Care providers have had to adapt to an ever-changing regulatory landscape in recent years. More changes are afoot. In October 2025, the Care Quality Commission launched a consultation into how it assesses health and care services in response to the 2024 rollout of the Single Assessment Framework, whose implementation was marked by increased complexity, difficulties in determining reliable ratings and IT platform challenges.
Yet it is only a small piece in the patchwork of evolving challenges that are making it increasingly difficult for providers to deliver the essential care that their service users so desperately need.
In addition to meeting evolving regulatory standards, providers are having to re-evaluate and remodel how they provide care, what care they provide and the outcomes they deliver. In many instances, they are also having to be more flexible about where the care is delivered. There is now a stronger focus on keeping people independent for longer and delivering care closer to home.
Changing care provider insurance needs
This seismic shift spans all areas of the care sector at a time when funding is constricted and the availability of associated support services from local authorities is receding.
In children’s social care, individual cases are becoming significantly more complex, driven largely by the increasing prevalence of mental health issues.
In adult care, medical advances have improved survival rates for people born with learning difficulties and disabilities, enabling them to enjoy full and happy lives for longer. This is an amazing success story, but it has completely changed the nature of care provision for those now living – and requiring support – into and through adulthood.
In older people’s care, increasing longevity is again a hugely positive step change. But it has created complex and layered care needs as ageing individuals are likely to experience a greater number of health conditions and frailties throughout their lives.
Understanding care provider insurance risk
As care providers evolve their services to meet these more complex needs, their risk exposures have changed dramatically. This puts pressure on insurers to seek out the information required to rate and assess their risks accurately and provide the most appropriate terms of cover for the risk in question.
Ironically, increased regulatory focus in recent years has made it harder, in many cases, to access up-to-date information. The increased attention on poorly performing providers means they are subject to shorter intervals between inspections. Whilst increased attention means these care providers will be monitored more closely and, hopefully, encouraged to achieve higher standards. This results in previous well-performing providers having longer intervals between inspections. Providers’ standards can change quickly due to the complex nature of the services being provided and the challenges that exist in everything from funding and recruitment to property maintenance and changing service provision. Without up-to-date regulatory oversight, it is difficult to understand a provider’s true risk profile.
Moreover, risk presentations often lack sufficient detail. For example, it is not unusual for presentations for cover to include nothing more than the property sums insured, the wage bill and the turnover.
Ideally, these basic metrics would be supported by more detailed insights. For example, how does the provider audit care provision? What training do staff receive? How often is training provided and by whom? What qualifications do staff have? What processes are in place to speak to service users and their families? What benchmarks are being used to measure performance? What processes are in place to improve performance and share best practices? How do providers deal with complaints?
Armed with such detailed information, it becomes significantly easier to offer swift responses with the sharpest pricing and the most attractive terms.
Collaborating to combat care provider complexity
The insurance market often talks about “good” and “bad” risks. While the terminology is understandable, it is not always helpful. There are markets with an established appetite for challenging risks and a desire to work with insureds to help them understand how they can improve their underlying risk profile, to reduce the potential for claims to occur. This is essential when not securing insurance cover means providers will have to close their doors.
Closer collaboration between insurers, brokers and risk consultants can improve data availability by encouraging providers to implement more structured operational processes. This can help generate the detailed data required and support the provision of higher and more consistent standards. It can also enable providers to evidence the steps they have taken to deliver the best outcomes for service users and demonstrate to insurers how the risk is managed.
Without such structured information, it can be difficult for providers to defend themselves against claims or show regulators they are operating compliantly and consistently.
In an insurance market where pooled capacity provision means each loss has an impact on the terms available to every insured, there is a very real incentive to improve performance across the board.
Care provision has never been more challenging, but when it comes to securing cover, the issues are surmountable. Early engagement, detailed risk information and genuine collaboration can make these challenges manageable.
