New analysis: most care homes closed by industry regulator are run for-profit

A close-up image of a nurse and a patient holding hands.

A new analysis led by researchers at the University of Oxford and funded by the Nuffield Foundation has found that virtually all care homes forced to close in England by the Care Quality Commission are run on a for-profit basis. The results, published in The Lancet Healthy Longevity, raise questions about the role of the private sector in exacerbating the care sector’s ongoing crisis.

The study assessed the number of care homes which had been forced to close by the independent regulator of health and social care in England, the Care Quality Commission (CQC). This found that almost all involuntary closures since 2011 occurred in for-profit care homes: 804 out of 816 closures. This translates into one in 30 for-profit care homes having been closed involuntarily by the CQC during this time.

Co-author Dr Benjamin Goodair (Department of Social Policy and Intervention at the University of Oxford) said: ‘Social care services in England are on a knife-edge of a crisis: underfunded, understaffed, and struggling to supply the quality of care deserved by the most vulnerable people in society. However, this new data challenges the assumption that these pressures can be eased by outsourcing more social care to the for-profit sector. Instead, what is needed is a comprehensive assessment of the impact of for-profit provision on the quality and sustainability of adult social care in England.’

An involuntary closure is typically a last resort for care homes that have put their residents at risk, or whose care services have continuously failed to meet industry standards. However, 52 of the homes which had been forced to close had been rated as ‘good’ during their last CQC inspection. According to the researchers, this suggests that these homes posed urgent safety concerns, with residents at acute risk of harm. The researchers estimate that up to 20,000 residents were forced to relocate urgently due to enforced care home closures since 2011.

The results are particularly concerning given the increasing dominance of for-profit care homes in the sector: according to the CQC data, in September 2023 more than 85% of all care homes in England were operated by for-profit providers; in 2011, the figure was 78%.

Lead author Dr Anders Bach-Mortensen (Associate Professor at Roskilde University and senior researcher at the Department of Social Policy and Intervention at the University of Oxford) said: ‘Involuntary closures are currently absent from the debate on outsourced care. Although these are rare events, enforced closures typically involve serious regulation and safety breaches that can inflict substantial costs to both the local authority and residents in need of relocation. But most importantly, the neglect leading up to an enforced and acute closure can be traumatic and harmful for residents. To protect care users going forward, it should be a priority to investigate if there are systematic reasons for why these enforcements occur almost exclusively in private for-profit provision.’

The new results reinforce the findings of previous studies which found that care homes operating on a for-profit basis tend to deliver poorer care than third and public sector providers.

The analysis was based on data on enforced closures requested from the CQC and from the publicly available CQC data repository. Registered charities, council and NHS Trust care homes were considered as ‘not-for-profit’ or public, whilst all private companies, partnerships, and individual providers without a charity number were considered as ‘for profit.’

The UK is currently in the grip of a ‘care crisis’ with public funding failing to keep pace with rising needs, a situation worsened by the continuing cost of living crisis and rises in inflation. The CQC itself has raised concerns that the lack of a sustainable funding plan poses a serious risk to the sector and its most vulnerable residents. In Scotland, proposals to establish a ‘National Care Service’ – with adult social care overseen by regional boards rather than local authorities- have been pushed back to 2028-29.

The research was funded by the Nuffield Foundation.