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The Future of Domiciliary Care in Wales: Predictions for the Next Few Decades

As Wales faces the realities of an ageing population and increasing pressure on public services, domiciliary care, care delivered in people’s homes, is becoming an essential part of the nation’s health and social care strategy. Over the next few decades, this sector is expected to undergo significant transformation, shaped by demographic shifts, policy reforms, technological innovation, and evolving community needs.


By 2040, the number of people aged 65 and over in Wales is projected to rise by more than 40%, with rural counties such as Gwynedd and Powys experiencing the steepest increases. This demographic shift will drive demand for home-based care, particularly among individuals with dementia, mobility challenges, and complex health conditions. The preference to “age in place” rather than enter residential care is growing, and domiciliary services will need to adapt to meet this demand with flexibility, compassion, and efficiency.


Policy developments are already paving the way for change. The Welsh Government’s commitment to establishing a National Care and Support Service aims to standardise and improve care across all 22 local authorities. Building on the foundations of the Social Services and Well-being (Wales) Act 2014, and the Regulation and Inspection of Social Care (Wales) Act 2016, the government is working with Social Care Wales and other stakeholders to develop a five-year strategic plan focused on improving care and support at home. As Social Care Wales noted, “We were asked by the Welsh Government to bring people and organisations together to develop a five-year strategic plan to improve care and support at home in Wales.” This collaborative approach is central to Wales’ vision for a more integrated and person-centred care system.


Funding remains a critical issue. Wales currently spends more per adult on social care than England, £250 compared to £71, but financial pressures continue to mount. A report from Cardiff University warns that increased spending on social care is inevitable and calls for a clear, long-term roadmap to ensure sustainability. At the same time, the Welsh Government has pledged to rebalance the domiciliary care market, shifting away from profit-driven models towards services that deliver social value. This policy shift could empower local authorities and community-based providers to deliver care that is more responsive and ethically grounded.


Workforce challenges are another key concern. Recruitment and retention remain difficult, especially in rural areas, due to low pay and limited career progression. With 80% of the residential care workforce in Wales made up of women, pay reform is also a gender equality issue. Innovative models such as micro-care services and Buurtzorg-inspired pilot projects are being explored to support small-scale, self-managed teams. As one health board noted, “There are some models of care in the home in Wales that draw on Buurtzorg principles... with £1.2m pledged toward pilot projects in three health boards.”


Technology will play a transformative role in the future of domiciliary care. Telecare, remote monitoring, and AI-assisted scheduling are already being piloted in parts of Wales, offering new ways to deliver care more efficiently and safely. These tools can support strength-based working and community-led care models, helping individuals maintain independence while receiving the support they need. As Carers Wales observed, “Much of domiciliary care is relationship-based, and the workforce has an important impact on the way care is experienced.” Technology must therefore enhance, not replace, the human connection at the heart of care.


Looking ahead, we can expect major changes in how domiciliary care is delivered. By 2030, telecare may become standard in rural care packages; by 2040, the National Care and Support Service could be fully operational, offering consistent, high-quality care across Wales; by 2050, AI and robotics may supplement human carers in routine tasks; and by 2075, universal domiciliary care could be funded through devolved health and social care budgets. These predictions reflect a broader shift towards personalised, ethical, and community-rooted care.


Wales is uniquely positioned to lead the UK in reimagining domiciliary care. With strong policy foundations, a commitment to innovation, and a focus on social value, the country has the tools to build a sustainable and equitable care system. But success will depend on bold investment, workforce reform, and a shared vision across government, providers, and communities.

 

Sources

  1. Social Care Wales – Improving Care and Support at Home

  2. WeCare Wales – Home Care / Domiciliary Services

  3. Care Choices – Accessing Care Services in Wales

  4. Homecare.co.uk – Home Care Providers in Wales



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