Key messages 

• ethnic minority workers are overrepresented in low-paid health and social care roles 

• recruitment and employment practices exposed workers to heightened insecurity during the pandemic 

• evidence points to institutional discrimination, harassment and bullying 

• gendered experiences shaped exposure to risk, workload and support 

• burnout and limited access to rewards or progression were widely reported. 

Policy implications 

• workforce policies should address institutional discrimination and unfair treatment 

• pay, progression and job security are central to workforce wellbeing 

• employers need clearer mechanisms to prevent harassment and to support staff 

• future pandemic planning should explicitly consider the experiences of low-paid and racialised workers. 

Gaps 

• most evidence focuses on England 

• limited analysis of differences across the UK nations 

• reliance on secondary sources constrains depth 

• longer-term workforce impacts are not fully explored. 

Commentary 

This rapid review brings together evidence on how the COVID-19 pandemic affected low-paid ethnic minority workers across health and social care. It highlights how existing vulnerabilities were intensified by crisis conditions, particularly in roles with high exposure and limited protection. 

The review shows that experiences of discrimination, insecurity and burnout were not incidental but shaped by structural features of the labour market. Gender, ethnicity and employment status intersected to influence who faced the greatest risks and least support during the pandemic. 

From a care equity point of view, the findings stress how inequities within the workforce translate into unequal burdens. Low-paid ethnic minority workers were more likely to experience poor treatment, limited progression and inadequate recognition, reflecting deeper imbalances in how care work is organised and valued. These conditions have implications for retention, morale and continuity of care. 

Overall, the review reinforces the need to treat workforce equity as a core component of health and social care resilience. Addressing discrimination, improving pay and creating fairer progression pathways are essential steps toward a more equitable and sustainable workforce beyond crisis contexts. 

Key messages 

• lockdown measures placed greater emphasis on the home as the main site of care, highlighting the role of housing conditions in supporting or limiting wellbeing 

• people living in smaller homes, overcrowded housing or without access to outdoor space experienced greater difficulties during lockdown 

• many households faced increased unpaid care responsibilities, including childcare, emotional support and support for older relatives during lockdown 

• the pandemic revealed how housing inequalities intersect with factors such as income, gender, disability and neighbourhood conditions to shape people’s ability to provide and receive care 

• housing conditions play an important role in people’s ability to care for themselves and others 

• the Covid-19 pandemic exposed existing social and housing inequities rather than creating entirely new ones 

• care is closely linked to the physical and social environment of the home and neighbourhood 

• inequalities in housing quality, security and affordability can affect people’s ability to provide and receive care 

• policy discussions about housing should recognise its role in supporting everyday care and wellbeing 

Policy implications 

• improve housing quality and space standards to support everyday care needs 

• strengthen housing security to reduce stress and instability for households providing care 

• recognise housing as part of the wider infrastructure supporting health and social care 

• consider neighbourhood facilities, green spaces and local services as part of care-supporting environments 

• integrate housing policy with health and social care planning 

Gaps 

• the article is a conceptual commentary and does not include large-scale quantitative analysis 

• evidence mainly reflects experiences during the early stages of the Covid-19 pandemic 

• further research is needed on how housing conditions influence long-term care provision and wellbeing 

• more evidence is required on how housing policies can reduce care-related inequities across different communities 

Commentary 

This commentary explores how the Covid-19 pandemic brought new attention to the role of the home in everyday care. During lockdowns, many people spent far more time at home than usual. This shift made housing conditions more visible as an important factor affecting wellbeing and the ability to provide care. 

Homes are often the main place where people care for themselves and others. Everyday activities such as cooking, resting, maintaining hygiene and supporting family members all take place within the home environment. When housing conditions are inadequate, these basic forms of care become more difficult. 

The pandemic highlighted how housing conditions vary widely across society. Some people had access to larger homes, gardens or nearby green space, which helped them cope with restrictions. Others lived in small or overcrowded homes, sometimes without outdoor space or with limited privacy. These differences shaped people’s experiences of lockdown. 

Housing conditions also interact with wider social factors such as income, gender and employment. For example, many households experienced increased unpaid care responsibilities during the pandemic, particularly childcare and support for relatives. People with fewer financial resources or insecure housing were often less able to manage these pressures. 

Neighbourhood environments also played a role. Access to local services, shops, parks and supportive communities influenced how easily people could maintain social connections and support networks during lockdown. 

From a health and social care equity perspective, the article highlights the importance of recognising housing as part of the wider infrastructure that supports care. Policies that improve housing quality, affordability and neighbourhood conditions may help strengthen people’s ability to care for themselves and others. 

Overall, the pandemic revealed how housing and care are deeply connected. Improving housing conditions and addressing structural housing inequities could play an important role in supporting wellbeing and strengthening care systems in the future. 

Key statistics 

• around 2 million non-decent homes in England are occupied by older people 

• non-decent homes make up 17% of the housing stock in England 

• the number of people aged 75+ living in non-decent homes increased from 533,000 in 2012 to 701,000 in 2017, a rise of 31% in five years 

• older properties are significantly more likely to fail housing quality standards, with 42% of homes built before 1919 failing the Decent Homes Standard 

• over 4.5 million people aged 50 and over provide unpaid care in England, with caring responsibilities increasing during the pandemic 

Key messages 

• housing conditions are closely linked to the health and wellbeing of older people 

• poor housing can contribute to respiratory illness, heart disease, mental health problems and increased risk of falls 

• the COVID-19 pandemic highlighted the central role of the home in protecting health, particularly during periods of lockdown 

• many older people live in homes that are unsuitable for ageing, including homes with hazards, poor heating or accessibility barriers 

• housing improvements and adaptations can support independence and reduce demand for health and social care services 

• unpaid carers play a critical role in supporting older people, but many experienced increased pressure during the pandemic 

• integrated policy approaches linking housing, health and social care are needed to support healthy ageing 

Policy implications 

• invest in large-scale programmes to improve housing quality and remove hazards in homes occupied by older people 

• expand funding for home adaptations and preventative housing improvements 

• integrate housing considerations into health and social care planning and policy frameworks 

• support services that help older people remain living safely in their homes 

• strengthen support for unpaid carers, particularly those providing care in unsuitable housing environments 

• use housing interventions as part of strategies to reduce health and social care demand 

Gaps 

• the report relies largely on existing evidence and policy analysis rather than new empirical research 

• limited analysis is provided on regional variation in housing conditions affecting older people 

• there is limited exploration of how housing inequities affect different socioeconomic or ethnic groups 

• more research is needed on the long-term health and social care outcomes of housing improvements 

Commentary 
This report examines how housing conditions affect the health, wellbeing and care needs of older people in England, particularly in the context of the COVID-19 pandemic. It highlights the central role that the home plays in supporting health and independence later in life. 

A key finding is that a large number of older people live in homes that do not meet acceptable housing standards. Around two million non-decent homes are occupied by older people, often containing hazards such as excess cold, poor repair or risks of falls. These housing conditions can contribute to a range of health problems including respiratory illness, heart disease and injury from accidents. 

The pandemic reinforced the importance of housing quality. During lockdowns, many older people spent almost all of their time at home, which intensified the effects of living in unsuitable or unhealthy housing. Poor housing conditions were associated with worsening physical health, mental health challenges and greater social isolation. 

Housing conditions also affect how health and social care systems function. For example, unsafe or inaccessible homes can delay hospital discharge, increase the risk of hospital readmission and make it more difficult for people to receive care at home. The report highlights the importance of home adaptations, such as grab rails, stair lifts and accessible bathrooms, which can help older people remain independent and reduce demand on health and social care services. 

Unpaid carers are another important part of this picture. Many carers experienced increased responsibilities during the pandemic as formal services were disrupted. Providing care in homes that are cold, unsafe or unsuitable can create additional strain for carers and increase risks for both carers and those receiving care. 

From a care equity perspective, housing conditions are unevenly distributed across society. Poor housing is more common among people with lower incomes and in disadvantaged areas. These housing inequities contribute to wider health inequities by increasing the risk of illness and reducing the ability of people to remain independent in later life. 

Overall, the report argues that improving housing conditions should be considered a core component of health and social care policy. Targeted investment in housing improvements and adaptations could support healthy ageing, reduce pressure on health and social care services and address wider inequities in health outcomes.

Key messages 

• low-paid health and social care workers felt deprioritised in national pandemic responses 

• participants perceived a strong policy focus on the NHS, with social care receiving less attention 

• frequent changes to COVID-19 guidance created frustration and uncertainty 

• low pay was seen as reinforcing a sense of undervaluation 

• workers described limited influence over decisions affecting their working conditions. 

Policy implications 

• crisis planning should explicitly include the social care workforce 

• clearer and more consistent guidance could reduce pressure on frontline staff 

• pay and employment conditions are central to workforce resilience 

• mechanisms to amplify care workers’ voices could improve policy responsiveness. 

Gaps 

• the study focuses on pandemic experiences only 

• findings are based on qualitative accounts 

• longer-term implications for workforce retention are not explored 

• perspectives beyond health and social care workers are not included. 

Commentary 
This study sheds light on how low-paid health and social care workers interpreted their place within the UK’s pandemic response. Participants described feeling overshadowed by a dominant focus on the NHS, with social care framed as secondary despite its central role. 

The rapid and repeated changes to guidance intensified workplace stress. For many workers, the lack of stability compounded existing frustrations linked to low pay and insecure conditions, shaping how they understood government priorities. 

In terms of care equity, the findings point to structural imbalances within the workforce. When social care workers are consistently positioned as lower priority, this reinforces inequalities between sectors and undermines the status of roles that are disproportionately occupied by women and people from marginalised backgrounds. These dynamics have implications not only for workers’ wellbeing, but also for the quality and continuity of care. 

Overall, the paper highlights how crises can magnify longstanding workforce inequities. Addressing pay, recognition and inclusion in decision-making is essential if social care workers are to be treated as equal partners within the health and care system, rather than an afterthought during periods of national pressure. 

Key messages 

• many health and social care workers reported poor mental health and wellbeing 

• burnout and emotional exhaustion were widespread 

• job insecurity and low pay contributed to stress and dissatisfaction 

• staffing shortages increased workload and pressure on remaining staff 

• workplace inclusivity influenced how workers experienced support during the pandemic. 

Policy implications 

• workforce wellbeing should be a central focus of recovery planning 

• addressing pay and staffing levels may reduce burnout 

• inclusive workplace cultures can support resilience 

• mental health support for staff remains essential beyond crisis periods. 

Gaps 

• the study focuses on experiences during the COVID-19 pandemic 

• challenges beyond the pandemic period are not directly examined 

• findings rely on self-reported experiences 

• longer-term workforce outcomes are not assessed. 

Commentary 
This study provides a detailed account of how the COVID-19 pandemic affected the working lives of health and social care staff. It documents high levels of burnout, declining mental wellbeing and the cumulative impact of sustained pressure during crisis conditions. Participants described how staffing shortages and job insecurity intensified workloads and reduced the capacity of services to meet demand. These pressures also affected morale and the ability of workers to provide the quality of care they aspired to deliver. 

From a care equity perspective, the findings highlight how workforce strain can deepen inequities within care systems. Workers in lower-paid or less secure roles faced greater exposure to stress and burnout, while service users experienced variable support depending on staffing levels and workforce stability. These dynamics risk reinforcing uneven experiences of care across settings. 

Overall, the study stresses the importance of workforce wellbeing as a foundation for equitable care. Addressing mental health, pay and staffing issues is essential not only for supporting workers, but for sustaining fair and reliable health and social care services in the longer term.