CQC’s State of Care Report: The health and social care system is fragmented and under severe strain

Overview

Demand for services is increasing across health and social care services in England and the system is already under severe pressure, the CQC has found.

The report highlights how pressures in one part of the system affect other parts. For example, hospitals are impacted when there is a lack of access to preventative and community-based support.

This is affecting the ease at which people can access their care, as well as its quality. There is variation in people’s experience of health and care services across the country, particularly affecting people in the most deprived areas.

CQC highlights innovations and excellent care in places. While there are challenges posed by the shift towards services being delivered in the community, this has also resulted in positive new initiatives being created.

The report looks into the shift towards the delivery of neighbourhood care, and how this raises concerns for experiences of care of groups including older people, people living with dementia and those using maternity services.

Specific services

Demand for GP services is growing and placing more pressure on services. In the 2025 GP Patient Survey, only 53% of respondents said that contacting their GP by phone was easy.

Access to NHS dental care remains a challenge and are very variable across integrated care systems (ICSs).

The number of children and young people waiting to access community health services for over a year increased by three times between January 2023 and December 2024.

In adult social care, the demand for local authority-funded support is rising, with requests for care being 8% higher in 2024/25 than in 2019/20. The support needed is largely for adults of working age. The proportion of older people who receive local authority-funded long-term social care has fallen from 8.2% to 3.6% over the past 20 years.

The report also finds that rising financial pressures are putting the sustainability of some adult social care services at risk. Some homecare providers are reportedly handing back local authority contracts due to risings costs. There is also a concerning burden on unpaid carers.

‘In 2024/25, people were still waiting too long for mental health care and were unable to access the care they need when they needed it’, the report found. Mental health services continue to face recruitment and retention challenges due to staff burnout.

Understaffing at hospitals, alongside pressure to admit patients to hospital despite a lack of capacity, is impacting staff wellbeing and therefore also the care that people receive,

The number of people waiting for more than 12 hours in A&E rose by 10% over the previous year. Demand for emergency care remains high, but the way in which people are accessing the care is changing, with calls to ambulance services increasing whilst there has been a drop in the number of calls to NHS 111.

There is a shortage of qualified staff in district nursing at a time when care is shifting from hospital settings into the community. This is resulting in care being delivered in a task-based way rather than holistically.

Analysis of wide-ranging experiences for the State of Care report found a consistent need for more person-centred care, with improved communication, coordination and collaboration between different services.

There is a need for holistic care which addresses both physical and mental health needs. Frequently, the CQC found, services are not joined up and information is not being shared as it should be.

‘While there has been some improvement, people are still facing long waits for elective care, and the length of time people must wait varies across the country’, the report found. 43% of elective patients reported that their health deteriorated whilst they were waiting to be admitted to hospital, CQC’s 2024 Adult inpatient survey found.

Navigating the care system remains challenging, especially for people with needs that are more complex to meet or who have limited advocacy. This is particularly the case for people living with dementia, autistic people and people with a learning disability and people living in more deprived areas. People aged 85 and over were most likely to not take steps when they were unable to contact their GP, risking poor outcomes for this group.

State of Care shines a light on inequalities in care, how people access and experience care and their outcomes from it.

People living in the most deprived areas of England are likely to find it harder to access GP appointments.

There is variation in regional and ICS areas leading to inconsistent quality in care across the country.

• People aged over 65 reported to mostly to have had positive experiences with hospital discharges and receiving follow-up care in the community. However, some said they did not feel ready to be discharged and that follow-up care did not meet their emotional needs. Some experienced a deterioration in their physical and mental health as a result, and relied on family and friends to take on unpaid caring responsibility due to gaps in care.
• Staff in health and social care do not always understand the specific care needs of people living with dementia. Person-centred care and dementia-friendly environments are not always being delivered.
• Maternity care is falling short, in spite of issues being reported over the last 10 years, and women with protected characteristics remain at greater risk of harm. The upcoming national maternity review presents an opportunity for positive change.
• Autistic people and people with a learning disability face barriers to getting an appointment with their GP due to booking systems not always being accessible. Reasonable adjustments are not always being made or made correctly in primary care.
• The report identifies longstanding inequalities in mental health care for Black men. It highlights a need for proper staff training to fight racism and for accountability of services.