The overall message of this year’s Care Quality Commission report into the State of Care report is stark. The CQC makes clear that without significant investment in both capacity and capability, the system cannot deliver the transformations envisioned in the Government’s ten-year health plan. 

Demand for care is rising faster than the sector can respond. Local authority budgets have not kept pace with the growing complexity and volume of need, and thousands are left without crucial support to live safely and independently. The pressure is being felt most by those already facing disadvantages: people in deprived areas, older people, and those with dementia, learning disabilities, autism, or complex mental health needs. 

These inequities, the CQC warns, are deeply embedded. Without tackling their root causes – chronic underfunding, workforce shortages, and uneven local commissioning – people who rely on care will continue to face barriers to accessing support that meets their needs. 

Ultimately, the report reinforces that community health and care services need immediate and sustained investment to keep pace with demand, empower people to live with dignity and independence, and underpin the NHS’s wider ambitions. Without this, the human and economic costs will continue to escalate. 

For providers, the report adds to the evidence supporting their every day experiences trying to meet demand while navigating workforce pressures and rising expectations about integration and outcomes. It also highlights both the opportunity and challenge of scaling high-quality, person-centred care in the community. 

We’ve broken down key summaries in each sector or service area addressed by the CQC in their latest report. 

Home Care 

Home care sits at the forefront of reform, and the State of Care data reveal both growth and fragility. The sector saw 11% growth during the last year but this masks widening gaps: the North East has only 69 services per 100,000 people aged 65+, compared with a national average of 116, and where London saw +13% growth in registrations, the North East only +3%. 

Behind these numbers lies a sector under mounting strain. The vacancy rate in home care now exceeds 10%, more than double that of care homes, and new visa restrictions have destabilised international recruitment pipelines.  

Providers face growing difficulty in meeting local authority demand at low rates, particularly in rural and deprived areas where travel times are long and hourly rates low. 

CQC’s Experts by Experience underline the impact: service users want continuity, yet too many experience a “carousel of carers.” The consequences aren’t abstract: inconsistency undermines safety, trust, and wellbeing, especially for people with dementia or complex conditions. 

The regulator also draws a direct link between funding levels and system outcomes: 

• Areas that pay less per hour of home care see higher A&E attendances and emergency admissions. 

• Areas with higher proportions of self-funders experience lower readmission rates and fewer avoidable hospital stays. 

The message is clear: social care funding decisions directly influence NHS performance.  

Home care is both the frontline of prevention and the backbone of system flow. Providers able to demonstrate continuity, retention, and measurable outcomes will be recognised as indispensable system partners, not just contractors. 

Complex and Reablement Care 

CQC’s data highlights reablement as a key pressure point, and one of the system’s greatest missed opportunities. The Home First model continues to deliver strong results, with some areas reporting 80% of people requiring no ongoing care after a short reablement programme. 

Yet, 26% of delayed hospital discharges are still caused by insufficient reablement capacity. 

The shortage of occupational therapists, lack of suitable equipment, and staff skill gaps are limiting recovery and independence. CQC found that where local systems operate integrated discharge and reablement teams, supported by the Better Care Fund, delays are significantly reduced. 

For providers, this is a space where collaboration can deliver both social value and measurable impact. The challenge is capacity – the opportunity is to become part of the evidence base for what works. 

Supported Living 

Supported living services have expanded rapidly: up nearly 50% in two years. This reflects a push toward supporting greater independence for working-age adults with learning disabilities, autism, or mental health needs. But CQC warns that quality has not kept pace with growth. 

Inspectors continue to see variation in leadership, workforce stability, and person-centred care. As cost pressures intensify, the regulator cautions against models drifting toward “mini-institutions.” Providers that embed co-production, autonomy, and genuine community connection stand out as examples of sustainable quality in a system under strain. 

Dementia and Older People’s Care 

As the State of Care report acknowledges, dementia is one of the defining pressures of the next two decades for the sector. 

The economic cost of dementia is projected to rise from £42 billion to £90 billion by 2040, driven by rising prevalence, longer lifespans, and escalating care costs. 

CQC’s 2024/5 review shows that people with dementia still face long waits for diagnosis and inconsistent post-diagnostic support. Those with access to well-integrated primary and community care report far better outcomes; others describe being “left to manage alone.” 

Workforce gaps compound the problem. Inspectors continue to find that staff often lack training in hydration, nutrition, and communication: the fundamentals of person-centred dementia care. Meanwhile, 26% of all delayed discharges relate to inadequate reablement or rehabilitation, disproportionately affecting older people. 

The report highlights persistent inequalities: people from minority ethnic communities and deprived areas remain less likely to access dementia services. The result is a widening gap between need and provision – a structural inequity that mirrors the system’s overall pressure. 

For providers, investing in specialist training, dementia-friendly environments, and carer partnerships will be critical to quality improvement. Dementia care is increasingly the yardstick by which system performance is judged, and it will define public trust in the sector’s ability to deliver compassionate, consistent care at scale. 

Learning Disability and Autism Services 

Few areas illustrate systemic strain more sharply. Of an estimated 1.3 million people with a learning disability in England, only 25% are on GP learning disability registers, and 12% of those are registered with practices that do not provide annual health checks. Workforce shortages mean many never receive the preventative care they are entitled to – and which the recent LeDeR report demonstrated is so vital. 

Even where services exist, quality is inconsistent. Only 40% of people with a learning disability and 42% of autistic people said they can see their preferred healthcare professional “always or most of the time.” Reasonable adjustments are often absent, leaving people to self-advocate within a system not designed for them. 

The CQC’s Independent Care (Education) and Treatment Reviews found individuals still held in long-term segregation without discharge plans or advocacy. This is despite the findings of the Baroness Hollins Review (2023) confirming what campaigners have long said: solitary confinement brings no therapeutic benefit, creates additional trauma, and must end. 

Across systems, 72% of ICS leaders report “moderate or significant” progress in tackling inequalities for this group – but 8% report none, the slowest rate of improvement across all Core20PLUS5 cohorts. 

The insight is clear: inclusion, accessibility, and co-production are no longer aspirational, they are non-negotiable. Providers that can demonstrate autism-informed leadership, partnership with people and families, and data-driven equality outcomes will align most closely with CQC’s Single Assessment Framework. 

Primary, Mental Health, and Acute Care 

Across community and hospital settings, the report reinforces how widespread the pressure has become. In primary and community care, district nurse numbers have fallen 43% since 2010/11, leaving just 3.5 per 10,000 people aged 65+. Referrals for older people have risen 28% since 2021/22, compounding strain. 

In mental health, inequalities persist: Black men are three to five times more likely to be diagnosed or hospitalised with schizophrenia. And in acute care, 58% of medically fit patients are waiting to be discharged: the clearest sign of how social care capacity and support now defines NHS flow. 

Performance of Integrated Care Systems and Local Authorities 

ICSs remain central to delivering “care closer to home,” but progress is uneven. Two-thirds of ICS leaders report only moderate progress in shifting hospital-based expertise into the community.  

However, exemplars like Haringey’s Multi-Agency Care and Coordination Team, which cut emergency attendances by 30% and achieved 94% satisfaction, show what integrated care can achieve when properly resourced. 

Local authority assurance work also reveals widening inequalities. Councils that pay lower hourly rates for home care see higher A&E attendances and readmissions. Clearly, underfunding social care does not save money – it displaces cost and risk across the system. 

Conclusion 

The State of Care 2024/25 report depicts a sector working at full stretch and holding the line despite chronic underinvestment. It reveals a widening mismatch between need and capacity, deep-rooted inequalities, and a workforce near breaking point. 

Yet, it also points to what works: collaboration, consistent leadership, and care grounded in dignity and inclusion. 

For providers, the challenge, and opportunity, lies in continuing to advocate for the value of social care and demonstrating this not just in moral terms, but in unavoidable measurable outcomes: preventing hospital admissions, supporting independence, and strengthening communities.