Care Quality Commission: The state of health care and adult social care in England 2025/26

Summary

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

Content

The CQC highlights the following key points in this report:

Inequalities across health and care, with children hit hardest

• Children and young people are experiencing some of the sharpest increases in need and waiting times, even as some adult waiting times have improved. This is illustrated particularly starkly in community health services, where over 80,000 children and young people – almost 11 times the number of adults – have been waiting over a year for an appointment. At the same time, the number of children waiting for their first contact with mental health services rose 31% in 2 years. Health visitor and school nursing numbers continue to decline despite growing demand, undermining early identification of need and safeguarding for children and young people.

• Deprivation continues to shape people’s outcomes from care. Hospital admission rates for children and young people with conditions including bronchiolitis, asthma and diabetes with links to social deprivation vary sharply by region, and levels of tooth decay for children living in the most deprived areas are more than double those in the least deprived areas.

• Unwarranted variation extends across the system. In primary care, ratios of staff to registered patients vary considerably by area, which can affect the quality of care people receive. Uptake of annual health checks for people with severe mental illness ranges widely by ICB area, despite this group facing a significantly increased risk of premature death. In hospitals, CQC's analysis found variation in maternal readmissions by ethnicity, reflecting entrenched disparities in maternal safety for Black women.

A social care market changing shape by accident, not design

• The adult social care market is changing rapidly. Underpinning much of this change is the varying ability of local authorities to plan for the care their communities need in line with a clear strategy, alongside a funding model that remains fragile. This is leaving care providers and local authorities exposed to pressures that are reshaping the market by accident rather than design. Homecare is fragmenting, with a growing number of small providers entering the market, while care homes are consolidating, with more of the available care home beds now located in large care homes and recent increases in institutional investors acquiring homes. These divergent trends – consolidation of care home ownership by institutional investors, and fragmentation of community-based provision – look likely to continue. CQC will continue to monitor quality carefully to ensure this does not have an impact on either personalisation of, or access to, care.

• Commissioning is one of the most powerful levers to drive quality, equity and sustainability in social care, as CQC's local authority assessments have highlighted. Where it is done well, it can make a real difference to people’s care both now and in the future. In Wigan, CQC’s assessment rated the council as outstanding, as it worked collaboratively with providers and people who use services to shape the local market and tackle health inequalities. By developing more local provision, it reduced reliance on care placements outside the borough. Its reablement service, rated outstanding and delivered jointly with health partners, means fewer people need ongoing support a year after leaving.

• But within this changing market, some local authorities are struggling to meet people's needs, and providers are increasingly seeking people who can self-fund their care in order to remain viable. This risks reducing choice and capacity for people who rely on council-funded support, which is already subject to significant regional variation.

• This comes despite some improvements in social care staffing, with vacancy and turnover rates falling slightly, although concerns remain about reduced international recruitment. It is a testament to hard-working care staff that almost three-quarters of the sector is rated as good or outstanding, but CQC has identified leadership as the area most in need of improvement. Inspections show clearly that well-led services deliver safer, more person-centred care.