Care homes in the United Kingdom

The regulatory laws applicable to the operation of care homes differ across the four jurisdictions that make up the United Kingdom. Broadly speaking, the legislation will set out which regulatory body the service provider is obliged to register with before the care home can legally operate. Accompanying regulations and guidance will also set out the standards and requirements which the service provider must continue to meet in operating a care home. Key legislation includes, but is not limited to, the Health and Social Care Act 2008 (England), the Regulation and Inspection of Social Care (Wales) Act 2016, the Public Services Reform (Scotland) Act 2010 and the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003.

As healthcare is increasingly delivered remotely, regulators are seeking to adapt. Rather than requiring a care home operator to have a presence in the local jurisdiction, regulators are focusing on the country in which the regulated activity is taking place. Care home operators are likely to require registration with the relevant healthcare regulatory body in the jurisdiction in which the care is being provided.

No. Operators run their businesses through standard corporate vehicles. The investors in the operator business may dictate whether or not a nominated individual and / or registered manager is required for care services eg. the Care Quality Commission in England requires service providers who are corporate organisations to appoint a nominated individual, but this is not a requirement for service providers who are a partnership.

Within the UK, the relevant regulatory body according to jurisdiction will routinely undertake inspections of service providers to monitor how well they are meeting the required regulations and standards. During inspections, care homes will be evaluated against a specific framework and will be given feedback. If any breaches of regulations and standards are identified, the regulatory body will often work with providers to help them to improve. The regulatory body has the legislative authority to take regulatory action against the service provider for any material breaches which could include suspending or cancelling the service provider’s registration, and preventing the care home from providing care to service users (either temporarily or permanently).

Yes, the providers of the care home must register with the appropriate regulatory body according to jurisdiction. These are the Care Quality Commission (England), the Care Inspectorate Wales (Wales), the Care Inspectorate Scotland (Scotland) and the Regulation and Quality Improvement Authority (Northern Ireland).

No, it will depend on the care home’s CQC registration, and the business use of the home as regulated by the Town & Country Planning Use Classes Order. From a regulatory perspective, care home providers must ensure that they only provide activities which are in keeping with the terms of their regulatory registration. During the process of registration, the provider will be asked about the type of activity they intend to provide and to how many service users, amongst other queries. The registration will then be granted on this basis and the provider must ensure they operate within the confines of the registration.

No.

Care Home individual clients are means tested on admission by their Local Authority. Currently, if the client has more capital than £23,350 in England, £28,000 in Scotland or £50,000 in Wales, they will be responsible for paying their own care costs. People with capital less than £14,250 in England, £17,500 in Scotland or £50,000 in Wales, will have their fees funded in full by the Local Authority and in nominated care homes.

Yes – the Care Quality Commission (England), the Care Inspectorate Wales (Wales), the Care Inspectorate Scotland (Scotland) and the Regulation and Quality Improvement Authority (Northern Ireland).

67,610,000. (source: UK Gov)

17.75% (source: UK Gov)

15,600

 There is not a UK wide waiting list, but individual homes may have waiting lists.

The four jurisdictions of the United Kingdom (England, Scotland, Wales and Northern Ireland) have different regimes in place to regulate and monitor the safety and quality of healthcare and social care/care home services. Although the overarching aims and objectives are very similar, each regulator’s processes and procedures are nuanced and in practice dealings with them can be varied. The regulators are as follows:

1. England

The Care Quality Commission (“CQC”) regulate all private healthcare and adult social care services based in England. The CQC ensure the quality and safety of care provided by services that deliver ‘regulated activities’ (for example, personal care or treatment of disease, disorder or injury). The CQC are responsible for:

• Granting registration to health and adult social care providers.
• Monitoring compliance with statutory requirements for healthcare and adult social care providers.
• Carrying out onsite inspections (both announced and unannounced), awarding a rating and publishing reports on findings.
• Taking action for non-compliance (for example, issuing warnings or cancelling registration).
• Conducting investigations in response to concerns and complaints. 
• In the most serious cases, the CQC can prosecute service providers using both civil and criminal sanctions.

2. Scotland

Healthcare

Healthcare Improvement Scotland (“HIS”) is responsible for regulating independent hospitals, hospices and clinics located in Scotland. The role of HIS is to ensure that independent healthcare providers comply with standards and regulations. HIS undertake the following:

• Granting registration to healthcare providers.
• Monitoring compliance with statutory requirements for healthcare providers.
• Carrying out onsite inspections (both announced and unannounced) and publishing reports on findings.
• Taking action for non-compliance (for example, issuing improvement notices or cancellation of registration).
• Conducting investigations in response to concerns and complaints. 
• In the most serious cases, the HIS has a route by which it can prosecute service providers using criminal sanctions.

Care Homes

The Care Inspectorate (“CI”) are responsible for regulating and inspecting care services based in Scotland to ensure they meet the right standards. The CI’s supervisory activities include:

• Granting registration to social care providers.
• Monitoring compliance with statutory requirements for social care providers.
• Carrying out onsite inspections (both announced and unannounced), awarding ratings and publishing reports on findings.
• Taking action for non-compliance (for example, issuing improvement notices or cancellation of registration).
• Conducting investigations in response to concerns and complaints. 
• In the most serious cases, the CI has a route by which it can prosecute service providers using criminal sanctions.

3. Wales

Healthcare

Healthcare Inspectorate Wales (“HIW”) is the independent inspectorate and regulator of healthcare in Wales. HIW is responsible for independent healthcare providers and its responsibilities include:

• Granting registration to healthcare providers.
• Monitoring compliance with statutory requirements for healthcare providers.
• Carrying out onsite inspections (both announced and unannounced) and publishing reports on findings.
• Taking action for non-compliance (for example, issuing improvement notices or cancellation of registration).
• Conducting investigations in response to concerns and complaints. 
• In the most serious cases, the HIW can prosecute providers using both civil and criminal sanctions.

Care homes

Care Inspectorate Wales (“CIW”) is the independent regulator of care services based in Wales. CIW is responsible for registering, inspecting and taking action to improve the quality and safety of care services. CIW are responsible for:

• Granting registration to social care providers.
• Monitoring compliance with statutory requirements for social care providers.
• Carrying out onsite inspections (both announced and unannounced), awarding ratings and publishing reports on findings.
• Taking action for non-compliance (for example, issuing improvement notices or cancellation of registration).
• Conducting investigations in response to concerns and complaints. 
• In the most serious cases, the CIW can prosecute providers using both civil and criminal sanctions.

4. Northern Ireland

The Regulation and Quality Improvement Authority (“RQIA”) is the independent  healthcare and social care regulator in Northern Ireland. RQIA through inspections, reviews, audits and the promotion of improvements, provides assurance about the quality and safety of healthcare and social care services. Its responsibilities include:

• Granting registration to healthcare providers
• Monitoring compliance with statutory requirements for healthcare providers;
• Carrying out onsite inspections (both announced and unannounced) and publishing reports on findings
• Taking action for non-compliance (for example, issuing improvement notices or cancellation of registration)
• Conducting investigations in response to concerns and complaints. 
• In the most serious cases, the RQIA can prosecute providers using both civil and criminal sanctions