribution is truly recognised and valued by society – one of the only ways we can resolve the recruitment challenges already plaguing the sector and which Brexit will likely exacerbate.

Such a shift in the public’s attitude, and that of the government, can only start when care providers, and the sector bodies which represent them, actively champion the role care workers play in society whilst highlighting the need for fair funding to enable fair pay.

Nathan Hollow is Head of Social Care at PLMR, a communications agency specialising in health and social care, offering expertise in crisis communications, media relations, planning and political engagement. Call 0207 622 9529 or visit

PLMR Insights: General Election Announced

Thanking our veterans for today’s General Election announcement

Add PLMR to your contacts

PLMR’s crisis communications experience is second to none, and includes pre-emptive and reactive work across traditional and social media channels. We work with a range of organisations to offer critical communication support when they are faced with difficult and challenging scenarios.