CQC State of Care 2025/26: Progress Is Being Made, but Are We Improving the System or Just Individual Services?

Reflections on the latest State of Care report and what it means for healthcare leaders, providers and the people who depend on their services.

By Mickael Iqbal | Director, COMI Health UK

The Care Quality Commission (CQC) has published its annual State of Care report for 2025/26, presenting a complex picture of England’s health and adult social care system.

There are reasons for optimism. Access to general practice is improving, elective waiting lists are gradually reducing, and the report identifies examples of innovation and compassionate care across the country.

Yet these improvements sit alongside some deeply concerning findings: growing demand, increasing complexity, persistent inequalities, and significant pressures on services that are already stretched.

Having worked as a CQC inspector and subsequently across healthcare governance and regulatory assurance, including within the NHS, there is one aspect of this year’s report that particularly resonates with me.

We have become increasingly sophisticated at assessing individual healthcare organisations, but some of our greatest risks exist in the spaces between them.

A hospital can deliver excellent clinical treatment, yet a patient may remain there because the care they need at home cannot be arranged. A GP practice may provide an appropriate referral, but the patient could still wait months for specialist support. A community service may have dedicated and capable staff, but struggle to meet growing demand without the workforce or resources it requires.

Each organisation has its own responsibilities, performance measures and governance arrangements. But patients experience their care as a journey, not a collection of separate services.

That distinction matters.

The NHS: Signs of progress, but pressure remains

The report presents encouraging evidence that some national efforts are delivering results.

The proportion of patients describing their last experience of contacting their GP practice as good has risen to 73%, compared with 67% in 2024. Meanwhile, the average number of incomplete elective care pathways has fallen from 7.5 million to 7.3 million.

These improvements should be recognised. Behind them are significant efforts by healthcare professionals, managers and organisations to adapt services in difficult circumstances.

However, the picture within urgent and emergency care remains particularly challenging.

In 2025/26, there were approximately 28 million attendances across urgent and emergency care services. More than 571,000 patients waited over 12 hours between the decision to admit them and their admission to hospital.

On an average day, approximately 13,000 patients who were ready for discharge remained in hospital.

Having worked within the NHS, I recognise how easily these figures can become discussions about targets, operational performance and capacity. Those are important, but the implications extend much further.

A delayed discharge is not simply an occupied bed. It may represent an older person experiencing unnecessary time away from home, a family struggling to understand what happens next, or an individual losing confidence and independence while waiting for suitable support.

It also affects the patient waiting in the emergency department, the ambulance crew unable to return to the community, and the clinical teams trying to maintain safe care under increasing pressure.

The quality and safety of hospital care cannot be considered entirely separately from the capacity and effectiveness of services outside the hospital.

This is not to suggest that individual hospitals are powerless to improve. There is still much that can be achieved through effective clinical leadership, discharge planning, communication and patient safety systems.

But sustainable improvement requires a level of coordination that goes beyond organisational boundaries.

Adult social care: A changing market and an enduring challenge

One of the most striking aspects of this year’s report is the changing shape of adult social care.

The care home market is becoming increasingly consolidated, with capacity concentrated in fewer, larger organisations. Meanwhile, homecare provision is expanding through a growing number of smaller providers.

This creates both opportunities and risks.

Smaller homecare services can offer personalised, flexible support that enables people to maintain their independence. Larger providers may benefit from economies of scale, investment and established infrastructure.

Neither model automatically guarantees good or poor care.

What matters is whether providers have the leadership, workforce, governance and financial resilience necessary to deliver safe and effective services.

The CQC’s findings on leadership are therefore particularly important.

Among the 3,783 care homes assessed under the current framework, approximately one-third were rated as requiring improvement or inadequate for the well-led key question.

It is important to recognise that these assessments have been predominantly risk-based, so the figures should not be interpreted as representative of every care home in England.

Nevertheless, the findings reinforce something I have seen repeatedly through regulatory work: good intentions and compassionate staff cannot compensate indefinitely for weak systems of governance.

In smaller organisations, particularly those established by experienced care professionals, there can be a tendency for governance to develop informally around the knowledge and commitment of a few individuals.

This may work well initially. But as organisations grow, staff change and regulatory expectations become more complex, informal arrangements can become vulnerabilities.

Effective governance does not have to mean unnecessary bureaucracy. It means having clear responsibilities, understanding risks, listening to concerns, reviewing outcomes and acting when something needs to improve.

Equally, we cannot ignore the financial circumstances facing the sector. The report highlights increasing reliance on self-funded care, pressures on local authority commissioning and the continuing challenge of maintaining a sustainable workforce.

Providers must manage their own responsibilities, but lasting improvement also depends on how the wider system funds, commissions and values social care.

Children and mental health: The long-term consequences of delayed care

Perhaps some of the most concerning findings relate to children and young people.

The number of children and young people waiting over a year for community health services increased by 129% in the two years to March 2026. More than 80,000 children and young people were experiencing these exceptionally long waits.

The report also highlights significant pressures on children’s mental health services, with average waiting times for first contact increasing considerably.

Behind these statistics are children whose development, education and wellbeing may be affected by delays in receiving the right support.

There are also consequences for families, schools, primary care services and, potentially, future demand on health and social care.

This raises an important question about how we define quality.

A service may provide excellent assessments and treatment once a patient reaches it. But if access is severely delayed, can we consider the overall pathway to be delivering consistently high-quality care?

This is not an argument for holding individual providers accountable for pressures entirely outside their control. It is an argument for assessing quality in a way that considers the whole experience of care.

The report’s repeated emphasis on prevention is particularly relevant here.

Investment in early intervention, community services and coordinated support is not simply about moving activity away from hospitals. It is about preventing avoidable deterioration and helping people receive appropriate care before their needs become more complex.

Without clear accountability, sufficient capacity and effective coordination, however, the ambition to deliver more care in the community risks moving pressure from one part of the system to another.

Leadership, culture and the difference between compliance and assurance

If there is one lesson I would encourage providers to take from the report, it is that regulatory compliance and meaningful assurance are not necessarily the same thing.

Across my experience of inspections and organisational assurance, I have encountered services with comprehensive policies, established committees, extensive audit programmes and detailed action plans.

These arrangements are important, but their existence alone does not demonstrate that care is consistently safe or that improvement is happening.

The more revealing questions are often quite straightforward:

• Do leaders understand what patients and staff are actually experiencing?
• Are concerns identified early, escalated appropriately and acted upon?
• Can the organisation demonstrate that improvements have worked, rather than simply that actions have been completed?
• Do staff feel supported and able to raise concerns?
• Does the evidence presented to senior leaders reflect what is happening in clinical and care environments?

For larger organisations, particularly NHS trusts, this means ensuring there is a reliable connection between frontline practice and Board-level oversight.

For smaller independent providers, the principle is exactly the same, even if the structures are simpler.

A strong governance framework should help leaders identify risks before they result in harm, recognise where improvements are required, and understand whether the services they provide are meeting people’s needs.

This is where meaningful internal assurance, listening to patients and staff, and triangulating different sources of evidence can make a real difference.

It is also important to recognise the human element.

Healthcare professionals are working in demanding environments, often balancing competing priorities and limited resources. Staff wellbeing, psychological safety, inclusion and effective leadership are therefore not peripheral organisational concerns.

They are fundamental components of safe and sustainable care.

What should providers take away from the report?

The State of Care report should not be treated as another document to read, file away and revisit when an inspection is approaching.

Nor does its publication automatically create a new set of regulatory requirements.

Instead, it offers an opportunity for organisations to reflect on their own services against the wider risks and challenges identified nationally.

I would encourage providers to consider three priorities.

First, look beyond your own service boundaries. Understand where patients may experience delays, fragmented communication or difficulties transitioning between services. Where these risks are outside your direct control, consider how effectively you work with partners to manage them.

Second, test whether your governance arrangements provide meaningful assurance. Look beyond policies and completed actions. Examine whether your evidence demonstrates that care is safe, responsive and improving in practice.

Third, listen carefully to the people who use and deliver your services. Complaints, patient feedback, staff concerns and everyday observations can reveal important issues that performance dashboards and routine audits may not fully capture.

These principles apply whether an organisation is a small homecare provider, an independent clinic, a GP practice or a large NHS trust.

Final reflections: A shared responsibility for improvement

The CQC’s State of Care report is not simply a story of a system in difficulty.

It also describes dedicated professionals, innovative services and organisations delivering excellent care despite considerable challenges.

Those achievements deserve recognition.

However, we should be cautious about allowing improvements in individual performance indicators to obscure the experiences of people who continue to struggle to access timely, coordinated and appropriate care.

The greatest opportunity for improvement may lie not only in making each organisation more effective, but in improving how organisations work together.

For healthcare leaders, this requires balancing immediate operational pressures with longer-term responsibilities for quality, safety, workforce development and organisational sustainability.

For regulators and commissioners, it requires a proportionate understanding of the challenges providers face, without losing sight of the standards people should reasonably expect.

And for providers, it means recognising that meaningful quality improvement is an ongoing responsibility, not an activity reserved for inspections.

Ultimately, the success of our health and care system should be judged not simply by how well individual services perform, but by how well people are supported throughout their entire experience of care.

That is, perhaps, the most important message from this year’s report.

At COMI Health UK, we support healthcare and adult social care providers with regulatory compliance, quality governance, independent assurance and practical service improvement. Our approach draws on direct experience of CQC regulation, healthcare leadership and frontline clinical services.

Source: Care Quality Commission, The State of Health Care and Adult Social Care in England 2025/26, published 23 October 2026.