Care Responds to CQC Report as Crisis Deepens
Care sector leaders have reacted to the CQC’s stark State of Care report published today, warning that the regulator’s findings on chronic workforce shortages, funding pressures and system fragmentation merely scratch the surface of the existential crisis facing residential and nursing care homes.
The report, which highlights adult social care vacancy rates running three times higher than the wider jobs market and reveals providers are increasingly handing back contracts due to unsustainable costs, has intensified calls for immediate government action on the promised fair pay agreement and long-term sustainable funding ahead of the Casey Commission.
Director of Policy and Research at the Health Foundation, Dr Hugh Alderwick, said:
“Over a year into the new Labour government, health and care services are still under massive strain. Too many people are waiting too long for care or struggling to navigate fragmented services.
“Gaps in care outside hospitals are pervasive – with shortages of staff in district nursing, community mental health services, social care, and general practice. GP numbers are lower in poorer areas, where health care needs are higher. All this can leave people without the support they need in the community and make it harder to free up space in hospitals.
“Labour is right to talk about shifting care out of hospital and strengthening care in the community. But – a year in – our analysis shows how far the government is from having a coherent policy agenda to make these promises a reality. Detail on how change will happen is lacking and resources to deliver reform are limited. A more concrete plan is now needed – including for rapidly testing and evaluating innovations that could improve local services.
“The CQC is right to call for investment in social care. The current social care system in England is a threadbare safety-net in desperate need of reform and investment. We estimate that meeting demand for care, covering rising costs, improving access to services, and making a meaningful and much needed improvement to care workers’ pay could cost an extra £8.7bn in 2028/29. But government funding promised for social care so far will barely be enough to meet people’s needs and cover a slight boost to pay and conditions.”
Caroline Abrahams, Charity Director at Age UK and co-chair of the CSA says:
“The last sentence in the press release accompanying this report is arguably one of the most important: in it the CQC repeats its call for long-term sustainable funding for social care, an objective we strongly share. In the meantime, the report is full of examples of the harm being caused to people and to any hope of building a truly effective health and care system without it. The Government’s ambitions to move care out of hospitals and into the community, tackle delayed discharges and meet the 18-week standard for elective care will ultimately fail.
“We have warmly welcomed the establishment of the Casey Commission and we are committed to helping in any way we can, but the report acknowledges that the full solution to the problems facing social care ultimately lies in the hands of politicians and in how they respond to the Commission’s findings in due course. As the work of the Commission gears up we need politicians on all sides to demonstrate their support for the process, so people who use social care can be hopeful that it will generate real change.”
Nuffield Trust Fellow Camille Oung said:
“This report lays bare the extent of the huge pressures facing almost every part of the health and care system. In particular, it reveals what an uphill struggle the government’s planned shift from hospital to home will be in the context of community services already struggling to deliver timely care.
“Almost 1.2 million people are waiting for NHS community care and 1 in 4 children on this list wait over a year for their treatment. Other countries which have tried to make this shift happen, such as Denmark and Ireland, have shown how important it is to invest in community services in parallel with hospitals – without additional funding it is extremely difficult.
“Our work to understand the progress made by integrated care systems in delivering key government priorities highlights that, while there are examples of good practice, financial and workforce barriers are still standing in the way of delivering tangible improvements across the board. It is striking that over a quarter of the system leaders we surveyed are not at all confident in their system’s ability to deliver the government’s ambitions to move care from hospitals to community or shift care from sickness to prevention.
“The CQC has also added to mounting evidence that the social care sector is under severe strain and still overreliant on overseas recruits. As tighter immigration restrictions kick in, this is becoming increasingly risky and firm plans to boost the domestic workforce won’t take effect until 2028/29 at the earliest.
Dr Layla McCay, director of policy at the NHS Confederation, said:
“Community services including primary care are a key part of the integrated neighbourhood health teams (INTs) that sit at the heart of the government’s ambitions to move more care out of hospital and closer to people’s homes. But, like the rest of the NHS, they are under significant pressure due to rising demand for care, often from patients with multiple or more complex conditions.
“As the CQC rightly points out, achieving the goals set out in the government’s Ten-Year Health Plan will require a shift in resources from hospital into primary and community care. Without this shift, community services will not be able to boost capacity enough to deliver the transformation the government and our members recognise as vital for putting the NHS on a sustainable footing.”
Sarah Woolnough, Chief Executive at The King’s Fund, said:
‘This report highlights that lack of access to community services is driving some people to seek care in A and E, and sometimes not seek care at all. A finding echoed in our recent NHS admin report, which shows issues of navigating the system can put people off seeking care altogether.
‘The government is absolutely right to want to shift the focus of the NHS from hospital to community, but that ambition is not new. Despite multiple attempts to move more care into the community, the focus of government remains on hospital care and waiting times targets. For the shift to happen successfully, the government must be clear that there will need to be trade-offs, with both more focus and more investment in primary and community services so that people can get the care they need to keep them living well wherever they live.
‘The social care system will also need to be better staffed, organised and funded than it is now. The CQC report highlights concerns about the high vacancy rate in adult social care, particularly in home care, which is a vital component of effective care in the community. It is also concerning to hear further evidence of how shortages in health and care staff in rehabilitation and reablement services is affecting how quickly people recover after hospital stays and are able to return to independent lives in their communities.
‘The picture in this report is not universally bad. The report states there are some positive examples of where health and social care services are working together to put people first. However, there is a real risk that these good news stories will remain isolated examples of local change unless the government ups its game on tackling the underlying causes of ill-health and picks up the pace on reforming adult social care.
‘The CQC has faced criticism in recent years from both politicians and the organisations it regulates and this week its chief executive has stood down. We have seen all too often what happens when our health and care providers fail the patients and public they are meant to serve. This only emphasises how an independent regulator, which assesses the quality of care without fear or favour, can have an incredibly powerful role in our health and care system. As the CQC undergoes a period of reform, I hope it can rapidly regain public confidence that it is capable of enhancing safety, raising standards, and improving the quality of the health and care services we all rely on.’
Vic Rayner, CEO of National Care Forum commented:
“This year’s report contains no major surprises in that it identifies that considerable pressure remains in the system. What we said in response to last year’s report unfortunately still stands.
“If the government is serious about its three-fold shift to prevention, it must ensure investment reaches the community care and support services that people need to live well. When resourced and organised properly, care and support enables people to live the lives they want, supports them to access wider community and health services at an earlier stage and helps them retain their independence for longer in strong communities – this ultimately reduces demand on acute services.
“What should be of major concern to policymakers is the increasing fragility of care and support services, particularly those providing services for working-age adults where demand has increased markedly over the last four years, but largely without the resources to meet this.
“We urge government to take note of the warnings contained in this report. The adult social care system needs a strong infrastructure to ensure it is able to support people, and providers alone can’t fix that.
“It will need local government and NHS commissioners to play their part as well in changing the way we do things. These are lessons that must be taken on board by the Casey Commission as it lays out a vision for what a National Care Service might look like. We need to ensure that commissioners and providers alike are supported and resourced to work together to provide the care and support people need and want.”
Minesh Patel, Associate Director of Policy and Influencing at Mind, said:
“This report makes clear that without the necessary investment the government will not realise its ambitious plans to shift care from hospital to community, outlined in the 10-year plan. Without proper resourcing and staffing, services risk being overwhelmed by demand, with the most marginalised groups bearing the greatest impact. But the report shows the difference that trauma-informed, person-centred care can make to people living with mental health problems.
“We also need to turn the tide once and for all on inequities in mental health care, particularly with Black men who continue to face pervasive barriers to accessing services including stigma and a lack of culturally appropriate care. The CQC has highlighted the importance of the Patient and Carer Race Equality Framework (PCREF) as a tool to tackle racism and dehumanisation, but there is poor awareness and a lack of consistency in applying it in mental health inpatient settings – this must change. This must form part of the wholesale cultural change we need to see to mental health services, including reforms to the Mental Health Act to tackle racial inequities.”
Kathryn Marsden OBE, Chief Executive of SCIE, said:
“The demand for social care is rising faster than the sector can respond. Local authority budgets have not kept pace with the growing complexity and volume of need, leaving many without the support to live safely and independently.
“The consequences of this growing strain are felt most acutely by those already facing disadvantage. This report provides further evidence that people living in the most deprived areas often experience poorer outcomes and encounter greater barriers to accessing care. Older people, people with dementia, people with learning disabilities and autistic people, and people with complex mental health needs are also struggling to navigate services and access the support they need.
“The inequities are deeply embedded in our health and care systems. Unless we focus on understanding and tackling the root causes, people who draw on social care will continue to face challenges in accessing care that meets their needs. As we work to reform social care for the long term, one clear priority must be to build a system that is fairer for all.
“The rise in Deprivation of Liberty Safeguards notifications illustrates the pressures facing the system. In 2024/25, there were over 185,000, a 15% increase on the previous year. Many people wait far longer than statutory timeframes for authorisations, leaving them at risk of being deprived of their liberty without the protections the law intends. We welcome the major changes to safeguarding and protections under the proposed Liberty Protection Safeguards, which are needed to break the current norm where many people are still not receiving the important safeguards they require.
“Community health and care services need immediate and sustained investment to meet these challenges, empower people to live with independence, dignity and purpose and support the delivery of the government’s NHS ambitions. This is a crucial step in establishing a resilient and sustainable system that is capable of protecting people’s rights and contributing to a fair and equal society.
Emily Hindle, Head of Policy at Alzheimer’s Society, said:
“The Care Quality Commission (CQC)’s latest report once again shines a light on the well-documented health and social care challenges faced by people living with dementia in England.
“Dementia is a progressive and complex condition which affects everyone differently. People with dementia have told us time and time again that they need quality, personalised care that meets their unique needs, provided by a workforce trained in dementia. Shockingly, however, only around a third of care workers in England have received dementia-specific training.
“CQC’s report makes it clear that urgent steps are needed to improve care and support for people living with dementia. It also highlights how people are waiting too long for a diagnosis, which risks them missing out on care, support and treatment in the first place.
“These findings reinforce the need for early and accurate diagnosis, mandatory dementia training for care workers, and wider social care reform.
“It’ll take a society to beat dementia, and we remain committed to working closely with the CQC in developing their dementia strategy to ensure that everyone living with dementia receives the high-quality healthcare and social care they deserve.”
Professor Martin Green OBE, Chief Executive of Care England, said:
“The report has painted a clear picture of the sector’s ongoing and growing challenges in workforce recruitment, funding pressures, integration with health services and equality of access. This has reached the point where the report has highlighted that care providers are already handing back contracts with local authorities, as rising costs are continuing to far outstrip the funding for care delivery.”
In another part of the report, good examples of the sector and advocates coming together to innovate were showcased, where Care England was praised as part of the Vivaldi Project, which has been measuring the spread of infectious diseases in care home settings.
Professor Martin Green continued: “It is incredibly heartening to see that this important project has been spotlighted in this report. Now that the Vivaldi project has been sharing its data with the NHS, it is enabling vital research that will help us understand the causes of hospital admissions in care, as one example. It is a testament that proper government investment in social care, and in projects like Vivaldi, will reduce pressure on the whole health and care system and allow us to provide proper joined-up services; another aspect of the system that the CQC’s report highlights needs improving.”
