Dr Richard Dune

16-07-2025

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How CQC reports reveal deepening crises in access, safety, and leadership, and what providers and policymakers must urgently address

Since 2009, the Care Quality Commission (CQC) has published its flagship State of Health Care and Adult Social Care in England annual report. More than just a regulatory roundup, it offers a powerful lens into the condition of a system that underpins the health, dignity, and well-being of millions.

With over a decade of reporting behind it, and another landmark edition on the horizon, this blog from Dr Richard Dune explores the origins, evolution, key themes, and significance of this vital annual assessment. He also looks ahead to what the 2024/25 edition is likely to reveal, and what this means for professionals, providers, policymakers, and training organisations alike.

Background and purpose

Established under Section 83 of the Health and Social Care Act 2008, the State of Care report is the CQC’s statutory duty to provide Parliament with an annual overview of the quality of health and adult social care in England. It draws on evidence from thousands of inspections, as well as feedback from service users, families, providers, and professionals.

Far more than a summary of inspection results, the report provides system-level insight into:

• Emerging risks and long-term structural pressures
• Workforce resilience, retention, and recruitment challenges
• Quality of leadership and safety culture
• Inequality in access and outcomes
• Opportunities for innovation and best practice.

The report helps national leaders understand where the system is working and where it is failing, giving stakeholders at every level an opportunity to learn, reflect, and act.

Who should read the report?

Although often referenced by policymakers and regulatory authorities, this report is essential reading for anyone involved in delivering, commissioning, or overseeing care services. Key audiences include:

• Registered Managers and Nominated Individuals in adult social care, domiciliary care, and supported living services
• NHS Trust and ICS leaders, commissioners, and board members
• Training providers and compliance leads are responsible for CPD and workforce development
• Safeguarding and quality assurance teams
• Voluntary and advocacy organisations, especially those supporting vulnerable groups
• People who use services, families, and carers, who deserve transparency and accountability

At The Mandatory Training Group, we use this report to enhance our training, guide our policy templates, and inform the development of digital compliance tools through ComplyPlus™ regulatory compliance management software.

Timeline: A Brief History of the Report

Table 1 - Year and Milestones for Timeline: A Brief History of the Report

Key themes over the years

From delayed access to digital adoption, recurring challenges reveal where progress has stalled and where future focus is urgently needed. These themes have consistently surfaced across annual reports, inspections, and sector reviews.

1. Access and capacity

Delayed access to services has become a hallmark of stress across the system, from GP appointments and elective surgery to social care assessments and mental health beds. Rising demand, resource limitations, and discharge blockages have become entrenched issues.

2. Workforce sustainability

Workforce issues now constitute the sector's greatest risk. Persistent vacancies, high turnover, and poor retention have left services struggling to operate safely and effectively. International recruitment, while vital, has raised ethical concerns around exploitation.

3. Safety and leadership

‘Safe’ continues to be the lowest-rated CQC domain. Services with weak leadership, poor governance, or unclear accountability structures are significantly more likely to fail. Conversely, strong leadership often predicts better service quality, even under pressure.

4. Health inequalities

The report consistently highlights disparities affecting people from Black and minority ethnic backgrounds, those with learning disabilities or autism, and those living in deprived areas. Disproportionate use of restrictive practices, detention, and under-resourcing of community alternatives are recurring concerns.

5. Integration and system reform

ICSs were established to promote joined-up care and better population health. However, integration remains patchy, and many systems struggle with shared data, collaborative commissioning, and coherent leadership.

6. Digital transformation

More providers now use Digital Social Care Records (DSCRs), with nearly 70% adoption in adult social care. However, digital maturity, interoperability, and access to NHS Mail remain serious gaps for smaller providers.

Implications for stakeholders

Improving care quality and compliance isn’t the responsibility of one group. It requires coordinated action across the entire system. From frontline providers to policymakers, here’s what the latest insights mean for your role:

For providers

• Benchmark service performance against CQC quality statements
• Use national insights to inform Quality Improvement Plans (QIPs)
• Ensure staff are trained in emerging compliance areas (e.g. safeguarding, restrictive practice, DoLS).

For ICSs and commissioners

• Identify and address service inequities across place-based populations
• Tackle access blockages and hospital discharge delays via joint working
• Focus on preventive, personalised, and community-based models of care.

For trainers and CPD leads

• Update training frameworks to reflect system challenges (e.g. digital skills, equality, trauma-informed care)
• Align CPD training with inspection expectations and workforce risk areas.

For policymakers

• Use the report to drive reform in workforce conditions, social care funding, and care quality enforcement
• Reassess the role of independent advocacy, regulatory oversight, and commissioning models
• Accelerate reform in high-risk areas like Deprivation of Liberty Safeguards (DoLS) and LD inpatient care.

Anticipated themes for 2024/25

From system reform to workforce challenges, these are the key themes set to shape the health and care agenda:

Structural reform and centralisation

With the abolition of NHS England and the planned removal of over 200 arm’s length bodies, including Healthwatch England and the National Guardian’s Office, expect significant analysis of how governance changes affect accountability, transparency, and co-production.

Workforce reform and safeguards

Modern slavery referrals in health and social care tripled in 2023/24. Ethical recruitment, fair pay, and workforce planning will likely dominate headlines. Reforms to Carer’s Allowance and unpaid care support may also be reviewed.

Mental health, learning disabilities, and autism

Expect renewed criticism of long-stay inpatient care for autistic people and people with learning disabilities. The use of seclusion, restraint, and the slow progress of community-based care alternatives remain central concerns.

CQC reform and public confidence

Following the July 2024 independent review, which found some CQC inspectors lacked front-line experience, expect scrutiny of inspector training, inspection methodology, and the regulator’s overall legitimacy.

Prevention and community health

With Labour’s 10-year health plan and the Independent Commission on the Future of Social Care in full swing, the report will likely highlight prevention, early intervention, and tackling the wider determinants of health, housing, poverty, and education.

Final thoughts

The State of Health and Adult Social Care in England report is not just an audit. It’s a reflection of our national values, systemic flaws, and collective responsibilities.

At The Mandatory Training Group, we use these findings to:

• Tailor our CPD training courses and statutory compliance content
• Build policy templates aligned with CQC expectations
• Strengthen digital compliance systems through ComplyPlus™
• Support providers, commissioners, and leaders through webinars, blogs, and resources.

As we look ahead to the 2024/25 edition, one thing is certain: the sector needs courageous reform, compassionate leadership, and coordinated action across every level of care.

If you're looking to future-proof your organisation and embed the latest regulatory insights into your operations, training, governance and compliance, speak to us.

From system strain to service strength - With ComplyPlus™

The latest CQC State of Care reports don’t just highlight sector stress. They expose systemic cracks in safety, staffing, leadership, and digital capability. But insight alone isn’t enough. Providers must act with clarity, agility, and purpose.

ComplyPlus™ gives you the tools to lead that change. It’s more than a compliance system. It’s your partner in building safer services, stronger teams, and smarter governance.

Explore the ComplyPlus™ suite:

• ComplyPlus™ E-Learning Courses (CPD-accredited online courses)
• ComplyPlus™ Compliance Centre - Live dashboards, inspection readiness
• ComplyPlus™ LMS - Sector-specific learning management system
• ComplyPlus™ TMS - Internal training tracking & CPD audits
• ComplyPlus™ Policies & Procedures - Fully editable & CQC/Ofsted-ready
• ComplyPlus™ Legal - Contracts, employment docs, and HR templates

Whether you’re tackling workforce burnout, building inclusive leadership or preparing for system reform, ComplyPlus™ helps you focus on what matters most before the next inspection. Not after.

Because compliance is not a checklist, it is a whole system responsibility. Make it work. Make it visible. Make it better.