The areas where elderly residents pay thousands of pounds for substandard care

Thousands of England’s residential care homes are failing their elderly residents with the care they provide, analysis of the latest available Care Quality Commission (CQC) data shows. In six out of England’s nine regions, around a fifth of adult care homes are rated inadequate or requiring improvement, according to the most recent overall ratings by the CQC. Trade bodies representing care providers say many CQC ratings are years out of date, with thousands of homes carrying a rating from more than six years ago, including many rated inadequate or requiring improvement. Shorts These ratings, and a lack of consistency in the recording of them, are an emblem of the social care crisis that Andy Burnham has vowed to fix, industry leaders said. He has pledged to spend “political capital” reforming the sector after decades of deadlock from successive governments, with homeowners forced to sell their homes to pay for care. Days after entering No 10, the Prime Minister backed a National Care Service closely aligned with the NHS, with better pay and training for care workers, but is yet to give details on how it will be delivered or funded – but he has not ruled out tax rises to help pay for it. CQC, the health and social care regulator, assesses care homes under four ratings – outstanding, good, requires improvement, and inadequate. Outstanding signifies a service is performing exceptionally well, good that it is performing well and meeting CQC expectations, while requires improvement shows the service is not performing as well as it should and CQC have told it how to improve. An inadequate rating shows that the service is performing badly and CQC has taken action against the person or organisation that runs it. The i Paper‘s analysis of England’s 13,600 adult care homes found that in the West Midlands, 22 per cent of care homes had the CQCs lowest two ratings, followed by East England (20 per cent), the East Midlands (20 per cent) and the North West (20 per cent). In Yorkshire and the Humber, around 19 per cent of care homes were rated inadequate or require improvement, while in the South East the figure was about 18 per cent. For London as well as the South West, the figure was just over 10 per cent, while in the North East the figure was eight per cent. Just over 2,240 of the care homes analysed were assessed as requiring improvement, while 121 – less than one per cent – were rated inadequate. More than 10,600 care homes were rated good and 616 were rated outstanding. At local authority level, there was a wider disparity, with some areas containing more than 50 care homes having around 10 per cent rated inadequate or requiring improvement while others had up to 35 per cent with the same two ratings. Professor Martin Green, chief executive of Care England, urged caution into reading regional patterns into the figures, and said many care homes rated requires improvement or inadequate were last inspected four or more years ago. “Yet these are the very ratings being used to judge quality today,” he told The i Paper. “While the CQC is clearing a substantial inspection backlog, it has, for some time, had to prioritise homes where it has either already had concerns or received reason to investigate, so recent inspections are weighted towards the services thought to be most at risk and are more likely to return a poorer rating by design.” However, he added: “None of this dismisses genuine concerns about quality where they exist. Providers want a regulator that inspects regularly, reinspects promptly, and gives the public an accurate, current picture of the sector.” Patchy picture of care across the country Nasra Ahmed, chair of the National Care Association, which represents small to medium-sized care providers, said “it can’t be right” that some care homes were reporting to her that they hadn’t been inspected for seven years. “Those people may have had a required improvement, but they could be delivering outstanding care right now,” she said. “The ramifications are substantial. Because as soon as you get a requires improvement type of rating, the banks start looking at you, getting loans and things becomes more difficult.” She added: “I’ve been in homes that were requires improvement, and the residents are really happy and tell us they’re well cared for.” Some of the care homes were assessed under different CQC methods, with a Single Assessment Framework phased in from 2023 to replace the previous rating framework. The CQC advises that ratings produced under the previous inspection methodology should not be treated as directly comparable with SAF ratings. Chris Badger, chief inspector of adult social care and integrated care at CQC, said the regulator had completed more than 5,200 assessments across adult social care since April 2025, ahead of its end of September target, with 75 per cent more assessments per month than in March 2025. “While we might not inspect a care home for a period of time, we continuously monitor services so we can respond to issues that arise and focus our resources where the risk is highest,” he said. “We are also working to review services which have not been inspected for some time and provide updated ratings where appropriate.” He admitted there was more to do to provide a more accurate picture of the quality of care across the country, with the Prime Minister now putting the issue front and centre of his new administration. One in seven face care costs of more than £100,000 The economist Sir Andrew Dilnot, who chaired a 2011 commission proposing a lifetime cap of £35,000 for people’s care costs, described the current system as “terrible”, but welcomed Burnham’s intervention. “I’ve always felt that one of the prerequisites to getting something done is a prime minister who cares about it,” he told The i Paper. “He’s absolutely nailed his colors to this one. It’s going to be very embarrassing for the Prime Minister to go into the next election without a very clearly worked out set of plans for implementation.” He added: “For users, social care is the only big risk that we all face where there’s no risk pooling available.” Currently, people who live alone with assets of more than £23,250 must fund their care if they have to move into a home, with the value of their property included in a financial assessment of assets. Around one in seven face care costs of more than £100,000, with the website carehome.co.uk putting the average cost of self-funded dementia residential care in England at £1,343 per week rising to £1,599 per week in London. It means homeowners could see almost the entire value of their property swallowed up by care fees. Dilnot said: “I would argue strongly for two things. First of all, for funding the existing means-tested system properly, which we’re not doing at the moment, and secondly, for putting a cap in so that the worst of the catastrophic risk is pooled for everybody.” At least 22 major reviews, commissions and reports, including Dilnot’s, have been published on social care since 1997. As well as the impact on users and families, Dilnot pointed to millions of carers for whom the system “just doesn’t work”. He added: “Our health risks are completely pooled to the NHS. Our flat burning down or having a car crash is pooled through private insurance. “There’s no insurance here. There’s no risk pooling, and that does terrible things to people’s utility and anxiety. “If you are one of the minority that have very large care costs, then things go very badly.”