CQC’S Homecare Regulation Deteriorates Further As Inspection Backlog Grows

A new Homecare Association report warns that the Care Quality Commission’s (CQC) regulation of homecare has worsened in the past 12 months. The new analysis reveals over 70% of homecare providers lack current ratings, with the situation worsening since the Association’s 2024 report.

The Homecare Association said its report showed that people with complex needs were at risk from “unsafe, poor-quality care” and that good providers were being squeezed out of the market by “cheap, unrated competitors”.

The report, CQC regulatory performance in homecare one year on, reveals that 70.3% of community social care providers now have either never been rated by the CQC (33.5%) or have ratings that are four-eight plus years old (36.8%). This represents a worsening from the 60% reported in the Association’s August 2024 analysis.

• Performance has worsened rather than improved. As of August 2025, 70.3% of community social care providers had either never been rated by the CQC (33.5%) or had a rating of 4 to 8+ years old (36.8%). This represents a deterioration from the 60% we reported in 2024, when 23% had never been inspected and 37% had ratings 4 to 8+ years old.
• The inspection backlog has grown substantially. The number of registered community social care locations increased from 12,574 in June 2024 to 14,137 in August 2025. More concerning, the number of uninspected locations rose by 64%, from 2,879 to 4,727 over this period.
• The scale of the challenge is now greater. We calculate 9933 locations currently lack a recent rating (uninspected plus those with ratings 4+ years old). At current inspection rates (1052 homecare inspections over 13 months = 81 per month), the backlog would never be cleared and is growing by about 312 locations every month, assuming no increase in locations. If growth of locations continues at the same rate of c. 112 per month, the backlog will increase by 424 per month. Today, only 29.7% of homecare locations have up-to-date CQC ratings. At the current inspection pace, that falls to 22% by 2030 and 21% by 2035 (assuming no market growth). If the market keeps expanding, coverage drops to 15% by 2030 and c.11% by 2035 – meaning almost nine in ten services will lack a current, independent quality assessment. CQC must increase throughput by 5× just to stop inspection coverage from deteriorating, and by 8-14× to clear the backlog within 3-12 months while maintaining a 3-year review cycle. If not, it will fall further behind each month, with the proportion of unrated or outdated services continuing to increase indefinitely.
• The CQC’s risk-based approach continues to identify underperforming providers. However, the fundamental problem remains: too few assessments are being conducted to provide adequate assurance on quality and safety across the sector.
• The impact on providers and people needing care has intensified. People continue to be at risk of harm from unsafe and poor-quality home-based care and support, which goes undetected. Councils continue to struggle with procurement decisions when a third of potential providers lack current ratings. Some are contracting with unrated providers, which is a risk, whilst others exclude them, leading to commercial detriment and market distortions.

Research analysed over 1,000 inspection reports from homecare providers across a 13-month period spanning 2024-2025. The findings demonstrated that regulatory assessments effectively distinguish service quality levels when conducted – ranging from exemplary providers delivering personalized, empathetic care to failing services exhibiting critical deficiencies in safety protocols and organizational oversight.

The data highlights ongoing challenges for local authorities in procurement processes, as approximately one-third of potential service providers operate without current quality ratings. This regulatory gap forces commissioners into difficult positions: some authorities accept contracts with unassessed providers despite inherent risks, while others implement exclusionary policies that may inadvertently prevent quality providers from participating in the market, ultimately disrupting competitive balance.

Commenting on the new analysis, Dr Jane Townson OBE, Chief Executive of the Homecare Association, said,
‘One year on, the picture is stark – the CQC is falling further behind in regulating homecare. People relying on care at home, their families and councils commissioning services cannot make safe, informed choices when most providers have no current rating and good providers are being squeezed out of the market in some places by cheap, unrated competitors.

‘The CQC must increase inspection throughput at least fivefold just to prevent coverage declining further – and by 8 to 14 times to clear the backlog quickly while maintaining a three-year review cycle.

‘Evidence shows that when CQC inspections do take place, they identify important quality differences – from excellent services that ‘go above and beyond’ to those with serious safety failings. This makes the current inspection gaps even more concerning for public protection.

‘At current rates, we are heading towards a future where 9 in 10 homecare services will lack a current quality rating. This is simply unacceptable for a sector supporting hundreds of thousands of people with complex needs who are at risk of harm from unsafe, poor-quality care. Urgent intervention is needed before the situation deteriorates beyond repair.’

The report makes recommendations for urgent action, including implementing surge capacity to clear the backlog and conducting an independent review of resources needed for effective regulation.

The analysis follows the Government’s ongoing review into the CQC’s operational effectiveness, led by Dr Penny Dash, which published a final report in October 2024 highlighting similar concerns about poor operational performance and IT system challenges.