Almost all the care homes shut down for endangering children or vulnerable adults were run to make a profit, according to a landmark study examining the long-term impact of outsourcing care to the private sector.
Research published last week by Oxford University reveals that 98% (804 out of 816) of the adult care homes closed by the Care Quality Commission (CQC) in England to protect disabled, mentally ill and elderly people from harm between 2011 and 2023 were operated by private companies. Only 12 homes were run by either local authorities or charities.
The researchers also found that just over 90% (48 out of 53) of children’s homes closed by Ofsted in England from 2014 to 2023 were run to make a profit. The watchdog only cancels the registration of providers if standards designed to protect children are being consistently flouted or if there is evidence children are being harmed. Only five were local authority or charity homes.
Anders Bach Mortensen, who led the research, said for-profit providers were severely overrepresented in forced-closure statistics in both adult and children’s social care. “Past research and reporting have shown that for-profit provision is often rated worse than public and third-sector provision, but it’s been unclear how this translates into practice,” he said.
“By tracking forced closures over the past decade, we’ve demonstrated that the strongest regulatory measure available to the CQC and Ofsted … is far more likely to occur in for-profit provision.”
Over the last two decades, care has been increasingly outsourced to the private sector, but the study still found a disproportionate number of businesses were stripped of their registration for serious breaches of standards. For-profit providers operated 82% of adult care homes and 79% of children’s homes during the period examined by the study.
Ben Goodair, a co-author of the research, said involuntary closures were the most extreme examples of care failure. “Forced closures are a last-resort intervention with severe consequences for residents. These closures often involve instances of severe neglect or abuse. They also incur substantial financial costs for local authorities, which are responsible for relocating residents,” he said.
The underlying data for the report, which has been shared with the Observer, shows that one company, Atlas Project Team, was ordered to close 14 care homes in 2012 – more than any other provider over the last 12 years. An adult safeguarding review in 2019 found that adults with learning disabilities, autism and mental health problems were subject to systemic neglect in homes run by the firm, which had pre-tax profits of £3m before it was dissolved. A police investigation identified 2,600 instances of seclusion, with some residents wrongly confined up to 400 times. Vulnerable people were left without food, drink, heating or access to toilets.
The study, which analysed millions of data points recorded by regulators, also found that the care market had led to a concentration of old people’s homes in affluent areas, where firms were more likely to attract wealthy self-funded residents, and a concentration of children’s homes in poorer areas, where companies could source cheap properties and generate higher profits.
The researchers note that these trends have left elderly people in deprived localities without enough care homes and have led to more vulnerable children being placed farther away from family and friends.
The Labour government has promised to create a national care service, but the party is no longer committed to providing the majority of care through the public sector, which was a manifesto pledge in 2019. Rachel Reeves cancelled a planned cap on social care costs in July as part of her effort to fill what she said was a £22bn black hole in the public finances.
A Department of Health spokesperson said it was tackling the significant challenges facing social care: “As part of this, we are also committed to building a national care service – underpinned by national standards and delivered locally – to improve the consistency of care and ensure everyone can live an independent and dignified life.”
