Alarm at failure to inspect 60% of England homecare providers in four years or longer

Care leaders have warned of a serious safety risk as research revealed 60% of homecare providers had not been inspected for at least four years, or ever.

As the government prepares to receive a report on profound failings at its Care Quality Commission (CQC) that triggered the chief executive’s removal this summer and a public apology, the Homecare Association warned 37% of providers of domiciliary care services had not been rated for at least four years and 23% had never been rated.

Inspectors are supposed to check staff are caring, properly trained and not harming the vulnerable people they look after.

Dr Jane Townson, the chief executive of the Homecare Association, whose members look after about 800,000 people in England in their own homes, said: “Insufficient inspections are jeopardising service quality, safety and public confidence.

“The state of homecare regulation in England is like a ship taking on water, with a crew using buckets instead of pumps to bail it out. People relying on care services are at risk of being left adrift.”

Labour says it wants to increase the amount and quality of care provided to people at home as part of its manifesto goal to move the NHS to more of a “neighbourhood health service, with more care delivered in local communities to spot problems earlier”.

The depth of the problems has created an uneven playing field, where some councils are awarding public contracts to providers that have not been assessed or rated. Others are disallowing providers without ratings and causing some to go out of business, the Homecare Association said.

It said a lack of inspectors to cover a fivefold growth in the number of small domiciliary care providers over the last decade and ineffective leadership at CQC were among the causes of the crisis.

Ian Trenholm stood down as chief executive of CQC in July after serious problems with a new IT system and complaints from Care England, which represents large private care home chains, about “CQC’s overreliance on outdated data, the lack of transparency in their regulatory approach and vast inconsistencies between assessments”.

In May, the Cabinet Office and the Department of Health and Social Care commissioned a wide-ranging independent review of CQC’s effectiveness, led by Dr Penny Dash, the chair of the NHS North West London integrated care board and a former partner with McKinsey, which is expected to report back in the coming weeks.

An interim report in July found “significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality – and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much-needed improvements in care”.

Care Rights UK, which represents care users and their families, said its advice line was hearing the same concerns. Its helpline and programmes manager, Emma Williams, said: “CQC’s insistence on continually reducing inspections is in ignorance to an increasingly struggling sector.

“The failure to inspect care homes has left people baffled as to where to find good care, and despairing when turning to the regulator with serious concerns.”

The Homecare Association’s figures on the number of providers that have not been inspected for years or ever were complied by analysing CQC data from 2010 to June 2024. A survey of 75 homecare providers found more than three-quarters were dissatisfied with the CQC, with issues including inspectors not answering emails for months and in one case “bullying tactics”.

Kate Terroni, the interim chief executive of CQC, said the regulator was working “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,” she said, adding it was increasing the number of people working in registration and working to improve on current IT systems “so we can improve waiting times and deliver better outcomes for everyone”.