The Care Quality Commission (CQC) continues to struggle with its core regulatory responsibilities in the homecare sector, with performance deteriorating further since our August 2024 analysis. This follow-up report examines the CQC data from August 2025 and compares it with our previous findings to assess whether the regulator has made progress in addressing the significant backlogs and operational challenges we identified.
Key findings
- 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 If not, it will fall further behind each month, with the proportion of unrated or outdated services continuing to increase indefinitely.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.
Underlying issues
The deterioration in performance since our 2024 report suggests the CQC has not yet addressed the fundamental problems we identified:
- Throughput remains the binding constraint. Despite organisational changes and new frameworks, the volume of completed inspections has not increased sufficiently to match sector growth.
- Resource allocation has not kept pace with market expansion. The growth from approximately 9,100 registered locations in 2017/18 to 14,137 in 2025 continues to outstrip the CQC's capacity to inspect them within reasonable timeframes.
- Systemic capacity gaps persist. The composition of uninspected services shows that 77% of the backlog comprises providers registered between 2022- 2024, indicating this is not a temporary issue but a structural problem.
Recommendations
Building on our August 2024 recommendations, we propose urgent action in the following areas:
- Immediate capacity increases. The CQC must substantially increase inspection throughput, potentially requiring surge capacity and temporary measures to clear the growing backlog.
- Transparent performance monitoring. Publish monthly data on inspection completions, backlog reduction, and regional performance to enable proper oversight of progress.
- Risk-based triage system. Implement a two-tier approach with rapid safety assessments for never-inspected services, followed by full inspections within 24 months.
- Realistic resource assessment. Commission an independent review of the resources needed to maintain a three-year inspection cycle across the expanded market.
- Interim market support measures. Work with commissioners to develop alternative assurance mechanisms for providers awaiting inspection, preventing market distortion.
- Fee structure reform. Review the funding model to ensure adequate resources while maintaining fairness for providers of different sizes and risk profiles.
The evidence shows that the CQC's regulatory performance in homecare has not improved over the past year but has deteriorated. Without urgent intervention, the situation will continue to worsen, undermining public protection and market confidence in the sector.
