The majority of care home residents still receive state support, but the proportion forced to pay their own fees is growing. (Matt Cardy/Getty Images)
Residents in state-funded private facilities more likely to receive below standard treatment, according to Oxford University study
The first time Martina Hanouskova heard about her mother Anna’s pressure sore was when she dropped by to see her in Dane View nursing home in Leicester. She had visited her in the previous two days, but staff at the private home had not mentioned the ulcer, which had become so severe that Anna couldn’t leave her bed.
She then returned every day and warned staff that Anna, whose 24/7 care was funded by her local authority, was looking increasingly unwell and dehydrated. She was admitted to hospital in January 2023 with sepsis and died 17 days later.
A Care Quality Commission (CQC) inspection later that year found the care provided by Dane View was inadequate, with residents unsafe and at risk of harm. One resident was given more than their prescribed dose of medicine, and a faeces-stained chair was left in the stairwell. Another had an accident because they had to while waiting for support to go to the toilet.
Dane View – which is owned by the Bayswood Care Group – was only moved out of a regime of additional monitoring and supervision this year.
A new Oxford University study, which has been shared with The Observer, reveals such care failings are far more common in for-profit homes looking after state-funded residents, whereas for-profit homes caring for better-off self-funded residents are more likely to receive good or outstanding ratings.
The research, which is funded by the Nuffield Foundation, shows that for-profit homes caring for state-funded residents had an estimated 25% likelihood of being rated substandard or unsafe by the CQC. Equivalent local authority-run homes had an estimated 11% likelihood of similar failings.
The paper compared the inspection ratings from nearly 14,000 homes with 29,000 data returns to the CQC detailing how residents paid for their care between 2021 and 2023. It concludes “the quality of for-profit care homes is strongly influenced by the proportion of self-funded residents”.
Anders Bach-Mortensen, who co-authored co-author of the research, said the findings may reflect that the fees paid by the state are often too low to meet operational costs. “This means commercial providers are incentivised to focus on attracting self-funders while looking for ways to cut costs in homes caring for more council-funded residents.”
‘It is unfair to have state-funded services treat poorer people worse than rich people.’
Benjamin Goodair, report co-author
Another one of the authors, Benjamin Goodair, added that the state should not be allowing worse outcomes for the poorest people. “This is the first time you see exactly who is being let down by the care system, and it is those people funded by the state.” “Obviously, that is not right… it is unfair to have state-funded services treat poorer people worse than rich people.”
The study comes as some charities looking after state-funded residents are handing back contracts in the face of rising costs and wage bills. There are mounting fears that this trend could leave only for-profit homes operating in poorer areas.
The majority of care home residents still receive state support, but the proportion forced to pay their own fees is growing. Last July the chancellor, Rachel Reeves, scrapped the previous government’s plan to fund the care costs of more people and impose an overall lifetime cap on care bills.
English councils contribute to care home fees when people have assets of less than £23,250. In Wales, that figure is £50,000, in Scotland £35,000.
Labour ministers have promised to deliver a national care service, but frustration is growing at the slow pace of change. Louise Casey has been asked to lead an independent commission to build cross-party support for care reforms. But her final report is not due until 2028.
Hanouskova hopes lessons will be learned from the death of her “fun, loving and caring” mother. The coroner who held the inquest into Anna’s death took place last year. The coroner found Anna’s sore was not noticed early enough by the Dane View staff and her deteriorating condition was not escalated to specialist nurses or her GP. There was evidence that she was not being turned in her bed every two hours and that she was left in a chair for long periods. The coroner concluded that she would not have died when she did “had it not been for the neglect of the home”.
Kim Truscott, group operations manager for Bayswood, said Dane View had undergone substantial reform since the coroner identified serious care failings, with new leadership and enhanced staff training. She added that the group was “committed to full legal and regulatory cooperation, and emphasised its resolve to rebuild trust and uphold high standards for all residents, regardless of funding source”. Hanouskova, who is bringing a civil case against the owners of Dane View, said the care her mum received was worse than she ever imagined. “Losing my beloved mum in this way has been extremely distressing and heartbreaking for our family.”
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