This report finds that the market for home care providers is extremely fragile, with squeezed margins and low fees forcing providers to leave. In 2017 providers handed back home care contracts in more than one in three local authorities, and some of the largest providers have withdrawn from the publicly funded home care market altogether. Staff shortages are a ‘relentless challenge’ for home care providers in many places. It finds concerns that fees paid by some local authorities are too low to maintain quality services, leading to high turnover of providers and staff. This has negative impacts on continuity of care and potentially wider effects on care quality. Researchers also uncovered fears that some care staff are being paid below legal minimum wage levels.