60% of community social care services have no or ‘outdated’ performance rating, analysis finds

Sixty per cent of community social care services in England have no or an ‘outdated’ performance rating, an analysis of Care Quality Commission (CQC) data has found.

Almost a quarter of home care, extra care, shared lives or supported living services (23%) had never been rated by the CQC as of June 2024, despite more than half of these having been registered with the regulator for more than 18 months at that point.

A further 37% of services had ratings that were four to eight years old, found the analysis by the Homecare Association, the representative body for domiciliary providers.

The association also found that 49.5% of residential services had a rating that was four to eight years old, though only 3.6% of these were unrated. It is possible that some of the findings are due to providers re-registering an existing service as a new location, making them appear as having not been inspected despite having received a relatively recent visit from the CQC.

However, the Homecare Association said its findings showed that the CQC was not inspecting enough services to ensure the quality and safety of social care.

CQC found ‘not fit for purpose’

The study echoes the damning findings of the interim report of a government-commissioned review of the regulator, published in July.

Dr Penny Dash found that an estimated one in five of the services CQC had the power to inspect had never received a rating and the average age of ratings was 3.7 years, while also criticising a lack of specialist inspection regime and the effectiveness of the regulator’s IT systems.

Her findings led health and social care secretary Wes Streeting to conclude that the regulator was “not fit for purpose”.

The Homecare Association’s analysis provides more detail than Dash’s interim report on the lack of inspections of social care services and the reasons behind this.

Huge increase in number of services

The association found there had been a 5.5-fold increase in the number of regulated community social care services from 2013 to 2024, from 2,303 to to 12,574.

However, over the same period, annual CQC expenditure only rose by a third, from £175m to £231.2m. As a result, its expenditure per registered location fell from about £7,700 in 2013-2014 to £4,400 in 2023-2024, while its number of staff per service dropped from 0.10 to 0.06.

The CQC operates a risk-based model of regulation, in which inspections are focused on those where there are greatest concerns about safety and quality.

The association found the regulator was identifying a greater number of under-performing providers, with the proportion of community social care providers rated requires improvement (the second lowest of the four ratings) increasing from 0.5% in 2017 to 26.3% in 2024.

However, it added: “A risk-based approach to regulation is fine, provided there is enough resource to reassess all providers. As the data show, 60% of all community care providers have no recent rating or no rating at all. Market intelligence suggests there are still too many poor quality providers operating undetected.”

Councils criticised for proliferation of services

But while the report was heavily critical of the regulator, the Homecare Association also took aim at councils for promoting a proliferation of home care services in their areas, making it harder for the CQC to effectively regulate the market.

It said authorities were spreading the home care hours they commissioned among multiple providers, with some contracting with about 200 organisations.

“By their own admission, they do not have the resources to monitor the quality of 200 providers in one local authority area. Neither does CQC. Spreading the hours across so many providers makes efficient deployment of the workforce difficult. It also makes it difficult for providers to be
financially efficient and sustainable since they cannot benefit from economies of scale.”

Among its recommendations, the association called on the government to commission “a realistic review of CQC’s resourcing needs” and to address the impact of local authority commissioning practices on care quality and market stability.

CQC ‘committed to increasing inspection numbers’

The study comes ahead of the final report from Dash’s review, due this autumn.

In a statement, the CQC’s interim chief executive, Kate Terroni, said: “We accept in full the findings and recommendations in the Penny Dash interim review, which identifies clear areas where improvement is urgently needed.

“Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong. We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.

“We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement. Alongside this we are working to improve how we’re using our new regulatory approach.

“We’re increasing the number of people working in registration and working to improve on current IT systems with involvement from providers and colleagues, so we can improve waiting times and deliver better outcomes for everyone.”