Quality and regulation of care providers

Who are the regulatory bodies in health and social care?

Each country in the UK has its own independent social care regulatory body, responsible for keeping a register of care providers. They are independent watchdogs that inspect the registered care providers to make sure the services they provide come up to scratch. By law, all care providers in the UK must provide services to minimum standards of safety and quality.

The four regulators in the UK are:

• In England: the Care Quality Commission (CQC) 
• In Northern Ireland: the Regulation and Quality Improvement Authority (RQIA)
• In Scotland: the Care Inspectorate
• In Wales: the Care Inspectorate Wales

What do the regulators monitor?

Each of the regulators sets minimum standards that someone receiving care should expect. These standards are documented and can be downloaded from the respective regulator’s website.

For example, the person being cared for should be: 

• treated politely and with dignity
• able to deal with their own finances and spend their money how they choose
• able to eat food prepared in line with their faith and to worship when and where they want to
• able to complain if they’re unhappy with their care.

What do the regulator’s inspections look at?

Regulators can inspect a care provider at any time. How often they are inspected depends on the rating they received at the last inspection, and the feedback given by care home residents, clients and local authorities. Generally, those providers with poor ratings or negative feedback will be inspected more frequently than those that are doing well.

Inspection reports

Following an inspection of a care provider, details of the findings are written into a report. These reports are publicly available – you can request a copy from the care provider or the regulator or find them on the regulators’ websites. We also link to the reports from our care services directory.

Care providers are legally obliged to display the results of their most recent inspection on their premises and website

Care inspections in England

In our directory, we publish the most recent CQC inspection ratings, which apply to five key questions:

1. Are they safe? You are protected from abuse and avoidable harm.
2. Are they effective? Your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence.
3. Are they caring? Staff treat you with compassion, kindness, dignity and respect.
4. Are they responsive to people’s needs? Services are organised so that they meet your needs.
5. Are they well led? The leadership, management and governance of the organisation make sure it’s providing high-quality care that’s based around your individual needs. It encourages learning and innovation, and it promotes an open and fair culture.

Each aspect is individually rated as:

• Outstanding: the service is performing exceptionally well
• Good: the service is performing well and meeting the CQC’s expectations
• Requires improvement: the service isn’t performing as well as it should and the CQC have told the service how it must improve
• Inadequate: the service is performing badly and the CQC have taken action against the person or organisation that runs it.
• Unavailable: used when the CQC hasn’t yet inspected a newly registered or re-registered provider.

An overall rating is also applied. Care providers are legally obliged to display the results of their most recent inspection on their premises and website, if they have one.

Care inspections in Scotland

In Scotland, new Health and Social Care Standards were introduced in 2018. They aim to ensure that individuals receiving care are treated with respect and dignity, and say that they should:

• experience high-quality care and support that is right for them
• be fully involved in all decisions about their care and support
• have confidence in the people who support and care for them
• have confidence in the organisation providing their care and support
• experience a high-quality environment if the organisation provides the premises.

A revised methodology for inspecting care providers is gradually being rolled out in Scotland. 

Under the original system, the Care Inspectorate awards grades to care providers for each of the following four areas.

1. Quality of care and support: how well the service meets the needs of each person who uses it.
2. Quality of environment: where the service is delivered; for example, how well maintained and accessible it is, the atmosphere of the service, how welcoming it is.
3. Quality of staffing: the quality of the staff, including their qualifications and training.
4. Quality of management and leadership: how the service is managed and how it develops to meet the needs of the people who use it.

As of early 2020, this framework was still in use for some Scottish care homes and most home care services. In our care services directory we list the most recent grades awarded to services in these four areas.

Under a new approach, services are graded according to five quality frameworks. This broadly adopts the four existing inspection categories (above) and adds a new question that asks how well a service supports people’s wellbeing. The new approach is now used for all new care home inspections

Each aspect is individually graded on a scale that ranges from from 1 (unsatisfactory) to 6 (excellent).

We’re unable to link to each provider’s inspection report from our directory, but there is a link to the Care Inspectorate’s ‘find a care service’ page for you to search further.

Inspections in Northern Ireland and Wales

The regulators in Northern Ireland and Wales are responsible for registering and inspecting care services, but they don’t award providers with ratings. Inspection reports can be downloaded from each of the regulators’ websites. You’ll find a link to the relevant website pages in our care services directory.