CQC State of Care 2025/26 front cover
The Care Quality Commission (CQC) has published its annual State of Care report, providing an assessment of the quality of health and adult social care services across England.
Published on 23 October 2026, the report presents a mixed picture. While there are examples of high-quality care and some improvements in workforce stability, significant challenges remain around access to care, funding, staffing and leadership.
Perhaps most strikingly, CQC describes an adult social care market undergoing rapid change, with concerns that developments are being driven more by financial pressures than by the needs of people requiring care and support.
Access to Care: A Growing Challenge
One of the report's most concerning findings relates to access to publicly funded adult social care.
CQC highlights that approximately 223,000 fewer adults were receiving long-term council-funded social care support at the end of 2024/25 compared with 20 years earlier.
The report also states that 70% of new requests for council-funded social care support resulted in no further action beyond providing information.
With the financial threshold for accessing state-funded care remaining unchanged for 15 years, increasing numbers of people must fund their own care, rely on unpaid family members and friends, or potentially go without the support they need.
These findings raise important questions about unmet need, inequalities and the long-term sustainability of the care system.
A Changing Social Care Market
CQC identifies two contrasting trends in the organisation of adult social care.
The care home sector is becoming increasingly concentrated, with larger homes accounting for a growing proportion of available beds. At the same time, home care is becoming more fragmented, with increasing numbers of smaller providers entering the market.
There are potential benefits to more community-based support, particularly where it enables people to remain independent in their own homes.
However, CQC warns that changes to the care market are not always being driven by strategic planning. Financial pressures, inconsistent commissioning arrangements and the growing reliance on people who fund their own care may affect choice and access to services.
The challenge is ensuring that changes in how care is organised do not undermine its quality, accessibility or person-centred nature.
The Workforce: Some Progress, but Challenges Remain
There is some encouraging news about the adult social care workforce.
Staff vacancy and turnover rates have continued to fall, suggesting some improvement in workforce stability.
However, both remain relatively high, and CQC expresses concern about the potential impact of reductions in international recruitment.
The report also identifies concerns about staff training, qualifications and competence.
In services rated Inadequate for safety, inspectors found examples where staff did not always have the knowledge, skills or competence needed to meet people's needs safely.
Research cited by CQC suggests that only 38% of staff directly providing care had completed training in dementia care.
Employers also identified the cost of training and the time needed to release staff as significant barriers to developing workforce skills.
These findings reinforce the importance of ongoing learning, effective supervision and ensuring staff are competent to undertake their responsibilities.
Leadership and the Quality of Care
Leadership emerges as a particularly important theme.
Among care homes assessed under CQC's current framework, approximately one-third were rated Requires Improvement or Inadequate for the Well-led key question.
Concerns included governance arrangements, accountability and clarity about roles and responsibilities.
These findings reflect an important principle: good care depends not only on the commitment of individual staff but also on effective management, supportive workplace cultures and systems that identify and address concerns.
Strong leadership helps ensure that staff feel valued, care is consistently person-centred and lessons are learned when things go wrong.
Recognising Good Practice
Despite these pressures, CQC also highlights the dedication of staff and examples of excellent care.
Of the services assessed under its current framework, 70% of care homes and 80% of home care services were rated Good or Outstanding.
CQC also identifies examples of effective partnership working, innovative approaches to supporting people in their communities and services that demonstrate compassionate, person-centred care.
These findings deserve recognition, particularly given the financial and operational pressures experienced by many providers.
However, CQC cautions that its current inspection findings are not necessarily representative of the entire sector, as assessments have often been prioritised where concerns about quality or safety have been identified.
Looking Ahead: What Needs to Change?
CQC's report highlights the importance of sustainable funding, effective commissioning, workforce development and stronger leadership.
It also reinforces the need for closer cooperation between health services, local authorities and care providers.
The government's renewed commitment to adult social care reform provides an opportunity to address some of these longstanding challenges.
However, meaningful progress will depend on whether reforms improve people's experiences of accessing and receiving care, while also supporting the workforce delivering it.
The overall message is clear: adult social care continues to demonstrate considerable strengths, but its long-term sustainability cannot be taken for granted.
Recognising good practice, investing in staff and maintaining a commitment to safe, compassionate and person-centred care must remain priorities as the sector navigates an uncertain future.