Quality and regulation of care providers

How are care providers regulated?

Each country in the UK has its own independent social care regulatory body, responsible for keeping a register of care homes and other care providers. They are independent watchdogs that make sure the services 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:

1. In England: the Care Quality Commission (CQC) 
2. In Northern Ireland: the Regulation and Quality Improvement Authority (RQIA)
3. In Scotland: the Care Inspectorate
4. In Wales: the Care Inspectorate Wales

What do the care 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 home or other 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. 

Care inspections in England

CQC inspection ratings are based on five key questions about the service:

1. Are they safe? You should be protected from abuse and avoidable harm.
2. Are they effective? Your care, treatment and support should achieve good outcomes, help you to maintain quality of life and be based on the best available evidence.
3. Are they caring? Staff should 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 must make sure it’s providing high-quality care that’s based around your individual needs.

The care provider will be rated on each of these questions, according to the following scale:

• 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

New Health and Social Care Standards were introduced in Scotland in 2018. They set out what people should expect when using health or social care services. The standards say that people should: 

• experience high-quality care and support that is right for them
• be fully involved in 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.

Since 2018 the Care Inspectorate has been gradually rolling out a new framework for inspecting care providers. Under this system, the regulator awards grades to care providers according to how well they measure up on on five key questions: 

1. How well do they support people’s wellbeing?
2. How good is their leadership?
3. How good is their staff team?
4. How good is the setting?
5. How well is care and support planned?

On each of these questions, the provider is graded on a six-point scale that ranges from 1 (unsatisfactory) to 6 (excellent).

Inspections in Northern Ireland and Wales

The regulators in Northern Ireland and Wales are responsible for registering and inspecting care services. The regulators don’t give providers a quality rating, but the inspection reports can be downloaded from each of the regulators’ websites. 

Should I worry about a care provider's rating?

If you’re choosing a care home or domiciliary care provider, it’s a good idea to read the service’s most recent inspection reports to help guide your decision. However, care inspection reports and ratings are just one part of the picture when it comes to choosing somewhere you’ll feel safe and well looked after. It’s just as important to base your choice on your own preferences and specific care needs.

A glowing report doesn’t necessarily mean it’ll be the right care provider for you. Likewise, if an inspection report has identified concerns about a specific provider, it doesn’t mean you should entirely write it off. However, it is a good opportunity to ask the provider what steps it has taken to address the concerns since the last inspection. 

For more guidance on how to pick the right care provider, and the key questions to ask, read our guides to choosing care services:

• Choosing a care home
• How to choose a home care agency

What if a care provider fails to meet the required standards?

If the regulator decides a care provider is not up to scratch and fails to meet the minimum standards, it will ask the failing service for an action plan for improvement and give it a deadline to make changes.

If the deadline is not met, the care regulator can give warnings, fines or even restrict the level of service the provider is able to offer. 

How to complain about a care provider

If you or a loved one experiences poor care, you have a right to speak up. First, you should raise your concerns directly with the provider, which might include making a formal complaint. Read our guide on how to complain about a care provider for more details. By law, every care provider must have an official channel for dealing with complaints.

If you’re not happy with the way your complaint was dealt with, you could log your concerns with the care regulator. Be aware that the regulator does not settle individual complaints, but letting them know can still be useful as it helps them decide where, when and what to inspect. In England, you can get in touch with the CQC via the feedback form on its website.