CQC ratings activity since the programme's inception reveals a sector that has not returned to its pre-COVID pace. The busiest year was 2016, with 15,620 ratings published, and the busiest single quarter was the second of 2016, with 4,209. Publication was still 12,834 in 2019. The pandemic interrupted the programme in 2020, and publication has not approached those levels since.

The CQC's single assessment framework, launched in late 2023, replaced the routine ratings inspections with ongoing assessments. Published ratings fell from 5,502 in 2023 to 2,377 in 2024 as the new model bedded in, then recovered to 3,310 in 2025 and 3,792 so far in 2026.

Of the 23,665 services that hold a current CQC overall rating, four in five (79.7%) are Good and 4.7% are Outstanding. But 15.6% sit below Good, a cohort of 3,685 services carrying significant human risk.

Only 166 services now hold an Inadequate rating: services rarely stay registered once rated Inadequate. With 51% of the sector neither inspected nor assessed for five years or more, that snapshot is far from complete.

Rating profiles diverge by care type. Nursing homes have the highest below-Good rate, 19.9% of rated services, against 16.5% in residential homes. Nursing homes also have the highest Inadequate rate, at 1.0%.

Home care has the lowest below-Good rate, at 13.0%: a 12.4% Requires Improvement rate and 0.6% Inadequate. It is also the least inspected. 62% of home care services have not been inspected or assessed in five years, or ever, against 42% of residential homes and 35% of nursing homes.

The inspection backlog is not evenly distributed. Over a quarter of all registered services (29%) were last inspected or assessed over five years ago, and a further 22% have no inspection or assessment on record. That is 15,701 services, or 51% of the register.

CQC's methodology assumes that deteriorating services will be identified and escalated within 12 to 18 months. With only 4,994 services (16%) inspected or assessed in the past 18 months, the regulatory early warning system covers a minority of the sector.

CQC assesses all services against five key questions. "Caring" returns the highest Good or Outstanding rate at 97%, reflecting that frontline workers maintain compassionate relationships even under severe systemic pressure. This resilience is the sector's greatest asset.

"Well-led" records the lowest score at 79%, a 18 percentage point gap versus "Caring". In this dataset, 98.3% of services rated below Good are failing on Well-led, more than on any other question. It is also the hardest domain to improve through enforcement alone.

AI analysis of 2,829 inspection reports shows which themes recur in each rating band. Leadership and governance features in effectively every report at both ends of the scale, so its presence alone does not separate good providers from poor ones. Safeguarding and medication follow closely.

Dignity and respect is the clearest positive differentiator, cited in 87% of Good and Outstanding reports but only 32% of poor ones, a 55 point gap. Training and recruitment follow the same pattern. 71% of the 2,829 analysed reports are for services since deregistered, so the sample is weighted towards below-Good reports and is not representative of the whole register.

Regional variation is real, but not where it is usually assumed. The weak spot is the Midlands, not London and 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, with the South West close behind at 10.4%. London sits at 11.2%, below the national average. The three northern regions and the four southern ones perform almost identically, so the story is one of local commissioning and market conditions rather than a simple north-south divide.

Local authorities with the highest below-Good concentrations are measured among the 146 councils with at least 50 registered and 30 rated services. The areas of greatest need receive the lowest investment.

Luton, Bexley and Medway now top the list, each with about a third of rated services below Good, while Merton has none below Good. This dataset cannot say why councils differ. Commissioning reform including longer-term contracts and quality premiums is increasingly cited as a necessary complement.

England's adult social care sector is dominated by home care. Domiciliary services account for 51% of registered services, ahead of residential care homes at 34% and nursing homes at 15%, reflecting demographic and policy preferences for ageing in place over institutional settings.

Among the 23,665 services that hold a current rating, 3,685 are Requires Improvement or Inadequate. Only 4.7%, some 1,115 services, have achieved Outstanding, the ceiling of excellence that CQC rarely awards.

Quarterly publication activity since 2014 reveals the shape of the disruption and the recovery. The peak of 4,209 published ratings in a quarter, reached in the second quarter of 2016, has not been approached since. The 2020 trough marks the first interruption, and the late-2023 framework change began a second.

The CQC Monitor tracks this cadence in real time. Darker cells indicate higher publication density. The fall to 461 ratings in the second quarter of 2024, and the steady rise to 1,248 by the third quarter of 2026, are visible structural features of the regulatory dataset.

The best-performing local authority areas demonstrate that structural disadvantage is not destiny. Merton records no rated service below Good, and Gateshead and Hammersmith and Fulham are both under 3%, against a national average of 15.6%.

These areas share commissioning practices that diverge from the national norm: long-term block contracts that provide fee stability, active market stewardship, and investment in workforce development. The contrast with hotspot areas illustrates the policy levers available to commissioners.

Ratings outcomes dipped sharply after the pandemic and have since recovered. From 2015 to 2019, between 58% and 69% of the ratings published each year were Good or Outstanding. The share fell to 51.0% in 2021, the weakest year, and has climbed since: 59.2% in 2024, 63.5% in 2025 and 71.7% so far in 2026, the highest of any year.

Which services CQC chooses to rate shapes these figures: after 2020 it concentrated on higher-risk services, and ratings published since 2024 are almost all made under the assessment model. Of the 2,377 ratings published in 2024, 59.2% were Good or Outstanding and 40.8% were Requires Improvement or Inadequate.

The inspection backlog is structural, not regional. Every part of England is affected. The West Midlands tops the list with 60.2% of services either never inspected or assessed, or last inspected or assessed more than five years ago. Even the best-performing region, the North East, leaves 35.6% of its sector operating on outdated quality data.

This near-universal gap means commissioners across all regions are making funding and placement decisions on the basis of regulatory intelligence that predates COVID, the workforce crisis, and the cost-of-living squeeze on provider finances. The market intelligence failure is nationwide.

Nursing homes show the highest below-Good rate in 8 of the 9 regions, level with residential homes in the South West. The North West nursing sector records the highest RI/Inadequate rate, 24.9%, with the West Midlands at 24.7%, against 13.8% for nursing homes in the North East. This mirrors wider workforce and funding pressures concentrated in urban areas of the Midlands and North West.

Domiciliary care has the lowest below-Good rate in 7 of the 9 regions, but this may reflect inspection methodology gaps rather than genuine quality advantage. Home care's dispersed model makes it harder to detect non-compliance before harm occurs. The North East has the lowest rate for residential and domiciliary care, which reinforces the case for commissioning reform nationally.