Care Quality Commission: The state of health care and adult social care in England 2024/25

Summary

The State of Care is the Care Quality Commission’s (CQC) annual assessment of health and social care in England. The report looks at trends, shares examples of good practice and highlights where care needs to improve.

Content

Access and demand for care

• Demand for services is growing. People cannot always access the care and treatment they need when they need it, and the system often fails to deliver effective, joined-up care, resulting in long waits and unmet needs.
• Over 700,000 more patients were registered with a GP on average in 2024/25 compared with 2023/24, and the number of appointments has risen by nearly 10% over the last 2 years.
• In adult social care, the demand for support funded by a local authority continued to rise – new requests for care were 4% higher in 2023/24 than in the previous year, and 8% higher than in 2019/20. 
• 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. During the year, there was an average of 453,930 new referrals to secondary mental health services every month – an increase of 15% from 2022/23. 

Workforce and capacity

• Issues with recruitment, retention and understaffing in some areas are affecting people’s care.
• Despite an 11% growth in the sector during the last year, the CQC have expressed concern that some homecare providers have said they are handing back local authority contracts due to rising costs.
• The CQC also note concern about the burden on unpaid carers.
• District nursing services are an important part of shifting care from hospital settings into the community, but the number of qualified district nurses per 10,000 people aged 65 and over has dropped by 50% in the last 14 years. 

People’s experiences

• The health and care system remains fragmented and pressure in the system has an impact on people’s experiences of care.
• There are significant challenges around funding and system working, as poor communication and collaboration between services, and problems with shared care protocols can have a negative impact on people’s experience of care, the co-ordination of their care and transitions between care pathways.
• Navigating the care system remains challenging, especially for people with needs that are more complex to meet or who have limited advocacy – this includes people living with dementia, autistic people and people with a learning disability and people living in more deprived areas.

Inequalities and concerns for specific groups of people

• The CQC have stated that they continue to see significant unwarranted variation and inequalities in care. This persists in how people access and experience care, and their outcomes from it.
• Variation at both a regional and ICS level is leading to inconsistent quality across the country.

Signs of improvement and innovation

• Although the system is under serious pressure, we have seen evidence of innovation and improvement making a difference for people. In CQC assessments, they state that they continue to see how good leadership can promote a culture of openness and learning.

Deprivation of Liberty Safeguards

• The number of applications to authorise the deprivation of a person’s liberty have continued to increase significantly over the last decade – far beyond the levels expected when the safeguards were designed, which often results in lengthy delays.
• Issues with the Deprivation of Liberty Safeguards (DoLS) system continue to disproportionately affect certain groups of people. Our survey of Mental Capacity Act leads in hospitals highlighted particular concerns around older people, including those with dementia.