Daisy Cooney, Head of Policy, Practice and Innovation at the Homecare Association, asks whether regulation can ever capture the true quality of homecare—those human moments of trust, compassion and flexibility that matter most.
Seldom does a form capture the essence of good homecare. It’s in the quiet moments: when a care worker instinctively knows to stay a little longer, when routines flex around a person’s changing needs, or when someone notices a client is unusually withdrawn and takes time to listen. These are the subtle, relational elements that make care in someone’s own home deeply personal and profoundly human.
But can these moments, so central to what people value, ever truly be captured by a regulatory framework?
The Care Quality Commission (CQC) has recognised the need to modernise. Through initiatives like The CQC Way and a series of nationwide roadshows, the organisation seeks to reset its relationship with providers and rebuild trust in the role. The ambition is sound: regulation that protects people, informs the public, and drives improvement.
Yet despite its stated ambition, implementing the Single Assessment Framework has left many providers frustrated and disillusioned. As highlighted in a recent Care Provider Alliance (CPA) review, providers describe the new regime as disorienting, burdensome, and often out of step with the reality of care. Rather than building trust, the system has, in its current form, deepened concerns that regulation is drifting further from what actually matters to people receiving care.
The framework asks inspectors to assess services against a rotating sample of 34 quality statements. In practice, this approach can miss key parts of the service, including relational, innovative care that doesn’t fit neatly into a box.
This burden falls heaviest on small and medium-sized providers, who lack the resources to dedicate staff solely to compliance. Front-line managers often find themselves navigating vague quality statements and gathering reams of documentation, while also running complex, responsive services. The administrative weight can be overwhelming and, ironically, take time away from quality improvement itself.
This is particularly problematic in homecare, where the care environment is someone’s private home. A space that providers neither control nor standardise. No two visits are the same, and flexibility is not a flaw in the model; it is the model. Being person-centred means adapting hour by hour, day by day. The framework does not yet fully account for this.
One of the most revealing facts is that the CQC hasn’t inspected many homecare providers in years. Backlogs and capacity constraints have left much of the sector in regulatory limbo. And yet, in the absence of formal oversight, good care has not just continued; it has flourished.
Providers have supported people through cost-of-living pressures, increasingly complex needs, and the echoes of a pandemic, often without external validation. Trust, continuity, and compassion have been their quality assurance. Where the inspection regime adds value, it must do more than check compliance; it must recognise and amplify these strengths.
None of this is a call to abandon regulation. On the contrary, most providers want a strong, effective regulatory system, one that is fair, proportionate, and grounded in a real understanding of how they deliver care. The CPA’s recommendations include reducing the number of quality statements, making guidance specific to service type, and ensuring inspectors are trained to appreciate different models of care.
Regulation can and should drive improvement. But it must do so by working with the grain of good care, not against it. It should support flexibility, not penalise it. It should elevate relationships, not obscure them under paperwork.
If we want regulation to drive quality, it must learn to see, and reward, the human heart of care, not just its evidence base.
