The State of Care 2025: What providers need to know

The Care Quality Commission’s (“CQC”) State of Health and Adult Social Care in England 2024/25 (“the Report”) illustrates a sector under strain, with rising demand, workforce gaps, and financial pressures upon health and social care providers. While there are causes for optimism - for instance in the innovative use of technology - the Report’s message is cautionary. The policy drive to move care out of hospitals and into the community is accelerating but capacity, workforce capability, and data sharing are not yet aligned to make that shift a success.

This article highlights some key themes from this year’s Report and considers the potential regulatory implications.

High Demand and Congestion throughout the Sector

The Report underlines continued high demand and long waits across acute, urgent and emergency care, mental health, and local authority‑funded adult social care. Hospitals report high demand for beds and extended lengths of stay, with instances of delayed discharges remaining high. This congestion results in knock-on effects “across the whole system”.

The CQC’s discharge and readmission analysis reinforces that flow problems are deeply connected to capacity in the community. On any given day in March 2025, nearly six in ten medically fit patients experienced delayed discharge, often due to a lack of appropriate follow-on care. Older people and those in more deprived areas were more likely to be readmitted within 30 days, pointing to gaps in post‑discharge coordination and the availability of timely care in the community.

These issues - though long-standing - point to a key line of effort for the CQC in the coming year. It is likely that strengthened discharge to community care pathways, supported by multidisciplinary coordination, will be key to regulatory assurance in 2025/26.

Shifting Care into the Community: Capacity and Financial Issues

The Report endorses the policy intent of the government’s 10‑Year Health Plan to rebalance care towards neighbourhood and community services. However, the Report warns that community services currently lack the capacity, capability and data standards to absorb the shift at scale:

• Homecare is expanding in volume but fragmenting. An increasing share of the market is made up of very small providers who are often less financially resilient. The CQC’s Market Oversight data show profitability pressures and a reduction in care hours delivered among providers, with instances of local authority contracts being ‘handed-back’ due to financial issues.
• Analysis of local authorities shows both innovation and problems. Where services work well, there is close partnership between hospital teams and social care, supported by the Better Care Fund and use of assistive technology. Yet chronic homecare capacity gaps - especially for complex needs and in rural areas - continue to delay hospital discharges and limit a “home first” approach.

Providers operating in community services should give close consideration to their workforce strategy and financial resilience, as the regulator aims to ensure increased market stability.

Adult Social Care: Demand Up, Workforce Risks Rising

The Report shows demand for local authority‑funded social care has risen further, notably among working‑age adults. Staff vacancies have fallen from pandemic highs but remain around three times the wider economy, with vacancies in homecare being significantly higher than in care homes. The sharp drop in international recruitment and ending of new care worker visas, discussed in our previous article, raise renewed concerns about staffing sustainability. The CQC calls for a sector‑wide workforce strategy and effective implementation of a previously proposed fair pay agreement.

Providers should anticipate closer scrutiny of governance systems that ensure safe staffing. A regulatory focus may be upon contingency arrangements where homecare providers or care homes face workforce pressures.

Inequalities of Outcome Persist

The Report again documents unwanted variation in care quality across regions and systems. Patients in the most deprived areas face more difficulty accessing GP appointments and are more likely to attend urgent and emergency care as a result. Children and young people face sharply rising waits for community services, including neurodevelopmental assessments.

For providers, demonstrable action on equality of access, experience, and outcomes is crucial. The CQC will expect to see the use of data to identify problems and make reasonable adjustments for those who need it. The Report highlights groups including autistic people and people with a learning disability, who often struggle with healthcare access. The CQC also flags growing concerns around Deprivation of Liberty Safeguards (DoLS), as deprivation of liberty applications continue to rise significantly in hospitals and adult social care settings.

Leadership Change at the CQC

The recent resignation of Sir Julian Hartley as Chief Executive of the CQC raises questions about the regulator’s momentum behind its recent Business Plan and Consultation programme. The plan recognises the need to rebuild the CQC’s foundational capabilities, increase inspection and assessment throughout, and clear registration backlogs after a period of scrutiny for the regulator.

The Report highlights deep challenges throughout the health and social care sector and providers may reasonably ask whether the CQC’s own reforms will continue at their planned, ambitious pace (see our article concerning the CQC’s business plan and assessment framework consultation). We will be following further updates in the health and social care sector, and our team is on hand to assist with your regulatory queries.

Co-authored by Philip Gaffney, Graduate Solicitor Apprentice