The health and social care system remains fragmented and under severe strain as it prepares for a major shift from hospital to community care, the Care Quality Commission (CQC) has warned in its annual State of Care report.
While there is some encouraging evidence of innovation, community services need significant investment in both capacity and capability to deliver the transformation in people’s care called for in the government’s 10 Year Health Plan for England.
Without more support to help community services deliver the vision of the plan, there is real risk of erosion in care quality, with people struggling to get the care they need and the most vulnerable groups likely to be hit hardest through longer waits, reduced access and poorer outcomes.
The report also highlights longstanding inequalities with some groups of people – including older people, people with dementia, people with a learning disability, and those with complex mental health needs – more likely to struggle to navigate services, often meaning their families and unpaid carers carry increasing burdens.
On any given day in March 2025, nearly 6 in 10 patients who were ready to be discharged experienced a delay. This reduces the number of beds available for new patients and creates knock-on effects for people’s care across the whole system, from how quickly they get seen in A&E to the length of time they wait for planned medical procedures.
Over the last ten years there has been a steady increase in percentage of emergency readmissions, with older people and people living in more deprived areas more likely to be readmitted within 30 days of being discharged from hospital.
CQC commissioned research from National Voices into people’s experience of the discharge process – although this includes positive experiences, it also describes very poor experiences, including someone whose hospital stay, and discharge left them feeling dehumanised.
Based on the information and insight from the CQC’s regulatory work, as well from the GP Patient Survey 2025, access to GP appointments remains a challenge, with evidence that some groups find it harder than others. This includes those living in the most deprived areas, autistic people and people with a learning disability, and people with a mental health condition.
When people can’t get help from their GP, it may mean they go to a service not designed to meet their needs. The GP Patient Survey 2025 found that when people couldn’t contact their GP or didn’t know what the next step would be, 1 in 15 went to A&E.
Dr Arun Chopra, Interim Chief Executive of CQC, said: “The Government’s 10-year plan is a real chance to improve care by putting people's needs first. But for the plan to succeed, community health and care services need more support. Without this, there’s a risk fewer people will be able to access good care, with vulnerable groups hit hardest.
“Right now, community services tell us they're struggling because the way care is funded and organised is designed around hospitals. That’s also true of how data about care is collected and how outcomes are measured. All these things make it harder to move towards care that keeps people well, delivered closer to home.
“We’re calling for more investment in care outside hospital, and more emphasis on measuring quality of care, not just numbers of procedures. Services need to focus on really understanding the needs of their local population – especially in deprived areas – and on working together to address those needs.”
Visit the CQC's website to download the full report: https://www.cqc.org.uk/
