Fragmented services putting people at risk as demand rises, CQC warns

Children are facing lengthy waits for health and mental health support, while gaps in community services and failures to coordinate care are increasing the risk of people’s needs going unmet, the Care Quality Commission (CQC) has warned.

The regulator’s State of Care 2025/26 report, published on 23 October, highlights growing pressures across health and social care, with rising demand, persistent inequalities and fragmented services affecting people’s access to support and their outcomes.

More than 80,000 children and young people are waiting over a year for an appointment in community health services – almost 11 times the number of adults. The number of children waiting for their first contact with mental health services has also risen by 31% in two years.

The CQC says declining numbers of health visitors and school nurses, despite growing demand, are undermining early identification of need and safeguarding for children and young people.

The findings raise concerns about the availability of early support for children and families, particularly where health needs intersect with social care. The report also highlights how deprivation shapes outcomes, with levels of tooth decay among children in the most deprived areas more than twice those in the least deprived.

The pressures extend to adult mental health services, where demand is increasing and people continue to face long waits for support. The CQC found that the average monthly number of referrals to secondary mental health services rose by 7% between 2024/25 and 2025/26, while the number of people with open referrals to community mental health services increased by 34% over three years, from 1.6 million to 2.2 million.

In its detailed findings on mental health care, the regulator reports that 39% of respondents to its 2025 Community mental health survey felt the wait between assessment and their first treatment appointment was too long. Among those who waited more than six months, 67% said their mental health had deteriorated while they waited.

The CQC warns that extended periods without contact can mean changes in people’s needs are not identified or supported quickly enough, potentially increasing safeguarding risks and the likelihood of people reaching crisis point.

It also identifies problems with continuity of support following discharge from inpatient mental health care, as gaps in community provision place additional pressure on services. More broadly, challenges in accessing social care are contributing to hospital discharge delays, demonstrating how problems in one part of the system can affect others.

Baroness Julia Neuberger, CQC Chair, said: “What strikes me most is how connected these pressures are. Challenges in social care provision are contributing to delays in hospital discharge. Gaps in community mental health provision are pushing more people towards crisis care.”

She added: “To repair a fracturing system, there must be a collective response. Providers, regulators, commissioners and government all have a role to play in improving care, and we’ll be judged not by what we achieve alone, but by what we achieve together.”

The report’s findings have prompted the Social Care Institute for Excellence (SCIE) and Think Local Act Personal (TLAP) to call for greater attention to how services are designed and coordinated around people’s needs.

Gerard Crofton-Martin, interim chief executive of SCIE, said the report highlighted the challenge facing the Casey Commission, which is examining the future of adult social care.

“This report is a timely reminder that we do not need to wait for wholesale reform to start building a better social care system. There is much we already know about what works and what needs to change to improve people’s lives. But the report also lays bare the scale of the challenge facing the Casey Commission: not simply to stabilise a system under strain, but to fundamentally rethink how care and support is designed, funded and delivered.”

He said local leaders needed support to use data and evidence to understand local needs, commission services around outcomes rather than activity, and ensure the voices of seldom-heard and marginalised communities shaped decisions.

Crofton-Martin also highlighted the risks faced by young people moving from children’s to adult services, where a lack of coordination can disrupt support at a critical stage of their lives.

“No young person should face a cliff edge in care simply because they reach adulthood,” he said.

The CQC says prevention and better coordination are essential to improving outcomes, but warns that rising demand and persistent inequalities are outpacing progress across the system.

Chris Badger, Chief Inspector of Adult Social Care and Integrated Care at the CQC, said: “None of this can be considered in isolation. Pressures in one part of the system compound others and are exposing fractures right across health and care, from mental health support to maternity and primary care, and in widening inequalities for children and young people.”

He added: “Success can't be measured by how well each part of the system performs on its own – it's how well those parts work together for the people who need them, regardless of who they are or where they live.”