Clinical homecare in action — the kind of support only a TDDI-registered provider can legally deliver.
When a family arranges homecare, they almost always assume the agency they choose can handle whatever comes up. A medication that needs administering. A wound from a recent operation. A health condition that flares during a visit. In most cases, that assumption is wrong. Most homecare agencies are registered to do one thing: provide personal care. If your relative needs anything clinical, the agency is legally not permitted to deliver it.
This is not widely understood until it becomes a problem. A family arranges what they believe is comprehensive homecare, only to be told that wound dressings, medication administration, or post-operative monitoring fall outside what the agency is registered to do. A second provider must be sourced. Coordination becomes complicated. The person at home, who simply wanted consistent support, ends up with two sets of strangers visiting on different schedules.
This article explains what a TDDI registration is, why relatively few providers hold it, and what it means in practice for families and for the clinicians and commissioners who refer people into homecare.
What does TDDI stand for?
TDDI stands for Treatment of Disease, Disorder or Injury. It is a regulated activity category defined by the Care Quality Commission (CQC) under the Health and Social Care Act 2008. To carry on this regulated activity, a provider must apply for and be granted CQC registration specifically for this purpose.
The TDDI registration is separate from and additional to the standard personal care (domiciliary care) registration. A provider may hold one without the other, both, or neither. When a provider holds both, it can legally deliver the full spectrum of community-based care — from personal care through to clinical support — within a single coordinated package.
What can a TDDI-registered provider do that others cannot?
The practical scope of TDDI registration in a domiciliary care setting includes services that trained carers and support workers deliver under a clear care plan, often in coordination with community nursing or a GP.
TDDI registration does not make a homecare provider a nursing agency. Regulated nurses carry out different, more complex clinical interventions. What TDDI registration enables is a level of health-adjacent community care that bridges the gap between basic personal support and clinical nursing — which is precisely the gap that causes the most difficulty in post-discharge and complex care packages.
Why do so few domiciliary care providers hold it?
CQC registration for TDDI requires a provider to demonstrate that it has the governance, staffing, training, and oversight systems to safely deliver clinical community services. This is a higher evidential burden than personal care registration alone. Many smaller or newer providers have not pursued it, either because their service model does not require it or because the registration process demands resources they do not have.
This scarcity creates a genuine market gap. When a hospital discharge team or a community nurse needs to arrange a post-discharge care package with clinical elements for a patient returning home, the pool of providers they can refer to is small. Waiting lists form. Discharge is delayed. People stay in hospital beds longer than they need to because the community provider who can safely receive them does not exist in sufficient numbers.
What this means for families
If your relative has any of the following, you need to specifically ask whether the homecare provider you are considering holds a TDDI registration alongside their personal care certificate:
Ask the provider directly: are you CQC-registered for Treatment of Disease, Disorder or Injury? Ask them for their CQC Provider ID and check their profile at cqc.org.uk. The registration details are publicly visible on every provider's CQC profile.
What this means for GPs, occupational therapists, and discharge teams
When you are looking to refer a patient into community homecare and their package includes any clinical element, confirming the provider's TDDI registration before the referral is made saves significant time and prevents the distressing situation where a package is arranged, care begins, and the carer then cannot legally complete one of the tasks that makes the whole arrangement viable.
Why Acrux Support Services holds both registrations
Acrux Support Services holds both a personal care registration and a TDDI registration (CQC Provider ID: 1-18041750500). We cover all East London boroughs and can begin new packages within 72 hours of referral. Our registered manager, Doris Rychlewski, is directly available to discuss complex referrals.
The short version. A TDDI registration means a domiciliary care provider can legally deliver clinical community services alongside personal care. Most providers cannot. If your relative needs anything beyond washing, dressing, and daily living support, you need to specifically check whether the provider holds this registration before you agree to a care package. It is a single question that can prevent a great deal of difficulty later.
Acrux Support Services is CQC-registered (Provider ID: 1-18041750500) for both personal care and Treatment of Disease, Disorder or Injury. We serve adults across East London and beyond. To check any provider's registration, visit cqc.org.uk and search by provider name or ID.