CQC ratings activity peaked in 2016 and fell steeply after 2019, shaped by austerity, the care home funding crisis, and the disruption of COVID-19. It dipped in 2020, recovered, then fell again when the Single Assessment Framework replaced routine ratings inspections with ongoing assessments in late 2023.

Ratings published for adult social care services, under either model, peaked at 15,620 in 2016, were still 12,834 in 2019, and held at about 4,700 to 5,800 a year from 2021 to 2023. They fell to 2,377 in 2024 as the new assessment model bedded in, then recovered to 3,310 in 2025 and 3,792 so far in 2026. The record is being refreshed again, but at a pace that would take about 9 years to cover the register once.

Of the 23,665 services that hold a current CQC overall rating, four in five (79.7%) are Good and 4.7% are Outstanding, a genuine achievement. But 15.6% sit below Good, a tail of some 3,685 services carrying significant human risk. Ratings made under the newer assessment model are less often Good: 23.9% of them are below Good, against 11.9% of those made by inspection.

Risk is not spread evenly. Nursing homes carry the highest below-Good rate at 19.9% and residential homes 16.5%, against 13.0% in home care: the settings serving the most medically complex residents are under the greatest quality pressure.

The inspection backlog is the defining regulatory challenge of the decade. With 51% of services not inspected or assessed in over five years, or never, and 39.2% of rated services holding a rating more than five years old, the ratings held on the CQC register are ageing proxies for a sector that has undergone profound structural change.

The CQC's Single Assessment Framework, launched in late 2023, was intended to modernise oversight. It replaced routine, comprehensive inspections with ongoing assessments, and 7,266 registered services (23.7%) now hold a rating made under the new model. Even so, 6,976 services (22.8%) carry no current rating of either kind.

CQC assesses all services against five key questions. "Caring" consistently returns the highest Good or Outstanding rate at 97%, reflecting that frontline workers maintain compassionate relationships even under severe systemic pressure.

"Well-led" records the lowest score at 79%, indicating that governance, leadership and organisational culture remain the sector's most persistent weakness. Among services rated below Good, 98.3% also carry a failing Well-led rating, a higher rate than any other domain.

AI analysis of the language in 2,829 inspection reports shows which themes recur in each rating band. Leadership and governance appear in every report at both ends of the scale, so their presence alone does not separate good providers from poor ones. Safeguarding and medication are almost as universal.

Dignity and respect separate the two groups most clearly: they are cited in 87% of Good and Outstanding reports and 32% of poor ones. Nutrition (43% against 18%) and infection control (63% against 39%) show the next largest gaps. 71% of the analysed reports are for services that have since deregistered, and most are below-Good reports, so the sample is not representative of the register today.

Reading the current ratings as a single spread shows the shape of the sector: a large middle of Good services (79.7%), a narrow band of Outstanding (4.7%), and 15.6% rated below Good.

That tail is where the human risk concentrates. Moving services out of it is overwhelmingly a question of leadership and governance — the domain that fails in almost every below-Good service.

Regional variation is real but not where it is usually assumed. The weak spot is the Midlands, not the North: 21.0% of rated services in the West Midlands and 19.0% in the East Midlands are below Good, the highest rates in England.

The North East is the strongest region at 7.4% below Good, and the South West is close behind at 10.4%. North and South perform almost identically overall, so the story is one of local commissioning and market conditions rather than a simple north-south divide.

Seventeen councils have more than a quarter of their rated services below Good. Norfolk is the largest of them, with 525 registered services and 29.4% of its rated services below Good.

Luton is the only council where more than a third of rated services are below Good (36.1%). Bexley (32.9%) and Medway (32.1%) come next. The CQC's data records ratings, not causes, so it cannot say why councils differ. Deprivation, the share of care that councils fund, and the fees they pay are the questions to test against it.