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CQC State of Care Report highlights the fragility of adult social care

The latest CQC report on the State of adult social care 20-21makes grim reading for all those involved in the sector. Care homes have reported to the CQC that they face challenges as a result of decreased occupancy, reduced admissions, increased costs and difficulty recruiting and retaining staff.

Reduction of occupancy in care homes

There is evidence that the anxiety and fear caused by the pandemic and restrictions on visiting resulted in families choosing not to send relatives into care homes or take up home-care services. No doubt this was further exacerbated by horrendous stories in the media about the deathrate and the difficulty in controlling COVID-19 because of shortage of PPE.

Profit margins in care homes declined through October 2020 to March 2021 to the lowest level since the Market Oversight scheme began in 2015, including earlier in the pandemic.

Similarly, profitability per registered bed also declined to a three-year low in March 2021 for providers in the scheme. The CQC recognises that reduced profit means that providers have less cash to pay debts, build and refurbish homes and invest in quality improvement.

Decrease in privately funded beds

Non-specialist care homes have seen a decrease in the proportion of privately funded beds relative to those funded by local authorities or the NHS (from 46% in the quarter ending March 2020 to 41% in the quarter ending March 2021). This could have a long-term impact on the sustainability of those providers dependent on the higher level of private fees. Care home providers with a low proportion of self-funders saw occupancy fall nine percentage points from the quarter ending March 2020 to the quarter ending March 2021, whereas providers with a high proportion of self-funders saw occupancy fall 11 percentage points over the same period.

Home-care flexibility

There are signs from Market Oversight analysis that home-care providers had greater flexibility to respond to fluctuations in demand throughout the pandemic. This is seen through staff costs (as a proportion of turnover) reducing and generally being lower than previous years. Home-care providers in the Market Oversight scheme have seen stable or improved profit margins over the course of 2020/21.

Sustainability of adult social care providers

While extra funding from the new health and social care levy announced by the government in September 2021 will be welcome, substantial questions remain about the sustainability of adult social care providers. In the 2021 Spring survey by the Association Directors of Adult Social Service, 82% of directors reported that they were concerned about the sustainability of some of their home care providers, and 77% about some of their care home providers. One of the report’s key messages was that “COVID-19 short-term funding has helped to prevent failure but there is profound uncertainty about the future”.

Urgent action is needed to tackle staffing pressures and the stresses caused by staff shortages, and the long-term impact of emotional exhaustion of staff.

CQC Concerns

The CQC is concerned that vacancies in adult social care may increase further as hospitality and travel industries speed up recruitment and offer incentives to new staff. These industries can offer higher salaries than the care sector. Staff from adult social care may also take up vacant posts in hospitals – especially registered nurses. These influences, combined with the effects of the requirement for all care home workers to be vaccinated against COVID-19, may lead to more care staff leaving, unless a new deal for the care workforce is developed. This should consider recruitment and retention, training, pay and rewards, the professionalisation of the workforce, and workforce resilience.


The CQC State of adult social care report pulls no punches in highlighting the challenges faced by adult social care. Namely, decreased occupancy, reduced admissions, increased costs and difficulty recruiting and retaining staff. The situation could have been worse, if COVID-19 short-term funding had not been made available to address the pandemic.

The action proposed by the government in terms of a health and social care levy is a long way off and could be swallowed up by the NHS before its inception. Last weeks budget saw no mention of any additional ring-fenced funding for social care. Given the reported drop in profits by the operators of care homes, it is hardly likely that we will see new investment in care homes. Until the government come up with a practical costed plan the sustainability of social care will remain in question.

Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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