New research finds outsourcing care homes in England disproportionately disadvantages poorer areas

Outsourcing care homes has compromised the accessibility and quality of care for the most vulnerable, particularly in areas of greatest deprivation, according to new research led by the Department of Social Policy and Intervention at Oxford University. The results, published in BMJ Public Health, raise questions about the role of the private for-profit sector in exacerbating the care sector's ongoing crisis.

The impact of the outsourcing of vital care services to the private sector on the growth and survival of care homes was previously unclear. The research is the first longitudinal study of care home closures in England that uses complete data on all care home closures, including inspection ratings.

The analysis shows that the shift towards for-profit provision is not explained by care quality. The results suggest that third sector and local authority homes are consistently rated better than for-profit homes by the industry regulator (the CQC) but are 1.6 and 1.8 times more likely to have closed compared to for-profit provision.

Lead author Dr. Anders Bach-Mortensen (Associate Professor at Roskilde University and Senior Researcher at the Department of Social Policy and Intervention at the University of Oxford) said, "Good third sector and local authority homes are closing, especially in the poorest areas of the country.

"This is problematic because for-profit care homes do not consistently provide high-quality care in deprived areas, which raises serious questions about whether outsourcing care services has inadvertently compromised the equity and accessibility of care for vulnerable people."

Co-author Dr. Benjamin Goodair (Department of Social Policy and Intervention at the University of Oxford) said, "This study aims to contribute to the growing body of work relating to the number of social care services being outsourced to for-profit and non-profit sector providers over the past 30 years. The data suggest that the competitive environment created by outsourcing does not prioritize quality or equity in care provision."

The challenges highlighted by the CQC, interest groups, and other regulators, underscore the need for a comprehensive approach to support these essential services, ensuring they can continue to provide high-quality care, especially in the most deprived areas. Addressing these challenges will require coordinated efforts from policymakers, funding bodies, and the care sector to create a more resilient and equitable system.

The analysis was based on data on enforced closures requested by the CQC and the publicly available CQC data repository. Registered charities, councils, and NHS Trust care homes were considered "not-for-profit" or public, while all private companies, partnerships, and individual providers without a charity number were considered "for-profit."