Money, not need, is shaping England's care market, says Independent Care Group

The regulator says nobody is steering the market

The adult social care market in England is being reshaped "largely by accident rather than by design", according to the Care Quality Commission's State of Care 2025/26 report (opens in a new tab), published on 23 October 2026. Care homes are consolidating, while home care is fragmenting.

Mike Padgham, Honorary President of the Independent Care Group, has named the cause: money. He argues financial pressures, not a plan for the sector's future, are deciding the market's shape (opens in a new tab), and that providers have raised these concerns for years.

On that reading, surviving at current fee levels is what decides which operators stay in the market. The market commissioners rely on is drifting, and the regulator has now said so in its own words.

Bigger homes, more small home care firms, and investors on watch

CQC describes two trends moving in opposite directions. In care homes, more beds are now in large homes and institutional investors own more of them. In home care, a growing number of small providers is entering the market.

The ten largest care home operators run nearly one bed in five. Our piece on the CMA clearing Welltower's care home deal shows how consolidation is playing out in local areas.

The report also raises concern about US and other institutional investors buying care homes. Regulators are watching this carefully in case it threatens plans for a National Care Service, BBC News reported (opens in a new tab).

Padgham wants fees that cover pay, training and leadership

Padgham's answer is fair commissioning: fees that reflect the actual cost of delivering care, including pay, training and leadership. "We cannot keep commissioning care on the cheap and expect a sustainable service," he said.

The gap he describes is not new to home care providers. Our piece on why no homecare contract studied met the Homecare Association's minimum price sets out how far council rates sit below what that body thinks care costs.

The link between fees and market shape is Padgham's reading. CQC describes the trends; it is the Independent Care Group that ties them to what councils pay.

Self-funders are being asked to fill the gap

CQC warned that providers are increasingly seeking clients who pay for their own care. Padgham argued this should prompt concern, and called it unfair to expect people paying privately to help make up the shortfall in publicly funded care.

The harder consequence falls on people who depend on council support. If providers cannot afford to accept publicly funded placements, Padgham warned, their choice narrows.

So the open question is who decides the shape of the market from here. If nobody does, the providers still willing to take council-funded placements will decide it, and with it the choice left to people who rely on council support.