Continued system pressures, unmet need and examples of innovative and outstanding care
Published later this month, CQC’s State of Care is its statutory annual assessment of health care and adult social care in England. It brings together what the regulator has learned from assessments, registration activity, people’s experiences, national surveys and wider data, and provides commentary on the direction of travel. With its emphasis on health inequalities and examples of how providers are taking decisive and innovative steps to respond to system pressures, it has become the go-to summary of key healthcare data, challenges, innovation and the wider political health and social care landscape. It is a pivotal document that goes beyond a description of performance, analysing where pressures are accumulating, where inequality is becoming embedded and where providers are finding better ways to deliver care.
Demand and Assessment Delays: Barriers to Accessing Social Care
Although the forthcoming State of Care is unlikely to reflect the recent announcement of plans for a National Care Service, it will provide important context for the debate. Its assessment of demand, access and unmet need will help to establish the scale of the challenge any future reform will need to address.
The report is likely to highlight ongoing barriers to timely access of social care, rather than a nationwide shortage of placements. DHSC’s August 2026 figures show care-home occupancy in England is currently 86.8%, with 10.2% of beds vacant and available for admission. Spare capacity does not. Spare capacity does not, however, guarantee suitable local care as assessments, funding arrangements and discharge coordination are all affecting access. ADASS estimated that around 409,000 people were waiting for assessments, support or reviews at the end of 2025/26. CQC’s July 2026 review reinforces that adult social care assessment delays remain a significant barrier to accessing care, with 78% of councils receiving lower scores for assessing needs, primarily because of delays in assessments and reviews.
It is hoped that the impending report will not solely consider the volume of requests and assessments but allude to the more important question of whether people are receiving help early enough to prevent deterioration, crisis and avoidable reliance on other parts of the system. It is widely understood that the consequences of unmet social care needs extend well beyond social care itself, as when support is unavailable or delayed, the pressure is absorbed by families and unpaid carers, general practice and urgent care. It becomes particularly visible when people cannot leave hospital safely.
Social Care Workforce Challenges and Provider Capacity
Workforce capacity offers a positive story for the next State of Care, with more posts filled and fewer vacancies in adult social care. Skills for Care estimates that the workforce in England had 1.59 million filled posts in 2025/26, an increase of around 22,000 over the year. Vacancies fell to 96,000, with the vacancy rate down to 6.2% from its 2021/22 peak of 10.4%. Together, these figures point to an improving workforce picture and provide grounds for cautious optimism about the sector’s capacity to meet demand. However, there is still progress to make, as the vacancy rate remained around three times the wider-economy rate of 2.2%. Nevertheless, the sustained reduction in vacancies is an encouraging sign of recovery.
The report will need to look beyond the headline improvement and consider whether it is translating into stable services and better experiences of care. Skills for Care estimates that turnover across adult social care was 22.1% in 2025/26, equivalent to around 320,000 leavers over the year. The rate was higher for care workers and support workers at 26.9%, although this was the lowest point in the reporting period. International recruitment also fell sharply, from an estimated 50,000 care workers in 2024/25 to 30,000 in 2025/26, following immigration rule changes. At the same time, the proportion of posts filled by British nationals continued to decline, with around 40,000 fewer posts filled by British workers than the previous year. In homecare, travel time, employment conditions, commissioning rates and narrow margins continue to affect recruitment and retention. These pressures are likely to shape CQC’s assessment of whether providers have enough skilled staff, with sufficient time and support, to deliver consistently good care.
The Shift to Community Care
These workforce and access pressures will also shape CQC’s assessment of the government’s shift from hospital to community. The 10 Year Plan envisages more care being provided at home and through neighbourhood services, with closer working between general practice, community health, social care and the voluntary sector. State of Care is likely to question whether there is sufficient workforce and assessment capacity to identify people’s needs and arrange timely support, enabling safe discharge and reducing avoidable pressure on hospitals and other healthcare services.
People’s experiences after discharge will be an important test of whether that support is in place. CQC’s most recent Adult Inpatient Survey offers a mixed picture: although experience improved across several measures, 24% of respondents said they did not receive enough health or social care support after leaving hospital. People living with frailty and those admitted in an emergency also reported poorer experiences. The next State of Care is therefore likely to examine not just the speed of assessment and discharge, but whether reablement, domiciliary care (homecare) and community services are sufficiently available and coordinated to sustain safe, effective care at home.
AI and Quality of Care in 2026
State of Care is an important resource for identifying examples of good, outstanding and innovative care. However, this year’s report should be read with caution, noting CQC’s lack of ability to capture the full picture by virtue of the continued slower pace of inspections. In the context of continuing organisational recovery, this year’s report marks a significant point in the regulator’s development, and although the report’s focus extends beyond CQC’s core delivery, the rebuilding of operational capacity provides important context for what we can expect from its findings. Whilst CQC inspection and assessment activity continues to increase, the regulator has not visited as many care providers as in previous years and therefore, the pool of first-hand insight is not what it once was. This is particularly relevant when the State of Care report seeks to highlight outstanding and innovative practice.
During 2025/26, care delivery underwent a significant shift, driven in part by the rapid adoption of AI. With fewer routine inspections taking place, some of the most important developments will have occurred beyond CQC’s direct view. The last year saw ambient AI scribes becoming commonplace in primary care, while social care followed suit with AI-drafted care plans and sophisticated tools designed to prevent falls. However, without a sufficiently broad evidence base captured through routine inspections, it is unclear whether the regulator has captured enough examples to assess the benefits and risks of this adoption, or to distinguish genuine innovation from technology that has been implemented without adequate oversight.
Access, Experience and Inequality in Primary Care
The 2026 GP Patient Survey is likely to provide the next State of Care with cautious grounds for optimism. Improvements in people’s overall experience of general practice and their most recent contact may be presented as evidence of progress. However, the report will need to recognise that this is a recovery from a low base and does not mean that longstanding access problems have been resolved.
CQC is also likely to look beyond the national figures and consider how the experience of access differs between groups and places. Telephone access remains difficult for many people, while the growing use of websites and the NHS App can make services easier to reach for some and create new barriers for others. Older people, carers, people with disabilities, those who lack digital confidence and people who need language support may experience the same access model very differently. State of Care will therefore need to consider whether apparent improvements are being shared equally, or whether national averages continue to mask persistent inequality.
The report may highlight services that use digital access as one route rather than the only route as positive examples, combining telephone support, multilingual communication, continuity and targeted outreach. This will be essential in showing that innovation can improve access without fragmenting responsibility or leaving some people behind.
Deprivation of Liberty: What Care Providers Need to Know
It is expected that the changing legal position on deprivation of liberty will feature in the next State of Care. The Supreme Court’s June 2026 judgment requires a broader assessment of whether restrictions amount to a deprivation of liberty, taking account of their nature, duration and effect rather than relying solely on the Cheshire West “acid test”. It also places greater emphasis on the person’s wishes and feelings when consent is considered.
It may be too early for CQC to reach firm conclusions about the effect of the judgment, but the report can provide an early indication of how consistently the revised test is being understood and applied. In particular, it may consider whether providers are reviewing care plans, capacity assessments, restrictive practices and authorisation processes, and whether staff have received the guidance and training needed to respond. The central question will be whether a more individualised approach is strengthening safeguards while giving proper weight to each person’s circumstances, wishes and feelings.
Taken together, these issues are likely to reinforce a familiar theme in State of Care. Improvement cannot be judged through national trends alone. CQC will need to show whether changes in access, technology and legal practice are translating into safer, fairer and more person-centred care.