Industry Reacts as CQC Warns of Growing Pressure on Social Care
Leading figures from across the social care sector have responded to the Care Quality Commission’s (CQC) latest State of Care report, warning of deep inequalities and that access to care remains a major challenge as rising demand increasingly falls on unpaid family carers, while thousands of people struggle to obtain the support they need.
Although the report points to some improvement in health and care services and hospital waiting times, concerns remain over the sustainability of the wider care system, particularly the continuing loss of smaller care homes, with around 1,500 closing since 2012.
Industry representatives are now highlighting the urgent need for a sustainable, properly funded social care system that can meet growing demand, support unpaid carers and protect the diversity and capacity of care provision across England.
Hugh Alderwick, Director of Policy and Research at the Health Foundation, said: ‘Today’s CQC report illustrates the massive pressures on the NHS and social care in England that risk becoming normalised – with too many people waiting too long for care and inequalities right across the health and care system. The report points to progress in some areas, like people’s experience of general practice. But the government is a long way from achieving the fundamental changes in the NHS and social care that it promised at the last election.
‘The report lays bare the massive challenges facing social care. Too many people struggle to access the care they need and face unacceptable variations in the quality of care varies too. These problems are not new. Decades of political neglect and underfunding have left an overstretched workforce being asked to hold a threadbare system together.
‘The prime minister’s commitment to reforming the sector and the Casey Commission’s work provide an opportunity to fundamentally redraw the state’s offer on social care in England over the long-term. But change is needed now to help strengthen the fundamentals of the system. Councils need enough funding, the right skills, and strong leadership to shape local care services around people’s needs, support prevention, and tackle inequalities in access to care.’
Care Quality Commission’s 2026 State of Care Report, Dominic King-Carter, Director of Policy at Carers Trust, said: “This year’s State of Care report sees the CQC make it clearer than ever that access to care is the biggest obstacle they see across the country. This means that so much of the demand for care is being passed on to unpaid carers – something the local carer services in our national network see on a daily basis. As the report suggests, no carer should feel “forgotten about” by their local council, and we know that the real-world impact of managing complex caring relationships without the right support is poverty, poor mental and physical health, or even suicide.
“Importantly however, the report also offers hope. It notes that simple changes to language could allow carers to better recognise themselves and stop local authorities, policymakers, and Government placing responsibility on individual carers, rather than the systems that are supposed to support them. We are continuing our work to challenge the narratives that act as barriers to unpaid carers, and rethink and reframe terms like “hidden carer” and “eligible needs” that the report rightly identifies as doing more to hinder meaningful changes for carers than drive them forward.”
Rachael Dodgson, chief executive of Dimensions said: “CQC’s finding that unequal access to support for adults with learning disabilities and autistic people is often accepted as routine should deeply concern us all. Behind those delays are people waiting for the support they need to live independently and play a full part in their local community.
“CQC’s findings also highlight the urgent need for a more strategic approach to shaping the adult social care market. It is important that people’s wellbeing comes before financial returns. Sustainable, high-quality support depends on commissioners and providers working together to balance financial realities with the needs, choices, and aspirations of people who draw on care and support.
“We welcome CQC’s recognition that commissioning is one of the most powerful ways to improve quality, fairness, and sustainability. Too often, short-term funding decisions and repeated re-tendering undermine the stability and consistency of support, disrupting relationships that are fundamental to people’s wellbeing and independence.
“CQC is right to highlight the importance of strong leadership in delivering safe, person-centred support. We know that maintaining high standards requires continuous investment in our managers and colleagues, supported by commissioning arrangements that reflect the true cost of delivering quality care.
“We are also encouraged that around 80% of people aged 14 and over on GP learning disability registers received an annual health check in the year to March 2026. However, uptake varies significantly across the country, ranging from 70% to 86% between integrated care board areas. Far too many people with learning disabilities also remain absent from GP registers altogether. Access to annual health checks should be consistent, regardless of where someone lives or which GP they attend. Crucially, every health check should result in a completed, accessible health action plan, with appropriate follow-up.
“CQC’s central challenge to the sector is to move beyond good intentions and individual examples of good practice towards consistently well-led services that can demonstrate sustainable, personalised outcomes. Ultimately, regulatory accountability from CQC is a key part of how adult social care makes lives better for people who draw on care and support.”
Siva Anandaciva, Director of Policy, Events, and Partnerships at the King’s Fund said: ‘Today’s report brings some tentative signs of improvement in health and care services in England. There has been a slight improvement in waits for routine hospital care, and some local pockets of innovation where care feels less fragmented. However, this report more fundamentally highlights the persistent and deep inequalities in how people in England access and experience healthcare – it is still sadly the case that the care we receive depends on who we are and where we live.
‘The report rightly highlights variation in the rates of provision of publicly-funded long-term care, and shows just how far we have to go to create genuinely national care services. The government has placed reform of adult social care at the heart of its agenda, and these reforms should seriously consider a national funding and assessment model to ensure people get fairer access the care they need. Without these changes, many people will be completely shut out of the state-funded system and forced to pay all their care costs themselves.
‘Very few other comparable countries exclude people entirely in this way, yet the report finds that the proportion of ‘self-funders’ is increasing. Social care reforms must allow everyone to access some support, with people contributing to the cost according to their means.
‘There is also a stark contrast between adult services and children’s care. While some adult waiting times show signs of stabilising, waiting lists for children and young people – particularly for community care – sadly continue to worsen. The decline of specialist roles that provide vital early intervention, such as school nurses and health visitors, alongside growing levels of demand on mental health services, are leaving children waiting too long for support at a critical point in their lives.
‘The CQC have praised the work in Wigan, where the local authority has worked with the health and care system in partnership to reduce health inequalities. This example demonstrates what is possible, but the real lesson here is about a way of working rather than a simple solution that can be dragged and dropped to other parts of the country. It is vital that other systems are given more support to develop the culture, skills and headspace needed for improvement.
‘Without a sustained effort to focus on prevention and health inequalities, we are just responding to the symptoms and not addressing the root causes driving demand for services in the first place.’
Professor Martin Green OBE, Chief Executive of Care England said: “Responsible external investment in social care is essential. The sector needs capital for buildings, technology, workforce and new capacity. But consolidation cannot be mistaken for sufficiency. CQC tells us that small homes are achieving the strongest ratings while more than 1,500 have disappeared since 2012. We should not allow good smaller-scale provision – a marker of how much choice there is for those who need care – to be lost simply because it cannot absorb costs that commissioners do not meet.
“CQC’s 27% Market Oversight ‘profitability’ figure also needs to be understood properly. It is an EBITDARM measure, before major costs such as rent, depreciation and interest, and it applies to a selected group of large providers. It is not net profit, and it should not be used as shorthand for what the whole sector earns. Our Financial Health of SME Care Homes report shows the financial pressure behind this trend; wage costs have risen sharply, cash cover has reduced and payment delays have increased, while our stress testing shows that even relatively modest cost increases or reductions in fee income can push a significant proportion of smaller providers into financial distress and could explain why so many have left the market.”
Professor Martin Green continued: “Commissioning is not an administrative process sitting behind care; it directly influences the quality people receive. When fees lag behind costs, uplifts arrive late, payments are delayed or capacity is fragmented across contracts, risk is transferred from the commissioner to the provider and ultimately to the person in receipt of care.
We need national commissioning standards and a national plan for sufficiency so government, local authorities and the National Care Service can see where capacity is being lost and act before services become unviable. Commissioners must pay agreed fees on time, make uplifts effective from the date costs arise and base fees on the real cost of safe, good-quality care.
The same principle must apply to the Fair Pay Agreement. Better pay is essential, but the FPA will only strengthen care if every additional employment cost is fully funded through commissioning from day one. Providers cannot finance a national workforce settlement through thin cash reserves or by asking self-funders to subsidise public placements.”
Dr Jane Townson OBE, Chief Executive of the Homecare Association, said: “Homecare workers are delivering good or outstanding care in eight out of ten services the CQC has assessed, often in very difficult circumstances. That is a credit to them. However, the CQC is right to warn that the social care market is being reshaped by accident rather than by design.
“We are pleased the CQC has drawn on our research. Our evidence shows most councils buy an average of 500 hours of care or fewer a week from each provider – a third of the 1,500 hours a service needs to run efficiently.
“Care packages are spread thinly, capacity sits idle and providers are pushed towards people who pay for their own care simply to stay viable. Meanwhile, people with assessed needs wait for support and older people remain in hospital when they are ready to go home.
“Councils in England now pay an average of £25.37 an hour for homecare – £9.05 below our Minimum Price of £34.42, the lowest rate needed to pay care workers the National Living Wage and run a safe, regulated service. Not a single contract in our latest research met that Minimum Price.”
