| 01 | Executive Summary | 3 |
| 02 | Inspection Timeline & Volume | 4 |
| 03 | Ratings Distribution | 5 |
| 04 | Ratings by Care Type | 6 |
| 05 | Inspection Gap Analysis | 7 |
| 06 | Five Key Questions | 8 |
| 07 | Concern & Strength Themes | 8 |
| 08 | Regional Variation | 9 |
| 09 | Local Authority Hotspots | 10 |
| 10 | Conclusions & Recommendations | 11 |
| 11 | Methodology & Data Sources | 12 |
This report was produced by Bridgehead Intelligence using the CQC Monitor platform (cqcmonitor.co.uk), which processes CQC open data on adult social care registrations and inspections across England. The dataset covers 65,339 registered locations and 16 years of inspection activity from Q1 2010 to Q3 2026. Quality percentages are calculated on the 32,538 services that hold a current published overall rating; inspection-recency percentages are calculated on all 65,339 registered locations. All analysis is based on publicly available data published by the Care Quality Commission. Figures represent the state of the register as of the extract date shown in the methodology section.
England's adult social care sector is facing a convergence of three structural failures: a post-COVID inspection backlog that has rendered the regulatory intelligence pipeline near-useless for the majority of the sector; a workforce crisis of historic severity; and a commissioning model that systematically underinvests in quality in the areas of greatest need. This analysis, drawing on 65,339 registered services and 16 years of CQC data, quantifies the scale of each failure and identifies the points of intervention that evidence suggests can produce sustained quality improvement.
The volume of newly published CQC ratings reveals a sector whose public quality record has stopped being refreshed. Publication peaked at 2,269 ratings in a single quarter in 2019, and 8,757 across that year. COVID interrupted the programme in 2020, and the Single Assessment Framework, introduced in late 2023, ended routine ratings inspections altogether.
Newly published rated inspections per quarter. The COVID interruption in 2020 and the Single Assessment Framework transition from late 2023 are the defining features. Publication fell from 633 in the first quarter of 2024 to single figures in every quarter since, and one rating in the whole of 2025.
Of the 32,538 services that hold a current published overall rating, 20.9% fall below Good, representing 6,799 services where the Care Quality Commission has concluded that minimum standards are not being met. A further 32,801 services, half the register, hold no current rating at all.
Breaking down ratings by care type reveals significantly different quality profiles across the three main service models — residential, nursing, and domiciliary care. Domiciliary care has overtaken residential care in Requires Improvement rates for the first time, a reversal of the historical pattern that points to accelerating quality deterioration in the home care sector.
Ratings distribution by care type, on the rated cohort. Nursing homes have both the highest Inadequate rate at 5.9% and the highest combined below-Good rate at 28.5%. Home care performs best on both measures.
The inspection gap analysis quantifies how far the sector has drifted from the CQC's own inspection frequency targets. Effectively the entire register is outside the CQC's 18-month target window, with only five services inspected in the past two years. For 32% of services, 21,020 in total, no inspection has ever taken place.
% of registered services by time since last inspection. Five services in the whole of England fall within the CQC's own 18-month target window.
| Gap Bucket | Services | % of Total |
|---|---|---|
| Never inspected | 21,020 | 32.2% |
| 5+ years ago | 32,230 | 49.3% |
| 3–5 years ago | 10,804 | 16.5% |
| 2–3 years ago | 1,280 | 2.0% |
| Within 2 years | 5 | 0.0% |
| TOTAL | 65,339 | 100% |
"Well-led" trails "Caring" by 19 percentage points — the largest domain gap in the dataset. Leadership quality is the strongest overall predictor of rating outcomes.
"Caring" consistently achieves the highest scores because frontline workers maintain compassionate relationships even under severe systemic pressure. This resilience is the sector's greatest asset and remains remarkably robust across all care types and regions.
"Well-led" records the lowest score because governance quality is the hardest thing to maintain under financial pressure, the last thing to recover after a leadership transition, and the most easily deprioritised when operational demands are acute.
Based on AI analysis of 2,829 inspection reports (2,410 below Good, 419 Good or Outstanding). The sample is weighted towards below-Good reports and is not representative of the register. Leadership and governance appears in effectively every report at both ends of the scale, so its presence alone does not distinguish good providers from poor ones. Dignity and respect is the clearest differentiator.
| Theme | RI/Inad (concern) | Good/Outst. (strength) | Differential |
|---|---|---|---|
| Leadership / governance | 100% | 100% | 0pp |
| Safeguarding | 94% | 100% | +6pp ▲ |
| Medication | 90% | 96% | +6pp ▲ |
| Risk management | 84% | 75% | 9pp |
| Training | 77% | 95% | +18pp ▲ |
| Care planning | 76% | 94% | +18pp ▲ |
| Dignity / respect | 32% | 87% | +55pp ▲ |
Regional variation is real but not where it is usually assumed. The weak spot is the Midlands, not London and not the North. 25.4% of rated services in the West Midlands and 23.8% in the East Midlands are below Good, the highest rates in England, against a national average of 20.9%. The North East is strongest at 14.4%, and London sits at 19.9%, below the national average. The best-to-worst gap is 11 percentage points.
National average is 20.9%. Bars show % of rated services below Good. No region exceeds 26%, and the best-to-worst spread is 11 percentage points.
Local authority-level analysis identifies the most acute concentrations of poor quality. The worst-performing areas share common characteristics: high deprivation indices, above-average reliance on publicly-funded care, below-average fee rates, and in many cases historical failures by the local authority itself to address market sustainability concerns before they reached crisis point.
| Local Authority | Below Good % | Risk |
|---|---|---|
| Walsall | 35.5% | |
| Medway | 34.8% | |
| Slough | 34.6% | |
| Luton | 34.3% | |
| Portsmouth | 34.3% | |
| Norfolk | 34.2% | |
| Bexley | 33.3% | |
| Wolverhampton | 33.0% |
| Local Authority | Below Good % | Status |
|---|---|---|
| Darlington | 5.8% | |
| Richmond upon Thames | 6.1% | |
| Bolton | 7.5% | |
| Wigan | 8.4% | |
| County Durham | 8.5% | |
| South Gloucestershire | 10.1% | |
| Westmorland & Furness | 10.4% | |
| Peterborough | 10.9% |
The data demands a systemic response. The convergence of inspection backlog, workforce crisis, and commissioning failure is not three separate problems — it is a single structural failure with three symptoms. Policy responses that address only one dimension will not produce sustained quality improvement. The following recommendations are grounded in the evidence and focus on the highest-leverage points for intervention.
Prioritise re-inspection of the 53,250 services never inspected or last inspected more than five years ago, starting with nursing homes in the Midlands, where the below-Good rate reaches 34.5%, and with the 21,020 services that have never been inspected at all. A triage model using self-reported data and automated risk-scoring could identify the highest-risk cohort within six months.
Establish a statutory minimum fee floor for adult social care, indexed to the real cost of care as calculated by LaingBuisson or equivalent. Areas below the floor should be required to produce a credible transition plan. The correlation between below-cost commissioning and poor quality outcomes is the strongest structural signal in this dataset.
Skills for Care puts sector vacancies at roughly 152,000, a figure outside this dataset but consistent with what inspection reports describe. It demands action beyond the current Skills for Care workforce strategy. Specific measures: sector-specific immigration fast-tracks, mandatory registration for senior care workers (creating a retention incentive), and a portable CPD framework that makes training investment transferable between employers. None of these require new primary legislation.
The Well-led gap is the highest-return intervention available. A ring-fenced leadership development fund — modelled on the NHS's Topol Programme — focused on RI and Inadequate providers in hotspot areas could directly address the domain where improvement has the highest multiplier effect on overall quality.
Mandate minimum 3-year contract terms for publicly-funded social care placements (currently ~60% of providers have contracts under 12 months). Short-term contracts are the single greatest driver of operational instability — they prevent workforce planning, training investment, and capital maintenance that are prerequisites of sustained quality.
The CQC's open data programme should be extended to include quarterly provider-level financial data (currently only collected, not published) and mandatory self-reported staffing metrics. Transparency creates accountability: markets and commissioners cannot price quality risk they cannot see.
All data in this report is sourced from the Care Quality Commission's open data publication via the CQC API (api.cqc.org.uk). The primary datasets used are:
Locations dataset: Registration data for all adult social care locations in England, including current rating, care type, local authority, region, and last inspection date. Extract date: 15 June 2026.
Inspections dataset: Historical inspection records including publication date, inspection type, and overall rating at time of inspection. Coverage: Q1 2010 – Q4 2025.
Analysis was conducted using the CQC Monitor platform (cqcmonitor.co.uk), built by Bridgehead Intelligence. The platform ingests the CQC API daily, processes and normalises location and inspection records into a structured Postgres database (Neon), and exposes analysis endpoints used in this report.
Chart data in Sections 2–9 is derived from live API calls at the time of publication. Where the platform's database has been used, figures are accurate as of 15 June 2026.
Scope: Adult social care services registered with CQC in England only. This includes residential care homes, nursing homes, domiciliary care agencies, supported living services, and extra care housing. NHS-run services are excluded.
Ratings currency: A key limitation of this analysis, and of CQC data generally, is that 81% of registered services have gone five years or more without an inspection or have never been inspected, and half the register holds no current rating at all. Figures for the proportion below Good should be treated as lower bounds of the true current quality distribution.
Local authority figures: LA-level analysis covers the 150 upper-tier and unitary authorities in England. City of London and Isles of Scilly are excluded due to insufficient provider counts.
Theme analysis: Report language analysis is based on keyword extraction from CQC inspection summaries, not full report text. Figures represent frequency of theme occurrence, not a clinical or regulatory assessment of significance.
Bridgehead Intelligence is the research and analytics division of Bridgehead Communications Ltd (Companies House #12736276). We build data-driven intelligence products for the public affairs, policy, and regulatory sectors.
Contact: intelligence@bridgeheadcommunications.com
Web: cqcmonitor.co.uk · bridgeheadcommunications.com