Effective regulation is vital to safeguard the wellbeing and rights of those who rely on services and maintain public trust in care. Complexity of need and demand for homecare is increasing. Never has it been more important to ensure effective oversight of quality and safety of care services.
Despite paying substantial regulatory fees, homecare providers feel neglected by the CQC. Their dissatisfaction has grown since the pandemic, when CQC gave low priority to homecare. To explore the issues, we studied CQC data from 2013 to June 2024, including annual reports and accounts, and gathered feedback from homecare providers. Our recent report paints a picture of a regulator struggling to fulfil core responsibilities.
Over the past decade, the social care landscape has transformed dramatically. The number of registered locations has increased almost two-fold to a staggering 12,574 in June 2024. A corresponding increase in CQC resources has not occurred, leading to CQC staff numbers per registered location across all health and social care services nearly halving, causing a significant dilution of regulatory oversight.
Alarmingly, 60% of community care providers had either never been rated by CQC (23%) or had a rating four to eight years old as of June 2024 (37%). For most homecare providers, this means CQC ratings are non-existent or woefully out of date.
Providers also complain about long delays in registration; inconsistent and flawed inspection methods; and difficulties communicating with the CQC. Local councils, unable to rely on CQC data for homecare tender processes, face hard choices. Some have resorted to contracting with unassessed and unrated providers. Others are disqualifying providers without ratings or with outdated ratings from bidding for work.
CQC has adopted a risk-based approach to inspection and is focusing on underperforming providers. The proportion of locations rated ‘Requires improvement’ has surged from 0.5% in 2017 to 26.3% in 2024. Residential care has shown a similar trend, with the proportion of locations rated ‘Requires improvement’ rising from near 0% in 2017 to about 33% in 2024. Despite this, there are still poorly performing providers operating, and some go undetected because of the CQC’s limited capacity for monitoring and inspections.
The CQC’s struggles have extensive repercussions. People drawing on services face more risks, and providers are experiencing harm. Delays in registration and ratings are causing severe financial problems for providers. Several underlying issues contribute to the CQC’s problems. Many councils have encouraged the proliferation of small homecare providers. About 87% of homecare providers have fewer than 50 employees, with 53% having fewer than 10. This fragmentation of the sector has compounded the CQC’s workload.
Other factors include flaws in the CQC’s funding model and fee structure; ineffective IT systems despite significant capital investment; and misalignment between CQC and local authority practices. The pandemic exacerbated these issues but is not their root cause.
To address these challenges, our report made several recommendations. These included commissioning a realistic review of the CQC’s resourcing needs; increasing transparency in operational costs and performance; reviewing the funding model, improving IT and data systems; and enhancing engagement with providers. We also called for improvements to CQC’s assessment of local authority commissioning.
Policymakers must recognise the interconnections between regulation, commissioning, funding and quality care provision. The CQC cannot succeed in isolation or without adequate resources. Effective regulation depends on intelligent market shaping, sufficient human resources, robust systems and the flexibility to adapt.
What is your experience of the CQC? What do you think could be improved? Leave a comment on this article or join the conversation to share your thoughts.
Dr Jane Townson OBE is Chief Executive Officer at the Homecare Association.
Email: [email protected] X: @homecareassn