Healthcare delivery
The State of Care report: CQC issues warning
The health and social care system remains fragmented and under severe strain as it prepares for a major shift from hospital to community care, the Care Quality Commission (CQC) has warned in its annualState of Care report.
The CQC warns that although 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 and the most vulnerable groups likely to be hit hardest through longer waits, reduced access and poorer outcomes. The State of Care 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.
Mounting pressures across mental health services Since the pandemic, there has been a steady increase in the number of people referred to mental health services – with many people waiting too long to get the help they need. CQC’s 2024 Community Mental Health Survey found 1 in 3 respondents reported waiting three 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 six months between their assessment and first appointment for treatment. The longer people waited, the more likely they were to report that their mental health deteriorated. After identifying concerns about systemic
issues across community mental health care, including a shortage of mental health staff and a lack of integration between services, CQC has begun a comprehensive inspection programme of community mental health services for working-age adults and crisis services. As part of this programme, CQC engaged with
providers who said that a lack of investment in community mental health services made it difficult to attract and retain staff with the right skills and to deliver good care. People who used community mental health services described the destabilising impact of moving between different services and of not having a single point of contact for their care. When people don’t receive timely care, they can end up in crisis. Over the last year, the number of urgent and very urgent referrals to crisis services has risen sharply.
When people don’t receive timely care, they can end up in crisis. Over the last year, the number of urgent and very urgent referrals to crisis services has risen sharply.
Adult social care under strain Demand for local authority-funded social care support continued to rise in 2023/24. While vacancies in the workforce have fallen to pre- pandemic levels, the vacancy rate in adult social care is still three times higher than in the wider job market. Homecare services are particularly affected, with vacancy rates more than twice as high as those in care homes. 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, CQC has identified factors that could limit the growth of the homecare sector. Providers are handing back contracts to deliver care back to commissioners due to rising costs and an increasing proportion of the market is made up of very small providers that may be less financially resilient than larger providers. CQC’s local authority assurance work has found
delays for people in getting access to homecare due to shortages of both homecare staff and
December 2025 I
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