The Care Quality Commission (CQC) has published its annual State of Care report, which reveals a health and social care system under “severe strain.”
The care watchdog has warned that a lack of funding for community services threatens the proposed shift towards care outside of the hospital environment and also risks an “erosion” in the quality of care.
The State of Care report provides the CQC’s annual assessment of the health and social care sector and workforce in England.
Published on 24th October, the report for 2024-25 shows some “encouraging evidence of innovation,” but also underlines the fact that community services will require “significant investment in both capacity and capability” in order to meet the vision of care set out in the government’s 10-Year Health Plan for England.
State of Care report shows community services need more support
The 10-Year Health Plan represents a transformation in health and social care services, with a greater focus on care in the community and keeping people out of hospital.
But, in order to deliver this vision, the CQC says that community services need more support and, if they don’t get it, there is a “real risk of erosion in care quality,” with people struggling to access the care they need and the most vulnerable groups likely to be the worst affected by longer waiting times, reduced access and poorer health outcomes.
The State of Care Report 2024-25 also highlights the following issues:
- Longstanding inequalities – some groups of people, including older people, people with dementia, people with a learning disability and those with complex mental health needs, are more likely to experience problems navigating services, with their families and unpaid carers bearing the brunt.
- Mounting pressures on mental health services – many people are waiting too long for mental health care, with too many ending up in crisis as a result. The CQC says there are systemic issues across community mental health care, including a shortage of staff and a lack of integration between services.
- Recruitment struggles – while demand for care services continues to rise, the vacancy rate in the adult social care sector remains three times higher than in the wider job market, with homecare services particularly affected. The end of new care worker visas is likely to increase these pressures. The CQC says this makes it “more important than ever that a sector-wide workforce strategy is agreed and the recently announced fair pay agreement has an impact.”
- Urgent need for more community services – if people are to be supported to stay in their own homes for longer, more community services are required. But the CQC says that rising costs are resulting in care providers handing back contracts to deliver services to commissioners. Meanwhile, a shortage of homecare and short-term care staff is the biggest contributor to delayed hospital discharges, due to limited capacity in rehabilitation, reablement and recovery services.
- Persistent delays in hospital discharges – The CQC found that, on any given day in March 2025, almost 60% of patients who were ready to be discharged experienced a delay. These delays reduce the number of beds available for new patients and “creates knock-on effects for people’s care across the whole system.” Adding to the strain is the increase in 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.
- Primary and community care capacity challenges – work is underway to increase capacity and improve access to primary care, but the number of fully qualified GPs per head of population has fallen, while demand continues to rise. People continue to struggle to access GP appointments and some groups, including those in the most deprived areas, autistic people, people with a learning disability and people with a mental health condition, finding it even harder. This places strain on the wider system, with people often going to A&E when they can’t contact their GP. The issue is compounded by a shortage of district nurses, who will be key to shifting care from hospital settings into the community.
A chance to improve care
The Interim Chief Executive of the CQC, Dr Arun Chopra, said the government’s 10-Year Health Plan represents “a real chance to improve care by putting people’s needs first.”
But he also warned that “for the plan to succeed, community health and care services need more support. Without this, there’s a risk fewer people will be able to access good care, with vulnerable groups hit hardest.”
He added:
“Right now, community services tell us they’re struggling because the way care is funded and organised is designed around hospitals. That’s also true of how data about care is collected and how outcomes are measured. All these things make it harder to move towards care that keeps people well, delivered closer to home.
“We’re calling for more investment in care outside hospital, and more emphasis on measuring quality of care, not just numbers of procedures. Services need to focus on really understanding the needs of their local population – especially in deprived areas – and on working together to address those needs.
“We’ll play our part – with a renewed focus on listening to what people tell us about their care and acting on their feedback. When we find poor care, we’ll take steps to protect people. We’ll work with healthcare providers and local systems to make care better, and we’ll find and share examples of good, innovative care that puts people first. And where we see barriers to good care, we’ll work with partners to find solutions.”
CQC warns about “fragmented” state of care
Meanwhile, the Chair of the CQC Professor Sir Mike Richards said that CQC inspections found “excellent examples of health and social care services working together to put people first,” but cautioned that the regulator also uncovered “too many examples where poor coordination between health and social care, inadequate information sharing, and lack of digital integration stand in the way of joined up care.”
He described the current system as “fragmented” and warned that “vulnerable people are falling through the gaps.”
The care watchdog believes the 10-Year Health Plan provides a “roadmap” to fix these issues but concludes that “long-term, sustainable funding for adult social care,” is needed to put these plans into action.
Training and support for health and social care
First Response Training (FRT) is a leading, national training provider.
They deliver over 7,000 courses each year in the fields of health and safety, first aid, fire safety, food safety, mental health, health and social care and other special focus topics.
Their diverse portfolio includes training awards designed for care workers, such as Learning Disability Awareness, Understanding Autism, Oliver McGowan Mandatory Training, Positive Behaviour Support, Safeguarding Adults, Equality, Diversity and Inclusion, Person Centred Care and Support and many others.
Their course portfolio spans Care Certificate standards, mandatory training awards, clinical skills, special focus courses and training for supervisors and managers.
A Trainer at FRT, says:
“We know that the health and social care sector faces multiple challenges. We hope that better integration and support for community services can benefit the sector and the people it cares for. The priority must always be high quality, safe, effective and compassionate care for all.
“Tailored training and development solutions can help ensure staff are focused on patient safety and empowered to deliver high quality care.”
You can contact FRT via freephone 0800 310 2300, send an e-mail to info@firstresponsetraining.com or submit an online enquiry.