By Phil Eckersley (Founder and Managing Director of Bridgewater Home Care)
The Care Quality Commission’s State of Care 2024/25 report paints a picture of a sector at a crossroads.
Domiciliary care is expanding at a record pace, driven by demographic change and growing demand for people to receive support in their own homes. Yet, the very services that make independence possible for older and vulnerable people are facing the toughest conditions we’ve seen in decades.
For those of us who have dedicated our careers to building sustainable, person-centred homecare businesses, this year’s report is both a wake-up call and a moment of opportunity.
The reality behind the headlines
The report confirms what many of us already feel on the ground: the system is under immense pressure.
Vacancy rates in homecare are above 10% – among the highest in any part of health and social care. Smaller providers are struggling to stay viable as fee rates fail to keep pace with rising costs. And with the end of overseas worker visas, recruitment challenges are set to intensify further.
At the same time, the expectations of regulators and clients are increasing. The CQC is clear that quality is inseparable from workforce wellbeing, leadership, and human rights compliance. In simple terms: a provider that doesn’t invest in its people, its values, and its systems cannot deliver safe or outstanding care.
A human service, not a commodity
Too often, homecare is viewed through a transactional lens – as an hourly cost rather than a life-changing relationship.
But those of us close to the work know that care is not a commodity; it’s a human service built on trust, continuity and compassion. Every act of care – from helping a client dress in the morning to preparing a meal or managing medication – carries emotional and relational weight.
That’s why Bridgewater has always championed a values-led model of care. We recruit for empathy, patience, and integrity before experience. We invest in ongoing training and reward long-term commitment. And we support our teams to grow into leaders – whether as Senior Care Specialists, Dementia Champions, or future franchise owners themselves.
When care professionals feel valued, supported, and proud of what they do, the ripple effect is extraordinary: clients thrive, families relax, and quality improves across every metric.
Dementia: The defining challenge of our time
One of the most urgent themes in the CQC report is the growing impact of dementia.
The economic cost is set to more than double to £90 billion within 15 years, but the human cost is far greater. For every statistic, there is a family navigating confusion, loss, and love – often without the right professional support.
The CQC found that inconsistent understanding of dementia remains widespread. Too many people living with the condition still receive care that focuses on physical needs while overlooking emotional, sensory, and communication support. In some cases, nutrition and hydration needs were not adequately met.
The best services, those rated Outstanding, demonstrate the opposite. They build care around the person, not the diagnosis. They use creativity and empathy to maintain identity, dignity, and purpose. Whether that’s involving clients in baking, reminiscence, or community activities, the difference lies in seeing the person first.
At Bridgewater, dementia care is not a specialism; it’s a core skill. Every carer receives dementia awareness training, and our senior teams are encouraged to become Dementia Friends and Champions. We understand that great dementia care isn’t just about what we do – it’s about how we do it: with patience, consistency, and genuine human connection.
The Importance of Leadership and Evidence
CQC’s message to providers is unambiguous: if you can’t evidence it, you didn’t do it.
Inspection under the new Single Assessment Framework demands robust proof of impact – not only on safety and effectiveness, but on quality of life, wellbeing, and inclusion.
This is where smaller, values-driven providers have an advantage. We can act quickly, innovate locally, and truly know our clients and teams. The challenge is to document what we do so well, so that inspectors, commissioners, and families can see the evidence of impact.
At Bridgewater, we combine human connection with professional discipline. Every care plan, review, and outcome is measured and recorded – not because the regulator demands it, but because it helps us learn, improve, and celebrate the difference we make.
Sustaining excellence in a fragile market
The report’s warning about financial fragility is real. Many small providers are handing back local authority contracts because fee rates are unsustainable. Yet, this is also driving innovation.
Providers that diversify – balancing private and funded work, focusing on specialist care, and building strong community partnerships – are proving that quality and sustainability can go hand in hand.
Bridgewater’s franchise network is built around exactly that principle: combining commercial strength with community purpose. Our franchisees are empowered business owners who deliver exceptional care through consistent standards, shared systems, and a strong support infrastructure. Together, we are building a network that can grow without losing its heart.
Looking ahead
The State of Care report isn’t just a mirror; it’s a map. It shows where we are and points towards where we need to go:
- A sector where homecare is recognised as a professional, respected career.
- Where dementia care is rooted in understanding, empathy, and dignity.
- Where data and human stories work together to demonstrate impact.
- And where business owners in social care can thrive – not despite the challenges, but because they lead with values.
Bridgewater Home Care was founded on the belief that excellent care begins with excellent people. That belief has never been more relevant.
As the sector evolves, those who put culture, evidence, and compassion at the centre of their work will not only survive – they will lead the future of care.
