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Our annual assessment of the state of health care and adult social care in England has been published.
The State of Care report explores trends, shares examples of good and outstanding care, and highlights where care needs to improve.
CQC warns lack of investment in community services threatens shift towards care outside hospital – and risks ‘erosion’ of care quality
In our annual State of Care report, we have warned that the health and social care system remains fragmented and under severe strain as it prepares for a major shift from hospital to community care.
While there is some encouraging evidence of innovation, community services need significant investment in both capacity and capability to deliver the transformation in people’s care called for in the government’s 10 Year Health Plan for England.
Without more support to help community services deliver the vision of the plan, there is real risk of erosion in care quality, with people struggling to get the care they need. The most vulnerable groups are likely to be hit hardest through longer waits, reduced access, and poorer outcomes.
Although the number of trainee GPs has risen per head of population this year, and work is underway to increase capacity and improve access, the number of fully qualified GPs per head of population has fallen, and demand continues to grow.
Based on the information and insight from our regulatory work, as well as from the GP Patient Survey 2025, access to GP appointments remains a challenge, with evidence that some groups find it harder than others. This includes those living in the most deprived areas, autistic people and people with a learning disability, and people with a mental health condition.
The end of new care worker visas is likely to put further pressure on recruitment, making it more important than ever that a sector-wide workforce strategy is agreed and the recently announced fair pay agreement has an impact.
More community services are urgently needed to help people stay in their own homes longer. However, we have identified factors that could limit the growth of the homecare sector.
Our local authority assurance work has found delays for people in getting access to homecare due to shortages of homecare staff and shortages in the workforce delivering short-term care to people recovering at home after a hospital stay. Capacity in rehabilitation, reablement, and recovery services is consistently the biggest cause of delayed discharges nationally.
Our 2024 Community Mental Health Survey found 1 in 3 respondents reported waiting 3 months or more - rising to almost 1 in 2 for those waiting for child and adolescent mental health services. Across all respondents, 14% reported waiting more than 6 months between their assessment and first appointment for treatment.
Over the last year, the number of urgent and very urgent referrals to crisis services has risen sharply.
On any given day in March 2025, nearly 6 in 10 patients who were ready to be discharged experienced a delay.
Over the last 10 years there has been a steady increase in the percentage of emergency readmissions, with older people and people living in more deprived areas more likely to be readmitted within 30 days of being discharged from hospital.
In a system struggling to cope, many people subject to DoLS authorisations are not having their rights upheld in the way that the system intended. In our last State of Care report, we called for urgent action to ensure that the system does not fail people in the future. We remain concerned that the current system is not effectively protecting the rights of many people who use health and social care services. Added to this, the level of understanding among staff of how and when to apply the safeguards, and the need to review restrictions regularly to ensure they remain relevant, continues to vary across both adult social care and hospital settings.
 Integrated care systems (ICSs) continue to face challenges in addressing health inequalities, shifting care closer to home, and supporting older populations.
- Financial constraints remain the dominant barrier to progress – systems cite insufficient funding and competing national priorities as limiting capacity for transformational change.
- There is some caution in confidence to deliver the ‘three shifts’ in the government’s 10 Year Health Plan – more than half of respondents to a survey of ICS leaders were moderately confident and around a quarter expressed no confidence at all.
Local authorities are working closely with public health to provide targeted interventions, to prevent future care needs and avoid hospital admissions.
Partnership working across integrated teams and including voluntary partners was key to aiding smooth and timely discharge. However, waiting lists and a lack of capacity in homecare caused delays. To address this, some local authorities provided bridging services.
Barriers to effective reablement included reablement capacity in some authorities, a lack of skill and capacity in private homecare services, delays and workforce shortages in occupational therapy, and the impact of Care Act assessment waiting times.
Homecare capacity and capability remains an issue. Shortages of skilled staff coupled with a lack of homecare service providers in some areas meant they struggled to address long delays and waiting lists, which affects people’s health and wellbeing. This was especially the case in rural areas.
 In this 2024/25 report, we focus on some specific concerns for particular groups of people. The concerns involve issues around safety, quality, workforce, and inequalities:
- Too many women are still not receiving the high-quality maternity care they deserve, and some women with protected characteristics under the Equality Act 2010 remain at a greater risk of harm.
- Longstanding inequalities in mental health care for Black men continue.
- The report also highlights longstanding inequalities with some groups of people – including older people, people with dementia, people with a learning disability, and those with complex mental health needs – more likely to struggle to navigate services, often meaning their families and unpaid carers carry increasing burdens.
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