Last August, we reported that 60% of community social care providers had no CQC rating or an out-of-date CQC rating. Critical reports by Dr Penny Dash and Professor Sir Mike Richards recommended radical improvement. This August, we published updated analysis showing deterioration in CQC’s performance. Now, 70.3% of community social care providers lack a recent rating – 33.5% have no rating and 36.8% are four to 10 years old.
Uninspected locations surged by 64%, from 2,879 in June 2024 to 4,727 in August 2025. Community social care locations increased by 72% from 8,856 in 2018 to 15,232 today, yet inspections have not kept pace. At the current rate of 81 homecare inspections monthly, CQC needs 393 per month to maintain a three-year review cycle. The backlog grows by 312 locations monthly, or 424 if market expansion continues.
Market fragmentation exacerbates problems. According to Skills for Care, 43.5% of homecare providers have just one to four employees, with a further 17.2% having five to nine. Overall, 76% have fewer than 20. Only 11.3% have 50 or more, and 1.6% operate at a scale of 250 or more. This excludes 104,000 individual care workers operating as personal assistants.
Micro-providers with low-value contracts cannot invest adequately in training, supervision, governance systems or competitive employment terms. Nor can CQC inspect over 15,000 locations regularly. Fragmentation also undermines Government’s neighbourhood health and digital transformation agendas.
The 10 Year Health Plan calls for shifts from hospital to community, sickness to prevention, analogue to digital and fragmentation to integration in neighbourhood teams. This requires collaboration between care providers, primary care, public health and community health services. It is hard to maintain effective relationships, co-ordinate care pathways and share information with hundreds of neighbourhood micro-providers.
Technology solutions to improve quality, efficiency and outcomes – digital care records, remote monitoring, predictive analytics and integrated data systems – are hard to implement at scale across a hyper-fragmented market. Each requires individual system integration, data sharing agreements and technical support; the transaction costs become prohibitive.
If Government is to realise its vision for quality, integrated care and fair employment, the market must reshape. In some areas, local authorities are letting homecare contracts of 1,500 to 3,000 hours per provider within a neighbourhood at fair fee rates. This provides sufficient scale for providers to invest in care teams, deliver efficient, high-quality services, be members of neighbourhood teams and implement technology solutions. It maintains manageable travel distances and compact rotas, allowing shift-based pay, whilst enabling effective oversight and regulation.
CQC could help by raising registration standards. Too many applicants lack understanding of the legislative framework governing homecare or fundamental business management capabilities. CQC should require applicants to show comprehensive knowledge of all relevant employment, health, care and safety legislation. Applicants should also prove they understand financial management, workforce planning and operational systems. Charging upfront registration fees that reflect thorough assessment costs would ensure only serious, well-prepared providers enter the market.
CQC must streamline inspection processes, increase administrative support and publish transparent monthly data on inspection completions, backlog reduction and regional performance. CQC must aim to reduce uninspected locations by at least 50% within 18 months and conduct rapid safety assessments for never-inspected services within 12 months, followed by comprehensive inspections within 24 months. Ensuring enough high-quality providers to meet demand, removing unsafe operators and encouraging innovation are essential foundations for a National Care Service.
Dr Jane Townson OBE is Chief Executive Officer at the Homecare Association. Email: [email protected] X: @homecareassn