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Why does joining up health and social care still feel so difficult in practice? And what does that mean for people navigating both systems?  This long read from the King's Fund sheds light on the ‘no man’s land’ many experience at the interface between health and social care, revealing the deeper structural issues behind delays, fragmented support and growing pressure on patients and carers.

This evidence review aims to examine what it feels like to experience ‘well-led’ health and/or care services and organisations, from the perspectives of people with lived experience and people working in health and social care. It is an extension to ‘Making it Real’ - a framework and set of statements co-produced by Think Local Act Personal (TLAP) and the Care Quality Commission (CQC) that describe what good, co-ordinated and personalised care and support look like from the perspective of people drawing on it. 

The term ‘neighbourhood’ when used in reference to health and care, often suggests a collective, cross-sector and/or community approach. A recent Digital Care Hub webinar investigated the latest updates connected to the NHS / DHSC’s Neighbourhood Heath Policy, what it might mean for adult social care providers, and what’s needed to unlock the digital systems and processes that will help make it a reality. If you missed it, the webinar can be viewed below.

The King's Fund has launched the latest edition of their annual Social Care 360 report. 2024/25 saw the continuation of a new trend in adult social care. Local authorities are spending more on social care, with that investment focused not just on paying higher fees to the providers who supply care, but, now, increasing the number of people who receive it as well. More people are now receiving publicly funded long-term care than at any time in the last decade. This change is due to increasing local authority spending power – the total amount that councils have to spend, both from money they raise themselves (for example, from council tax and business rates) and from central government grants. However, councils still do not have the resources to meet all the demands on them and their overall financial position is worsening. As a result, local authorities are increasing fees below the increase in costs faced by social care providers. This has potential implications for market stability, quality, and particularly private-paying clients, who are being charged much more for their care so that providers can balance their books. Taken together, the picture for social care remains precarious, then, with significant pressure on the government to ensure stability in the sector in the medium term, and on the Casey Commission to identify coherent proposals for reform in the long term.

The government has published its much-awaited Neighbourhood Health Framework. It sets out in new detail what neighbourhood health aims to do and how this will be achieved, building on the 10 Year Health Plan, the Neighbourhood health guidelines 2025/26 and the Medium Term Planning Framework.  The framework describes neighbourhood health as putting the person at the centre of how local services are organised and delivered – including GP and community services, urgent care and outpatients, as well as services commissioned by local authorities such as social care and public health.   The new guidance brings some long-awaited clarity to commissioners and providers about what neighbourhood health should deliver. There is much to welcome. But questions remain around whether targets can ease pressures on the acute sector as well as improve patient care and experience; whether focus can be maintained on long term population health priorities among a plethora of specific shorter term delivery goals; whether permissiveness in designing local services and rigid structures can coexist; and, fundamentally, whether integrated care boards (ICBs) and other organisations have the capacity to action it all.  In this King's Fund article, experts set out their more detailed analysis of the framework. They consider the parts to celebrate, the aspects that raise some concerns, what’s missing, and the questions that remain outstanding.  

Every year millions of children in England spend time in hospital. Most children are in hospital only for a short period, often just after they are born or during brief periods of illness. However, for a number of children, hospital becomes a place they spend months and sometimes years of their lives. For the first time, this report shows how long children spend in hospital over their childhoods through new analysis of NHS data. This report sets out why children are waiting to be discharged and what their experience of delayed discharge is like. For some children, time they spend in hospital waiting to be discharged is avoidable. That is particularly true for two groups of children. First, children with serious and complex medical needs. While advances in modern medicine are making a monumental difference in giving them a stronger chance in life, the systems that surround these children – community and primary care, children’s social care, palliative care, housing and education – have not kept pace. The Children’s Commissioner’s office has focused on what this means for children who are waiting in hospital, ready to be discharged. Second, for some children admitted to hospital with social, emotional, behavioural and/or mental health needs. For children admitted with these needs but who do not meet the criteria for inpatient mental health services, their experience waiting in hospital for the right care and support in the community is similarly rooted in challenges facing health, social care and education which has resulted in them being let down, and being admitted to hospital in crisis - waiting for the right therapeutic support in the community. This report brings together data on how long children spend in hospital across their childhoods, alongside the voices and experiences of families, health and care professionals working in hospitals, hospices, community nursing teams and care providers. It sets out the issues facing children whose hospitals stays are being prolonged or more frequent because the support they need to be in the community is not in place.

The Covid-19 Inquiry published its third report and recommendations following its investigation into ‘the impact of the Covid-19 pandemic on the healthcare systems of the United Kingdom’ on Thursday 19 March 2026. It examines the governmental and societal response to Covid-19 as well as dissecting the impact that the pandemic had on healthcare systems, patients and healthcare workers. Recommendations There are many lessons to be learned from the experiences of the UK’s healthcare systems during the Covid-19 pandemic and many areas for improvement. The Inquiry has made 10 recommendations and considers them all to be necessary to prevent healthcare systems being overwhelmed in the next pandemic: Recommendation 1: Ensure that decision-making on infection prevention and control is underpinned by clear structures and a cautious approach to transmission risk The UK government must ensure that there is a body (equivalent to the UK Infection Prevention and Control Cell) in place ready to be convened at the outset of any future pandemic, to consider and draft infection prevention and control guidance for healthcare settings. This body must: have clear lines of responsibility and a clear, pre-defined role and remit during a pandemic have multidisciplinary membership, including experts in the science of viral transmission as well as those with clinical expertise ensure that its guidance accounts for the risk of all plausible routes of transmission until sufficient evidence emerges to rule out specific routes ensure that guidance clearly explains the underlying rationale for the precautions recommended. Separately, the Department of Health and Social Care, NHS National Services Scotland, Public Health Wales and the Public Health Agency (Northern Ireland) should review the national infection prevention and control manuals and any future guidance to ensure that the approach to identifying risk of transmission is not confined solely to specific procedures. Emphasis should be placed on a combination of risk factors, such as rates of transmissibility, environment, setting and procedure. Recommendation 2: Guidance for visiting restrictions The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should publish guidance for the implementation of visiting restrictions in hospitals in the event of a future pandemic. The guidance should identify the circumstances in which visiting restrictions should be introduced, escalated, decreased and removed alongside the measures and exemptions at each level. The guidance should be led by the following core principles: Measures applied should be the least restrictive possible, both in terms of severity and the length of time for which they apply. Restrictions should be decided upon and applied at the most local level possible. Unless restrictions are applied at a specified level, trusts and health boards should take decisions on the severity of restrictions based on local risk assessments. Communications with the public must clearly explain the measures in place and the reasons why restrictions apply. The guidance should be reviewed every three years in line with the Inquiry’s Module 1 Report (Recommendation 4) Recommendation 3: Better preparation for fit-testing The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with employers, including health boards and trusts, to review the availability of qualified fit testers and take steps to increase the number of fit testers accordingly. Availability should be reviewed every three years in line with the Inquiry’s Module 1 Report (Recommendation 4). The Health and Safety Executive and the Health and Safety Executive for Northern Ireland should update their guidance to employers to emphasise the need to ensure that sufficient fit-testing capacity is available. Recommendation 4: Improve data systems to identify individuals at high risk during a pandemic The UK government, Scottish Government, Welsh Government and Northern Ireland Executive must ensure that health data and digital systems have the capability to identify individuals at high risk of morbidity or mortality from a pandemic disease quickly and accurately in a future pandemic. This should include action to improve health data systems and patient record-keeping by: improving patient data by enabling more granular diagnostic coding ensuring that care records are compatible across primary and secondary care enabling secure data-sharing and linkage across multiple health datasets and systems for identifying individuals at high risk. Recommendation 5: Prepare to scale up urgent and emergency care capacity The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, in conjunction with organisations responsible for delivering services, should plan for surge capacity in urgent and emergency care during a pandemic. Plans must ensure that there is sufficient workforce capacity and the ability to surge, including the number and type of staff required, recruitment and training provision. This should be completed as part of the whole-system civil emergency strategy recommended in the Inquiry’s Module 1 Report (Recommendation 4). Plans should be published and subject to review every three years. Recommendation 6: Prepare for and test the ability to scale up hospital capacity The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with trusts and health boards to ensure that pandemic plans include practical steps to rapidly scale up hospital capacity to treat acutely unwell patients. This should include critical care services that can deliver multiple levels and types of organ support. It should also cover necessary equipment, supplies, space and staff, including redeployment and training. All trusts and health boards must keep an easily accessible, up-to-date record of the information needed to implement these plans in the hospital sites they operate. This should include technical aspects of critical care expansion such as power, ventilation, oxygen and waste management systems. Plans for expanding capacity should be published, subject to review every three years and tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6). Recommendation 7: A framework to guide the allocation of intensive care resources in the extreme event of saturation The UK government and devolved administrations should publish a UK-wide framework setting out ethical and operational principles to guide the allocation of adult intensive care resources in the extreme event that they are saturated during a pandemic. That framework must: be informed by comprehensive engagement with the public and developed in conjunction with professionals across healthcare, law and ethics, as well as with regulators of healthcare professionals set out clearly established triggers for its use, based at least in part on a UK-wide system that measures critical care capacity strain and facilitates mutual aid (such as the CRITCON tool used in England) establish clinicians’ legal and professional duties in applying the framework, which should be clearly explained to clinicians through guidance be regularly reviewed with reference to contemporary patient data during a pandemic, and any future use of it must be evaluated and reported on publicly. A plan and timeline for completing this work should be published within six months of this Report. Application of the framework should be tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6). Recommendation 8: Systematically recording and publishing healthcare worker deaths The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with their respective public health agencies and healthcare employers to develop nation-specific mechanisms to collect, analyse and publish data systematically on the deaths of healthcare workers in the event of a pandemic outbreak. The UK Statistics Authority should work with data providers to ensure that the data are comparable across the four nations of the UK. Recommendation 9: A standardised process for advance care planning across the UK The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with trusts and health boards, should establish and promote one standardised process across the UK (such as ReSPECT, the Recommended Summary Plan for Emergency Care and Treatment) for clinicians to ascertain and record their patients’ wishes and preferences for future care and treatment in order to inform individualised decision-making, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices. Recommendation 10: Psychological and emotional support for healthcare workers The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with healthcare employers and professional bodies, should put in place plans to deliver effective support for healthcare workers at scale from the outset of a pandemic. Plans should cover the nature and level of support that will be provided during and after a pandemic. All four governments should develop a programme of peer support visits that can, from the outset of a pandemic, be targeted towards areas of acute hospitals under considerable strain. The purpose of the visits should be to support front-line staff, collect insights on the pressures that healthcare workers are facing and understand what further support they might need. See also: UK Covid-19 Inquiry Module 1: The resilience and preparedness of the United Kingdom Covid-19 Inquiry: Module 2, 2A, 2B, 2C Report – Core decision-making and political governance

Patient safety culture is crucial to ensuring the quality and safety of healthcare. Assessing safety culture raises awareness of patient safety, identifies areas for improvement, and supports tracking changes over time. Given the increasing growth of home care, the complexity of care, and its unique characteristics, understanding safety culture in home care is essential to informing practice and guiding further research. This study aimed to identify instruments used to measure patient safety culture in home care, including its associated factors and outcomes.

In this blog for the Care Quality Commission, Professor Bola Owolabi, Chief Inspector of Primary Care and Community Services, discusses the State of Health and Adult Social Care in England 2024/25 report.

Right Care, Right Person (RCRP) is an approach that is aimed at ensuring that people of all ages who have health and/or social care needs, are responded to by the right person, with the right skills, training, and experience to best meet their needs. Home Office and Department of Health and Social Care (DHSC) analysts evaluated the implementation of RCRP through a rapid process evaluation covering police, fire, health and social care services. The findings highlighted the importance of communication, openness and transparency across agencies when implementing RCRP. While generally supportive of RCRP principles, participants highlighted some implementation challenges, such as capacity limitations for health and social care services. Early data monitoring showed a reduction of police time spent on health-related incidents post RCRP implementation. Recommendations to support the implementation of RCRP are included.

The Public Services Ombudsman for Wales has powers under the Public Services Ombudsman (Wales) Act 2019 to undertake ‘Own Initiative’ investigations, where evidence suggests that there may be systemic service failure or maladministration. Four local authorities were included in the investigation: Caerphilly County Borough Council, Ceredigion County Council, Flintshire County Council and Neath Port Talbot Council. The investigation considered: Whether the local authorities being investigated were meeting their statutory duties under the Social Services and Well-being (Wales) Act 2014 and its Code of Practice and The Care and Support (Assessment) (Wales) Regulations 2015. Whether those entitled to a carer’s needs assessment were being made aware and understand their right to request a carer’s needs assessment. Where carers’ needs assessments are commissioned, whether those assessment services are being delivered appropriately and whether local authorities appropriately monitor the contracting arrangements. Whether carers’ needs assessments, including those completed by commissioned service providers, are undertaken in accordance with the Social Services and Well being (Wales) Act 2014. The investigation considered evidence provided by each of the Investigated Authorities, in the form of documentary evidence and evidence from staff, evidence from commissioned service providers and their staff, evidence from those with lived experience of having their needs as carers assessed and evidence from other organisations. Advice was also sought from one of the Ombudsman’s professional advisers The investigation found: Between 10% and 12% of the population (over 5 years old) in the Investigated Authorities identified as a carer in the 2021 Census. Only 2.8% of the carer population in the Investigated Authorities had their needs assessed. Only 1.5% of the carer population in the Investigated Authorities had an assessment that led to a support plan. Many carers are not aware of their rights and are unaware of the support that may be available to them. There was evidence of carers not being fully informed of their rights by the Investigated Authorities. In some instances, carers were signposted to commissioned service providers without being informed of their rights. Carers’ needs assessments are referred to by different names, which caused confusion amongst carers and carers were sometimes unaware that their needs had been assessed. There needs to be consistency in the language used. There is lack of clear information about the process of assessment, the role of commissioned service providers (where applicable), what carers may expect from the assessment and how carers may be supported following an assessment. This would enable carers to make an informed decision about whether to have their needs assessed. Where they are undertaken, carers’ needs assessments at the Investigated Authorities are generally being completed appropriately, with the exception of young carers’ needs assessments in Ceredigion and Neath Port Talbot. Some improvements could be made to the recording of carers’ needs assessments, including the involvement of the cared for person (where feasible), the extent the carer is able and willing to provide care and the carer’s wishes in terms of work, education, training and leisure. There is a need to implement quality assurance audit processes for completed carers’ needs assessments in Caerphilly, Ceredigion and Neath Port Talbot council areas. There are discrepancies between the Investigated Authorities in the way that support provided to carers is recorded. Improved, consistent and comparable data collection could enable better analysis to drive improvement, monitor progress and identify areas in which further improvements are necessary. Carers must be offered advocacy – the decision on whether an advocate is needed is not one for the staff completing assessments to make, nor is it appropriate for the staff member to consider themself to be the advocate. The appropriateness of Direct Payments for carers is variable and 3 of the Investigated Authorities need to ensure that Direct Payments are something the carer is able to manage, with this being reviewed if circumstances change. The SSWB Act places a duty on both local authorities and health services in respect of carers. Collaboration and joint working between health services and local authorities in relation to carers and their rights is essential and should be strengthened. The recording of equality data relating to carers is limited and inconsistent at the Investigated Authorities.

A King's Fund long read reflecting on the UK's Autumn Budget. Headline announcements Real-terms increase in core local government spending power of around 3.2%, including £600 million of new grant funding to support social care (for both adults and children’s services) and a £86 million increase to the Disabled Facilities Grant. Total health spending increases by 3.8% a year on average in real terms between 2023/24 and 2025/26. This includes a 3.4% increase to day-to-day (resource) spending on items like staff salaries and medicines, and a 10.9% increase in capital investment on items like buildings and equipment over this period. Disincentivising activities that cause ill health by renewing and increasing duties on tobacco-related products and the Soft Drinks Levy. Increases to the National Living Wage and National Insurance Employer Contribution costs, which will particularly affect non-public sector employers.

The 'State of Care' is the Care Quality Commission (CQC) annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve. Areas of specific concern The 2023/24 report highlights some areas of specific concern. The concerns involve issues around safety, quality, workforce, and inequalities, including: Too many women are still not receiving the high-quality maternity care they deserve. Of the 131 locations we inspected in our national maternity inspection programme, almost half were rated as either requires improvement (36%) or inadequate (12%). We have concerns that children and young people are not always able to access services in a timely way – both planned and in an emergency. Anecdotal evidence suggests that parents and carers are well placed to recognise when their child is very unwell, but many feel they are not being listened to. The number of health visitors, who give individual support for young children and their parents, has declined by 45% over the last 9 years. Only around a quarter of people with a learning disability were recorded on the learning disability register, which means that many people are missing out on the proactive care and treatment they are entitled to. Despite fewer new referrals for autism diagnoses over 2023/24, the average waiting time to start an assessment reached a peak of nearly a year (328 days) in April 2024, rather than the recommended 3 months. People in Black or Black British ethnic groups are over 3 and a half times more likely to be detained under the Mental Health Act than people in white ethnic groups. Work on our cross-sector dementia strategy is highlighting the compassionate care and initiatives that are improving people’s lives, but staff do not always understand the specific needs of people with dementia.

This analysis from Age UK finds that 2 million older people in England are now living with some unmet need for social care. Drawing on the latest available data, the report concludes that England’s health and care services continue to be under enormous pressure so that, despite the best efforts of many dedicated staff, they are currently unable to meet the needs of all the older people presenting who require treatment, care and support.

This review by the UCL Institute of Health Equity (IHE) concludes that racism damages health and wellbeing and drives inequalities in London.  Racism in the capital is widespread and persistent causing damage to individuals, communities and society as a whole. Its impacts are experienced in different ways and to varying levels of intensity related to individual experiences, socioeconomic position and other dimensions of exclusion such as disability, age and gender. The intersections with other dimensions of exclusion can amplify the effects of racism. The focus of this review is on the effects of racism on health and its contribution to avoidable inequalities in health between ethnic groups – a particularly unacceptable form of health inequity. It is urgent that society tackle the damage to health and wellbeing as a result of racism. The review is part of a series of evidence reviews funded by the Greater London Authority (GLA) to build the evidence for reducing health inequalities in London through action on specific social determinants of health. The other three reviews cover housing, the cost of living and adult skills.

This service model brings together the good practice taking place in local areas, and that  which has previously been described for this group of people. It recognises that improvements  are typically underpinned by visionary leadership, a focus on human rights based approaches,  workforce development, co-production and a preparedness to reflect and learn. It aims to support  commissioners across health and social care to work together to commission the range of services  and support required to meet the needs of this diverse group.

This framework sets out what good digital working looks like for care providers and local authorities with responsibility for adult social care in England.

As the NHS is approaching its 75th birthday, this report from the Tony Blair Institute for Global Change proposes how the NHS needs to transform if it is to survive. The paper propose six areas for reform where radical-but-practical policy action will begin to transform the future of the NHS and deliver better patient care: 1. Put patients in control of their own health: First, the government must provide every person with a digital Personal Health Account (PHA) that offers a simple, single digital front door to the NHS and wider health-care services. It will become the portal through which people interact with the NHS, allowing patients to have direct access to services, including general practitioner (GP) appointments, at-home diagnostic services and even opportunities to participate in clinical trials. Most importantly, it will give people direct access to and ownership of their health data, including information provided by third-party providers or wearable technologies. 2. Create new access routes for services and providers: The range and availability of health-care services must increase to reflect citizens’ demands and their increasingly complex needs. Pharmacies, gyms, supermarkets, workplaces and other spaces should all be able to provide or facilitate the provision of health care, bringing services closer to patients and reducing demands on general practice. Most importantly, the PHA will create a new marketplace for services. This should focus on high-volume, low-complexity services – for instance dermatology – to make them directly available to patients. Introducing multiple providers, including third parties, will offer patients greater choice through the ability to balance outcomes, waiting times and costs. 3. Harness the power of genomics and other “omics” platforms to personalise care: The NHS Genomic Medicine Service should be made accessible to more patients for a greater range of conditions to improve early diagnosis, prevention and treatment. Specifically, universal clinical whole-genome sequencing should be offered to all patients upon disease diagnosis, all newborns and all healthy populations with known risk factors, including a family history of disease. As science progresses, other omics disciplines such as proteomics and metabolomics, should be integrated into routine clinical care, to improve the prevention, management and treatment of disease. 4. Create a locally led and self-improving system: There must be a new deal for accountability and autonomy between Whitehall and the Integrated Care Systems (ICSs). This must allow local leaders to operate with much greater freedom and hold them to account for delivering a set of clear and transparent outcomes focused on creating and improving health, rather than simply treating sickness and delivering against activity targets. ICSs should also be given multi-year budgets that are adjusted for the needs of their local population. And they should be allowed to keep and redeploy savings from innovating and improving care. Finally, quality and care outcomes should be made transparent and available to patients to empower them to make an informed choice between GPs and secondary care providers within an ICS. 5. Invest in new and more efficient infrastructure to deliver better care: NHS productivity and efficiency must be transformed through investment in basic technology as well as increasingly powerful AI, and by enhancing existing infrastructure. This will require upfront investment but will be offset, at least in part, through increased automation of processes and by finally tackling wastage across the system. The future operating model we are setting out in this paper will be much more capital intense, much more efficient and much less reliant on labour. 6. Energise and modernise the NHS workforce: The new NHS Long Term Workforce Plan is welcome and will provide much-needed investment to help create a pipeline of future talent, increase long-term capacity and provide new training routes to increase workforce diversity across the NHS. However, the NHS is facing an immediate workforce crisis with concerns over staffing pressures and pay that must be resolved. In addition, putting more staff into an outdated and unproductive delivery model is not sustainable and much greater focus is needed on harnessing the potential for technology to improve the efficiency of services, help to reduce the demands on frontline services and improve outcomes for patients. In addition, a comparable commitment and long-term plan is needed for social care and public health to create fully supported health and care services.

Report, together with formal minutes relating to the report. Three years after the start of the COVID-19 pandemic, the Department of Health and Social Care (the Department) has spent £14.9 billion of public money overpaying and over ordering significant volumes of Personal Protective Equipment (PPE), COVID-19 medicines and vaccines. The Department will never use a significant proportion of the PPE purchased, which will end up being burnt at a significant cost to the taxpayer. The PPE storage costs remain high and were nearly £200 million in the first 9 months of 2022–23 and the Department estimates that its future storage and disposal costs for unusable PPE will be approximately £319 million. The UK Health Security Agency (UKHSA) became fully operational on 1 October 2021, in the midst of the pandemic. There were significant issues in setting up this new organisation and the Department failed to appropriately support UKHSA during this process. This led to a fundamental absence of governance arrangements and controls. Non-executive directors were not appointed until April 2022 and UKHSA’s financial controls and processes were so poor that the organisation could not prepare auditable accounts for the 2021–22 financial year. This resulted in the Comptroller and Auditor General (C&AG) disclaiming his audit opinions. UKHSA faces a significant challenge implementing strong financial controls and processes and the Department must provide sufficient support and oversight to achieve this. Over the last few years, there have been repeated governance and financial control failings across the Departmental group leading to a number of qualified accounts. This has undermined Parliamentary accountability and resulted in the Departmental group incurring expenditure without Parliamentary approval. The Department has also been unable to lay its accounts before the summer recess, only just managed to do so before the final statutory deadline. It has not yet got a credible plan to return to laying its accounts before the summer recess. The Department must strengthen its governance and financial controls and set out a clear plan to restore timely accountability across the Departmental group. To do this, the Department must work with NHS England and local auditors to restore timely financial reporting across the NHS.

Visits from loved ones are vital to the health and wellbeing of people receiving care in care homes, hospitals and hospices. There have been concerns about visiting restrictions in health and care settings for several years, and the restrictions introduced in response to the COVID-19 pandemic exacerbated these concerns. While those restrictions were in place at the time to control the risk of transmission and keep people safe, it was detrimental for loved ones to have been kept apart or not to have had someone supporting them in hospital. Guidance is now clear that visiting should be encouraged and facilitated in all circumstances. This consultation seeks views on introducing secondary legislation to protect visiting as a fundamental standard across CQC-registered settings so that no one is denied reasonable access to visitors while they are resident in a care home, or a patient in hospital or a hospice. This includes accompanying people to hospital appointments (outpatients or diagnostic visits). Related reading on the hub: Visiting restrictions and the impact on patients and their families: a relative's perspective It’s time to rename the ‘visitor’: reflections from a relative

The Care Quality Commission (CQC) State of Care is an annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve. Access to care Getting access to services remains a fundamental problem, particularly for people with protected equality characteristics. Along the health and care journey, people are struggling to get the care they need when they need it. Record numbers of people are waiting for planned care and treatment, with over 7 million people on elective care waiting lists in June 2023. But the true number of people could be much higher, as some people who need treatment are struggling to get a referral from their GP. In the community, people are facing ongoing struggles with getting GP and dental appointments. As a result, some people are using urgent and emergency care services as the first point of contact, or not seeking help until their condition has worsened. Once at hospital, people are facing longer delays in getting the care they need. In 2022, over half (51%) of respondents to our urgent and emergency care survey said they waited more than an hour before being examined by a nurse or doctor, up from 28% in 2020. Insufficient capacity in adult social care is continuing to contribute to delays in discharging people from hospital. Ongoing staffing and financial pressures in residential and community services are having an impact on the quality of people’s care, with some at greater risk of not receiving the care they need. Quality of care Increasing demand and pressures on staff are taking a toll on their mental health and wellbeing. Staff have said, without the appropriate support, this is affecting the quality of care they deliver. Many people are still not receiving the safe, good quality maternity care that they deserve, with issues around leadership, staffing and communication. Ingrained inequality and the impact on people from ethnic minority groups remains a key concern. The quality of mental health services is an ongoing area of concern, with recruitment and retention of staff still one of the biggest challenges for this sector. Innovation and improvement varies, but the use of artificial intelligence (AI) in health care has the potential to bring huge improvements for people. Given the speed of growth of AI, it is important to ensure that new innovations do not entrench existing inequalities. Inequalities Midwives from ethnic minority groups say that care for people using maternity services is affected by racial stereotypes and a lack of cultural awareness among staff. They described a ‘normalised’ culture where staff tolerate discrimination from colleagues, and say they are less likely to be represented in leadership and managerial roles. People from ethnic minority groups who have a long-term condition felt they were talked down to about their treatment and were not treated as individuals. They also said a lack of cultural competency was a barrier to receiving good quality care. These people were also more than 2.5 times more likely to say that staff in the emergency department talked as if they were not there, compared with people in White ethnic groups who did not have a long-term condition. Failures in the system and a lack of funding can mean that budgets are prioritised above truly person-centred approaches to support in supported living services. The health and care workforce Staff regularly fed back that they are overworked, exhausted and stressed – sometimes to the point of becoming ill, injured or leaving their job altogether. They say this can affect their ability to provide safe and effective care to people. Just over a quarter (26%) of NHS staff were satisfied with their level of pay. This is 12 percentage points lower than before the pandemic. Dissatisfaction with pay is linked to industrial action by healthcare staff during 2023. In adult social care, some providers are struggling to pay their staff a wage in line with inflation. Over half of the respondents of adult social care providers in England said they were having challenges recruiting new staff, and 31% said they were having challenges in retaining them. Despite this, there has been a steady decrease in staff vacancy rates for care homes, from 11% in January to March 2022 to 7% in April to June 2023. In 2022/23, approximately 70,000 people arriving to work in the UK from overseas started direct care roles in the independent adult social care sector, compared with around 20,000 in 2021/22. Providers of adult social care services have told us that recruiting staff from overseas has enhanced the diversity and skills of their team and helped resolve staffing issues. But there is a growing trend of unethical international recruitment practices. In 2022/23, we made 37 referrals for concerns regarding modern slavery, labour exploitation and international visas – more than 4 times the number made in 2021/22. Deprivation of Liberty Safeguards There are ongoing problems with the current Deprivation of Liberty Safeguards (DoLS) system that have left many people who are in vulnerable circumstances without legal protection for extended periods. Systems The way health and social care works in England has changed significantly over the past year, with new integrated care systems now formalised. Local systems should now implement plans to address unwarranted variations in population health and disparities in people’s access, outcomes, and experience of health and social care. Local authorities are tackling workforce problems in adult social care and trying to address gaps in care as they plan for the future. But they will need to demonstrate an understanding and preparedness for the changing and complex needs of local populations. Assessing carers’ needs is vital. Carers, including many unpaid carers, are a critical part of all local care systems and they are not always getting the support they need – there is variation across the country and many carers are facing financial problems.

The Patients Association spoke to Christiana Melam, Marie Adams and Susan Leach during Patient Partnership Week to talk about all things to do with social prescribing.  Christiana is the Chief Executive of the National Association of Link Workers, the UK's professional network for social prescribing link workers. She is an advocate for diversity, inclusion, coproduction, bottom-up approaches, social justice, empowering people and reducing inequality. Marie is a social prescriber, and Susan is a patient who has used social prescribing as part of her healthcare. Susan talked candidly about the relationship with Marie and how Marie has helped her cope with some serious challenges in her life. 

This report presents findings from a rapid evidence review into improvement cultures in health and adult social care settings. The review aims to inform CQC’s approach to assessing and encouraging improvement, improvement cultures and improvement capabilities of services, while maintaining and strengthening CQC’s regulatory role. It also identifies gaps in the current evidence base.