The key facts
- The five largest companies own roughly one in seven care homes in England, with their share up 26% over two years.
- The CQC calls the funding system fragile: providers increasingly target self-paying clients at the expense of council-commissioned care.
- Over 14 years, the number of small homes combining care with nursing support has fallen by a quarter.
Consolidation under the regulator's watch
The Care Quality Commission (CQC) warns in its annual report that the buy-up of care homes for older people in England by large private companies could hinder the government's ambitions to create a universal care service. According to the regulator, the five largest firms have increased their market share by 26% over the past two years, aided by the interest of American real estate investors; together they own roughly one in seven homes. The CQC notes the trend may have benefits, but there are concerns it could lead to price rises and lower quality of care — which, in the regulator's view, needs to be monitored.
Fragmentation of home care and the decline of small homes
The home care sector — help with washing and dressing at home — has become more fragmented: the number of small providers is growing, and nearly a third of these services serve four or fewer people, which the CQC estimates creates inefficiency. Meanwhile, small care homes, which the regulator considers important for specialised and personalised care, are becoming fewer: over the past 14 years their number has fallen markedly, especially those combining care with nursing support — down by a quarter.
A fragile funding system
The CQC characterises the funding system as fragile: services are paid for either by users themselves or, for the least well-off, by the state. In some areas, providers increasingly target self-paying clients, making it harder for councils to commission care for those relying on state support. The CQC's chief inspector of adult social care, Chris Badger, said the reshaping of the market is happening 'mostly by accident rather than by design' — driven by economic pressures and councils' problems with commissioning services. He welcomed the government's renewed attention to social care — the prime minister, Andy Burnham, has made it one of his key priorities — but stressed that the market must be shaped 'around what is best for people' and that 'a clearer vision is needed'.
Reactions from experts, the sector and the department
Hugh Alderwick of the Health Foundation think tank said the CQC report 'lays bare the enormous problems' facing the government, and that the prime minister's pledge to reform the sector offers a chance to redefine the state's commitments in social care, but changes are needed now: councils need sufficient funding, the right skills and strong leadership. Professor Martin Green of Care England, which represents care providers, urged the government and regulators, if concerned about consolidation, to take concrete measures to support small care homes: in his words, changes to employer national insurance contributions, inflation and rising energy prices are making small homes unviable, and without progress on funding the closure of small homes will continue. The Department of Health and Social Care said the report demonstrates 'the scale of the problems inherited by this government' but confirmed its commitment to reforming social care.
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