The annual CQC state of health care and adult social care 2024/25 report runs to just over 200 pages this year. Published on 23 October 2025 there's a lot to digest!
There are three key chapters covering:
- Access and quality in health and social care services
- Inequalities and concerns for specific groups of people
- Local systems
The foreword, written by Professor Sir Mike Richards, Chair, and Sir Julian Hartley, now former Chief Executive, starts by commenting on how the system is “fragmented and under severe strain”.
It's wide ranging and not the cheeriest of reads:
- Community services: Described as needing more focus and “significant investment”.
- Community mental health: Given concerns about systemic issues across community mental health care, CQC have started a comprehensive inspection programme of these services for working age adults, crisis services, and health-based places of safety.
- Adult social care: They are hearing more providers telling them about handing back contracts to local authorities due to rising costs.
- Casey Commission: Noted to be an important milestone but CQC are concerned that it won't improve the core sustainability of adult social care which will be crucial to the delivery of the NHS 10-year health plan.
- Delayed discharge: They note little improvement since last year’s report speaking of system “gridlock” and note that, on any given day in March 2025, 6 in 10 patients who were ready to be discharged experienced a delay.
- Dementia: Their dementia strategy highlights how badly a clear, accessible, easy to navigate pathway of care between social care, community care and other health services is needed. Later in the report CQC note that the number of people being diagnosed with dementia is increasing.
- Coordination: They see too many instances where poor coordination between health and social care, inadequate information sharing and lack of digital integration are creating barriers to good care.
The summary then goes on to state that their work exposes issues about the readiness of the system for a shift to delivering neighbourhood care.
Statistics include:
- A&E: 1,809,000 people waited over 12 hours in 2024/25 - 10% more than in 2023/24.
- Social care: Vacancy levels three times higher than the wider job market.
- Dementia: Although more people are being diagnosed with dementia staff in health and social care don't always understand the specific care needs and providers don't always have the necessary knowledge of person-centred approaches and dementia friendly environments.
- Maternity: Underlying causes of poor care continued to fall short (so the national review presents a real opportunity for change).
There are many interesting points which come out of the main body of the report:
- AI in primary care: Although over four-fifths of GPs surveyed thought that AI will have a positive impact on general practice in the next five years less than half (42%) were using it. Respondents were concerned about several things including AI making errors (83%) and data protection and security (69%). The main barriers to adoption were limited funding (73%), unclear regulatory requirements (69%) and concerns over professional responsibility or liability (66%).
- Community healthcare: CQC have seen the risks of taking on too many referrals. One provider of district nursing services created lists for people who were prioritised for visits into critical or deferred but those who spent days on the deferred list ended up on the critical list as their health had deteriorated.
For more information on mental health, social care, maternity and deprivation of liberty safeguards you can read our summary sections below.
Mental health is covered in detail at pages 62-81 of the report.
Last year their rapid review of Nottinghamshire Healthcare NHS Foundation Trust highlighted concerns about systemic issues with community mental health care. Therefore, this year CQC started a programme of inspections of community mental health services. CQC report that providers noted higher levels of aggression and violence in community services and raised concerns that current system changes meant that what happened in Nottingham wasn't an isolated incident, and could happen again elsewhere.
Key points
- Demand for mental health services has continued to grow. There has been an average of 453,930 new referrals to secondary mental health services every month (an increase of 15% from 2022/23). There's a helpful table setting out recent growth at page 63.
- The number of new community treatment orders (CTOs) has continued to rise increasing by 17% from 2023/24 to 2024/25.
- There has been a steady increase in the number of people with serious mental illness who have accessed community mental health services at least twice in the previous year, rising to 11% from 576,081 in 2023/24 on average per month to 640,619 in 2024/25 on average per month.
- Several providers raised concerns around ageing estates that are increasingly not fit for purpose and don't meet the needs or safety of patients and staff.
- CQC have been told that a lack of collaboration between services and across the mental health system was their biggest challenge. Providers expressed frustration around poor communication and information sharing, including sharing care plans between providers.
- Another concern was too many IT systems in place that don't speak to each other.
- Both mental health providers and GPs expressed frustration and concerns around shared care protocols. This has been shared with Department of Health and Social Care and NHS England.
Social care is covered in a lot of detail at pages 44–61 of the report.
Key points
- New requests for local authority funded social care support rose by 4% in 2023/24 compared with the previous year, and by 8% compared with 2019/20.
- 37% of new requests from working age adults were advised to contact universal services.
- International recruitment has more than halved falling from 105,000 recruits in 2023/24 to around 50,000 in 2024/25.
- While the total number of care home beds registered with the CQC has remained unchanged over the past year, the rate per 100,000 people aged 65 and over has declined by nearly 2%.
- The number of adult social care locations that offer supported living services has increased by nearly half in the last two years from 2,612 to 3,823. However, CQC are still concerned about inconsistent quality.
- The volume of the homecare market made up by very small services (providing care to four people or fewer) has grown by 7% in the last two years, making up more than 28% of the market. CQC is concerned about their financial resilience.
- CQC are concerned that with local authorities around the country looking to make savings, it seems likely more will signpost people to support in the community, ration the care they do provide and reduce the provision of other statutory and non-statutory services. As well as negatively affecting the health and wellbeing of those in need, they fear that this could increase the pressure on the health and care system and the voluntary community and social enterprise sector, and further increase the burden on unpaid carers, never mind the wider societal costs.
- They note the range of activity taking place to drive change in adult social care such as the Independent Commission chaired by Baroness Casey, the Fair Pay Agreement the 10 Year Health Plan and the adult social care workforce strategy. However, they make the point that it's important that these are connected across government and the wider sector.
Substantial portions of the report are devoted to deprivation of liberty safeguards (DoLS) pages 13,17,121 and 155-159.
This year CQC ran a survey among Mental Capacity Act leads working in hospitals and heard from staff at over 40 trusts. They also worked to share the survey with independent hospitals and the independent provider safeguarding network.
As in previous years CQC are concerned and make the following points:
- We have raised serious concerns about the safeguards and the need for system-wide reform for several years. Applications to authorise the deprivation of a person’s liberty have continued to increase significantly over the last decade – far beyond the levels expected when the safeguards were designed.
- In a system struggling to cope, many people subject to DoLS authorisations are not having their rights upheld in the way that the system intended.
- We remain concerned that the current system is not effectively protecting the rights of many people who use health and social care services.
- Added to this, the level of understanding among staff of how and when to apply the safeguards, and the need to review restrictions regularly to ensure they remain relevant, continues to vary across both adult social care and hospital settings.
- Many of the issues we raise risk infringing people’s rights or even contributing to abuses of individuals’ rights. For example, this includes people being deprived of their liberty without legal protection while waiting for an authorisation.
- While some local authorities reported not having any DoLS backlogs, others were struggling to meet demand, and a few hospital providers told us that local authorities were not completing timely assessments or providing adequate feedback on the application process.
- The Association of Directors of Adult Social Services’ Spring survey shows that directors have the least confidence that their adult social care budgets will be sufficient to meet their legal duties in relation to DoLS in 2025/26, compared with other legal duties.
- Staff at one local authority outlined that lower risk assessments could take two to three years to complete. CQC are concerned that this poses a significant risk of people being unlawfully deprived of their liberty while they wait years for an authorisation. It may also increase inequalities for people who are more likely to be deemed lower risk, such as people with a learning disability or those living with dementia.
- A provider said their “biggest concern” is “patients being unlawfully deprived of their liberty because [local authorities] are unable to meet their legal obligations.”
- CQC also heard how a lack of consistency in how local authorities process DoLS applications can be difficult for providers to navigate.
- There remains a particular focus on staff understanding and application of DoLS. CQC report:
- This year, we continued to find examples of staff not properly understanding when DoLS is needed or failing to recognise and review restrictions appropriately.
- Many respondents to our survey of Mental Capacity Act Leads raised the need for improved training to enhance understanding of the Mental Capacity Act and therefore protect people’s rights. One noted the “poor application of knowledge to practice” even when this training forms part of the provider’s mandate for all staff. Examples like this one show that training alone is not enough, and it is important that staff can demonstrate that they understand what the requirements of the Mental Capacity Act and DoLS mean for the people they are caring for and are confident in applying this learning in their role. We have also found evidence of these challenges in our inspection activity.
- We continue to see examples in our inspection activity of providers not reviewing restrictions regularly to check if these remain proportionate. This could mean that people receive overly restrictive care or may remain deprived of their liberty for longer than they need to. Reviews could also show that a person needs enhanced safeguards. Not only does this represent a missed opportunity to improve care, but it also contradicts the principles of the Mental Capacity Act and means people’s human rights may be affected.
- We expect providers to apply for renewals in a timely way using the correct process, but we continue to find examples in our inspection activity of this not happening.
- We have also seen cases where staff did not always recognise restrictions, such as locked bedroom doors or people not being able to leave where they live without support from staff. When services stop recognising restrictions there is a risk that they become part of the culture. At one adult social care service, we observed staff applying restrictions on multiple residents without lawful justification
- At a service, while some members of staff demonstrated a sound understanding of DoLS, others were unable to explain what this means for people in their service. One member of staff simply said “I don’t know” when asked about DoLS. In that assessment, inspectors identified multiple areas of concern and issued six warning notices for improvements to be made in areas, including the need for consent.
CQC have welcomed the government’s recent announcement that it intends to take forward the consultation on the Liberty Protection Safeguards. They recognise that the sector will need time, resources and support to prepare for the introduction of the new system and they state that they will work with key stakeholders as part of this process. However they remind readers that during this process, it'll be vital that the human rights of people affected by the current DoLS system remain a focus.
CQC note the number of high-profile investigations over the last ten years into the quality of care at individual maternity services conducted by Dr Bill Kirkup and Donna Ockenden. They remind readers that their National Review of maternity services 2022-2024 found that issues identified in those investigations aren't confined to a few hospitals, but are widespread. They list the same themes as:
- Workforce challenges
- Lack of leadership and oversight
- Poor working cultures and siloed working
- Poor risk assessment
- Lack of communication
- Failures to investigate and learn when things go wrong
Their recent inspection reports continue to show challenges with risk assessments. Alarmingly they state that not all services are able to properly assess and manage risk. Some apparently don't always complete proper risk assessments, or don't properly record these in a way that makes for safe care across the maternity pathway. Then, when risks are identified, they aren't always acted on promptly and effectively.
Ongoing concerns about the learning culture was another theme emerging from their analysis of recent inspection reports. Some staff told them they weren't always encouraged to report incidents, or that services didn't always systematically embed learning from incidents.
This takes up a small section of the report (pages 139 –145) but there is a key point which comes out of these which relates to providing joined up care.
The “complicated commissioning landscape” has been raised as a potential barrier to patients leaving long term segregation.
Issues appear to have arisen when the patient is in secure care of mental health services for children and young people and a provider collaborative is involved. CQC clearly state that the provider collaborative isn't responsible for community provision but needs to work closely with the Integrated Care Board (ICB) and local authority to effect discharge. They've noted that there can be difficulties in understanding who is best placed to discuss discharge planning. They've been told of a lack of engagement from ICBs in the review process with quotes such as “we haven’t got enough time to come to the IC(E)TR” or “we don’t come to IC(E)TR as a matter of policy because the provider collaborative is involved”.
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