Unpaid caring – the hidden health inequality we can no longer ignore and why we must intervene to prevent ill-health in carers

Laura Greene, Head of Volunteering and Community Partnerships and Lead for Unpaid Carers at Kingston and Richmond NHS Foundation Trust, discusses the significant impact of caring and hospital discharge on carers’ health, provides insight on preventive health improvement programmes, and why adult social care directors are best placed to reframe caring as a determinant of health.

Unpaid caring is a social infrastructure, as important as housing, transport and paid care – but it is taking too much from the carers themselves.

More than 5.7 million people in the UK are unpaid carers (ONS 2021; Carers UK 2023). They are the invisible infrastructure of our health and care system, enabling people to live at home and reducing pressure on hospitals, GPs, and local authority services. Yet the evidence is clear: caring itself is risking the health of those who provide it. 

High-intensity caring – more than 50 hours per week – has risen by 260,000 carers in England since 2011 (ONS 2021). Those providing the most care are more likely to live in deprived areas and experience financial hardship. In public health terms, unpaid caring has all the hallmarks of a social determinant of health. Public Health England recognised this in 2021, but unlike poverty or poor housing, it is rarely treated as such in policy or practice. The English Longitudinal Study of Ageing (ELSA) even shows that intensive caring is associated with higher mortality and earlier disability for a carer. 

What the evidence tells us 

The health gap between carers and non-carers is consistent across datasets: 

• Mental health: 81% report increased stress and anxiety, and 77% say their mental health has worsened (Carers UK 2022). An ONS survey found 36% of carers feel lonely “often or always”, compared with 6% of the general population (ONS 2022). 

• Physical health: carers providing 50+ hours per week are twice as likely to report poor health compared with non-carers (Brimblecombe et al., 2018), while 43% say their physical health has worsened since taking on caring (Carers UK 2022). 

• Older carers: 1.5 million people aged 65+ provide unpaid care; most report strain, sleeplessness, and anxiety while managing their own long-term conditions (Age UK 2023). 

• Financial wellbeing: 1.2 million unpaid carers live in poverty, including 400,000 in deep poverty (JRF 2023). Caring disrupts employment and pension contributions, compounding health risks. 

Taken together, unpaid caring systematically erodes health and wellbeing. These are not incidental effects – they are predictable outcomes of prolonged, intensive caring. 

The missing piece: prevention 

Despite this, interventions that prevent ill-health among carers are almost non-existent. Support remains reactive: crisis respite, carer assessments, or benefits advice. 

Data capture is patchy. The Census records caring hours, and GP codes can flag carers, but health and care systems rarely translate this into proactive health offers such as NHS Health Checks, accelerated screening, vaccinations or social prescribing. Carers’ health remains invisible in routine monitoring. 

Why this matters for adult social care 

Adult social care depends on unpaid carers. Their contribution is estimated at £162 billion per year – equivalent to a second NHS (Buckner & Yeandle 2015; updated Carers UK 2021). Without them, services would face collapse under the weight of unmet need. 

But if caring predictably impacts carers’ health, then we are eroding the foundation on which the system rests. This is not only an issue of fairness – it is about sustainability. 

A carer in poor health is less able to continue caring, more likely to reach crisis, and more likely to need services themselves. Ignoring carers’ health in hospital discharge planning risks failed discharges or repeat admissions – with both patient and carer caught in a cycle of deterioration. 

What good looks like 

There are examples of practice that show what’s possible. At Kingston Hospital in South West London, the Carers’ Clinical Liaison Service supports around 1,500 unpaid carers a year accessing hospital services. Carer Clinical Liaison Practitioners co-produce support plans covering safe transitions of care, contingency planning, entitlements, and the health and wellbeing of an unpaid carer. Evaluation shows that when carers are supported in this way, the people they care for are 13% less likely to be re-admitted within six weeks of discharge. Carers’ confidence in decision-making rises by more than 50%. Despite this impact, such services are hard to fund and harder to scale. The evidence of what works exists but remains fragile and piecemeal. 

A call to action 

Directors of Adult Social Services are uniquely placed to reframe caring as a determinant of health and lead a system-wide response. That means: 

• Recognising carers as a priority group in population health strategies, alongside other inequality groups. 

• Embedding carers’ risk assessments into social care and discharge planning. 

• Offering proactive health checks for high-intensity carers, especially those aged 65+. 

• Providing targeted wellbeing support – mental health programmes, MSK/back care, sleep support and respite. 

• Embedding carer health metrics into ICS dashboards to make carers’ health visible. 

• Leveraging entitlements such as Carer’s Allowance to unlock wider financial and health support 

Why care for carers?  

Carers give their time, energy, and often their own health to hold up our health and care system. To continue lauding them as “unsung heroes” while ignoring their health inequalities is no longer tenable. 

Caring is not just a personal choice; it is a determinant of health. Recognising it as such, and investing in preventive interventions, is not a luxury. It is the only sustainable way to protect those who protect others 

References: Age UK (2023); Brimblecombe et al. (2018); Buckner & Yeandle (2015; Carers UK 2021 update); Carers UK (2022, 2023); Joseph Rowntree Foundation (2023); ONS (2021, 2022).