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The increasing acquisition of care homes for older adults in England by private companies poses a risk to the government’s goal of establishing a universal care service, according to the Care Quality Commission (CQC). Their latest annual report reveals a growing concentration in ownership within the care home sector, with the top five firms expanding their market share by 26% over the past two years. Much of this growth is linked to investments from US property companies, who together now hold about one in every seven care homes.
Although the consolidation of care homes under large companies may offer some advantages, concerns have been raised about its potential to drive up prices while diminishing the quality of care provided. The CQC emphasizes the need to keep a close watch on these developments. Contrastingly, the home care sector, which assists people with personal tasks such as washing and dressing within their own residences, has become much more fragmented and dominated by numerous smaller providers. The regulator points out that this fragmentation may lead to inefficiencies, noting that nearly one-third of home care services are supporting four or fewer clients.
Small care homes, which historically have been a very small portion of the overall care home market, have declined sharply over the past 14 years. This decrease is particularly marked among facilities offering combined nursing and care services, which have dropped by about 25%. The CQC also highlights ongoing fragility in the social care funding system, where individuals either pay for care themselves or rely on state assistance if they have limited means. Increasingly, some providers are focusing on attracting self-funders, posing challenges for local councils trying to secure care for people dependent on public funding.
Chris Badger, the CQC’s chief inspector of adult social care, observes that this market evolution has occurred “largely by accident rather than design,” influenced by economic pressures and difficulties councils face in purchasing services for people reliant on state-funded care. He welcomes the government’s renewed emphasis on social care, noting that its vision must center on what benefits individuals. “A clearer vision is needed,” he insists. Experts like Hugh Alderwick from the Health Foundation emphasize the severe challenges confronting the government, acknowledging the prime minister’s commitment to reform but stressing the immediate need to bolster core aspects such as council funding, workforce skills, and leadership. Meanwhile, Professor Martin Green of Care England points to the financial strains affecting smaller providers, warning that without meaningful funding improvements, the ongoing closures of small care homes are likely to persist. The Department of Health and Social Care recognizes the magnitude of these challenges but pledges to continue efforts to transform the social care landscape
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