CQC warns underfunded community services risk “erosion” of care quality

In its annual State of Care report, the regulator said the health and social care system remains “fragmented and under severe strain” and that community services urgently need greater investment to deliver the Government’s 10-Year Health Plan for England.

The CQC warned that without stronger support, “there’s a risk fewer people will be able to access good care, with vulnerable groups hit hardest.” It said this includes older people, people with dementia, learning disabilities, or complex mental health needs, as well as those living in deprived areas.

Demand for council-funded social care continued to rise in 2023–24, and while vacancy rates have fallen to pre-pandemic levels, they remain three times higher than in the wider economy. Homecare services are particularly affected, with vacancies more than twice as high as in care homes.

The report warns that the end of new care worker visas could further increase workforce pressures unless a national workforce strategy and the promised fair pay agreement deliver real change.

CQC found that local authorities are facing significant challenges commissioning and sustaining homecare provision. Rising costs have led some providers to hand contracts back to councils, while a growing number of very small providers lack the resilience of larger operators.

Shortages in homecare and reablement services are now a key cause of delayed hospital discharges. In March 2025, nearly six in ten patients ready to leave hospital were delayed, leading to wider system pressures and a rising number of emergency readmissions — particularly among older people and those in deprived areas.

Mounting pressure on mental health services has led to longer waits and increased crisis referrals. CQC’s 2024 Community Mental Health Survey found that one in three respondents waited three months or more for help, rising to nearly one in two for children and young people. Fourteen per cent waited more than six months between assessment and treatment, with many reporting that their mental health worsened in that time.

The regulator said that shortages of mental health professionals, poor integration, and fragmented care continue to undermine service quality. Many people described “the destabilising impact” of moving between different services without a single point of contact.

CQC has now launched a comprehensive inspection programme of community mental health and crisis services to address these systemic issues.

District nursing capacity has fallen sharply, with the number of qualified district nurses per 10,000 people aged 65 and over halving over the last 14 years. CQC analysis suggests new trainee numbers are consistently less than half of those leaving the profession.

Dr Arun Chopra, CQC’s Interim Chief Executive, 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.”

He said the system remains “designed around hospitals” — from funding structures to how data and outcomes are measured — making it harder to move towards community-based, preventative models of care.

CQC said it will strengthen its focus on listening to service users and acting on poor care, while highlighting examples of innovative practice where health and social care services work effectively together.

Professor Sir Mike Richards, Chair of CQC, said there are “excellent examples” of integrated, community-based care, but too many areas still suffer from “poor coordination between health and social care, inadequate information sharing, and lack of digital integration”.

He added that long-term funding for social care remains unresolved: “The 10-year plan provides a roadmap to fix these problems… but it won't solve the core funding problem. We continue to call for long-term, sustainable funding for adult social care.”

Kathryn Marsden OBE, Chief Executive of the Social Care Institute for Excellence (SCIE), said the pressures identified by the CQC were being felt most by people already facing disadvantage.

“Local authority budgets have not kept pace with the growing complexity and volume of need, leaving many without the support to live safely and independently,” she said.
“Older people, people with dementia, people with learning disabilities and autistic people, and people with complex mental health needs are struggling to navigate services and access the support they need.”

She also highlighted the rise in Deprivation of Liberty Safeguards (DoLS) notifications — up 15% in 2024–25 to more than 185,000 — as evidence of a system under strain, with many people “waiting far longer than statutory timeframes” for authorisations.

Marsden said the forthcoming Liberty Protection Safeguards reforms were “urgently needed” to ensure people receive the protections the law intends.

“Community health and care services need immediate and sustained investment to meet these challenges, empower people to live with independence, dignity and purpose, and support the delivery of the government’s NHS ambitions,” she added.