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Best and worst areas for care home quality in england revealed in new research

Independent Age

4 min read Partner content

A stark variation in the quality of care homes at a regional and local authority level across England has been highlighted by new research.

The North West is the worst performing region in England when it comes to the proportion of satisfactory care homes, whilst London is the best performing region. In some areas such as Stockport or Salford, older people and their families face little choice of quality care, with 3 in 5 homes rated not good enough. That’s according to new analysis by Independent Age, the older people’s charity.

The key regional findings reveal:

  • The North West contains seven of the eight worst performing English local authorities on care home quality, with one in three care homes across the region performing poorly.
  • The North West (33.6% of care homes performing poorly), Yorkshire and The Humber (32.2%) and South East (28.2%) are the worst performing regions of England for care home quality.
  • London (20.3% of care homes performing poorly), the East of England (20.8%) and the South West (21.1%) are the best performing regions for care home quality.

The new analysis is based on CQC inspections of care homes which rate homes as either ‘Outstanding’, ‘Good’, ‘Requires improvement’ or ‘Inadequate’. The analysis regarded homes rated ‘Requires improvement’ or ‘Inadequate’ as being poor performers.

Performance at local authority level shows even greater variation. Five local authority areas have more than half of homes rated ‘Inadequate’ or ‘Requires improvement’:

  • Stockport – 62.9% of homes
  • Salford – 61.5%
  • Tameside – 54.8%
  • Manchester – 51.3%
  • Kensington and Chelsea – 50%

In contrast, five local authority areas have less than 5% of homes rated ‘Inadequate’ or ‘Requires improvement’, including three that have no care homes with those ratings:

  • Isles of Scilly, Islington and Rutland – 0%
  • Richmond upon Thames – 2.3%
  • Thurrock – 2.9%

And variation even within a single region can see older and disabled people living in neighbouring areas facing very different choices:

  • In Bury, which is in the North West, around 1 in 8 care homes in the local authority are rated ‘Inadequate’ or ‘Requires improvement’.
  • But in neighbouring Salford, older and disabled people are faced with far fewer choices of quality care, with 3 in 5 homes in the local authority rated ‘Inadequate’ or ‘Requires improvement’.

Commenting on the findings, Simon Bottery, Director of Policy at Independent Age, said:

“No one should be forced to live in an unsatisfactory care home but our analysis shows this is the grim reality in some parts of the country. The market is simply not providing a decent choice for older people and their families but there is little indication that local authorities or the government are giving the problem the attention it deserves. Money is likely to be one cause but not the only one. The government has an opportunity to address this in its upcoming Green Paper on social care but, in the meantime, councils must demonstrate that they understand the reasons for care home failures and are working to resolve them.”

Independent Age believes the drivers for care home quality variation includes factors such as low levels of funding by local authorities, low pay and difficulty recruiting staff, and the lack of a good support mechanism for improving care homes that are struggling. The care homes market is now valued at nearly £16 billion. However, social care is facing a £2.6billion funding gap by 2019/20.

In order to improve quality in the market, Independent Age makes the following recommendations:

  • The Government must seek to tackle variation in care home quality in their forthcoming Green Paper on social care.
  • In areas where there is a failure of quality, the Local Authority needs to understand the drivers for variation in the area and must do more to fulfil their Care Act duty to shape the local care market.
  • Drawing on CQC data, Department of Health must understand what drives regional variation and demonstrate leadership on tackling variation in care home quality.

The briefing ‘Care home performance across England’ is part of an Independent Age campaign to improve the quality of care homes available to older people.

Independent Age offer a free advice guide, ‘How to find the right care home’. The guide looks at what to consider and essential questions like location and cost, what you want from a home and whether a care home is actually the best option. The guide is available to download for free or to order at

Independent Age has developed eight new ‘Care Home Quality Indicators’ to assist local Healthwatch organisations with evaluating the quality of care homes in their area available at



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