Last Updated on March 15, 2018

The quality of care homes got worse in one in five local authorities in the last year, new research on care home performance across England reveals.

The new analysis by Independent Age found that the proportion of care homes rated Inadequate or Requires Improvement increased in one in five local authority areas in 2017. It also identified that a dramatic variation in the quality of care homes at a regional and local authority level across England continues to exist. According to the analysis, the North West is the worst performing region when it comes to the proportion of satisfactory care homes, while London and the East of England are the best performing regions.

In some areas such as Tameside or Portsmouth, older people and their families continue to face little choice of quality care, with around one in two homes rated not good enough by the Care Quality Commission.

The main regional findings are:

• The North West contains five of the eight worst performing English local authorities on care home quality, with more than one in four care homes across the region performing poorly.
• The North West (28.2% of care homes performing poorly), Yorkshire and The Humber (26.1%) and the West Midlands (21.3%) are the worst performing regions of England for care home quality.
• London (17.4% of care homes performing poorly), the East of England (17.4%) and the East Midlands (18.2%) are the best performing regions for care home quality.

The analysis is based on CQC inspections of care homes which rate homes as either Outstanding, Good, Requires Improvement or Inadequate. The analysis regarded homes rated Requires Improvement or Inadequate as being poor performers.

In November, research by Which? found that a lack of quality care means some parts of the country have more than half of their care home beds in homes rated Requires Improvement or Inadequate.

Independent Age identified that performance at local authority level shows even greater variation. Seven local authority areas have more than two in five homes rated Inadequate or Requires Improvement:

1. Tameside – 56.8% of homes.
2. Portsmouth – 46.5%.
3. Kensington and Chelsea – 45.5%.
4. Manchester – 43.8%.
5. Bradford – 43.6%.
6. Stockport – 43.3%.
7. Trafford – 43.1%.

In contrast, eight local authority areas have less than 5% of homes rated Inadequate or Requires improvement, including five that have no care homes with those ratings:

• Bracknell Forest, Isles of Scilly, Reading, Rutland and Southwark – 0%.
• Thurrock – 3%.
• West Berkshire – 4.5%.
• Richmond-upon-Thames – 4.7%.

This research also provides, for the first time, a year-on-year comparison on care home performance across regions and local authorities in England.

Commenting on the findings, Janet Morrison, Chief Executive of Independent Age, said, 'Older people and their families are still facing an unenviable choice between poor care homes in some parts of the country. While it is encouraging that there has been an overall improvement in quality, this masks persistent variation in the quality of care homes within each region of the country. The market simply does not seem to be able to drive the rapid improvement needed in many areas. While the Government seems happy to deflect all decisions about social care into the vague promise of a Green Paper, local authorities are having to make difficult decisions now about care in their area.

'We urgently need both Government and local authorities to demonstrate that they understand the reasons for this variation and that they have the ability to address it.'

Independent Age believes the drivers for care home quality variation includes factors such as low levels of funding by local authorities, low pay and difficulty recruiting staff, and the lack of a good support mechanism for improving care homes that are struggling.

In order to improve quality in the market, Independent Age makes the following recommendations:

• The Government’s forthcoming Green Paper must not be restricted to narrow questions of social care funding and finance, but must also address questions of quality in the social care market.
• In areas where there is a failure of quality, the local authority must do more to fulfil their Care Act duty to shape the local care market.
• The Department of Health and Social Care must demonstrate leadership on tackling regional variation in care home quality.

The briefing Care Home Performance across England 2018 is part of an Independent Age campaign to improve the quality of care homes available to older people.