CQC State of Care 2025/26: Key Findings for Care Providers

Estimated reading time: 13 minutes

England’s care system is facing growing demand, more complex needs and difficult decisions about workforce, funding and service capacity. For care providers, the challenge is not simply knowing that the system is under pressure. It is understanding which risks they can address through better leadership, governance and everyday practice.

The Care Quality Commission (CQC) published its State of Care 2025/26 report on 23 October 2026. It presents a national assessment of health and adult social care services, highlighting both promising improvement and continuing concerns about access, quality, sustainability and the way different services work together.

This analysis considers what the findings mean for existing adult social care providers, Registered Managers and organisations planning a new CQC-regulated service. The focus is practical: what leaders should review now, what evidence matters and how to prepare services to deliver safe, person-centred care.

What does the CQC State of Care 2025/26 report mean for care providers?

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CQC State of Care 2025/26: Key findings at a glance

CQC describes a mixed picture: demand is rising and inequalities persist, while innovation and improvement have not always kept pace. The following figures help explain the practical challenge for care organisations.

CQC finding	Reported evidence	What providers should consider
Care home quality	70% of 3,783 assessed care homes were rated good or outstanding.	Maintain quality consistently, not only at inspection time.
Leadership and governance	34% of those care homes were rated requires improvement or inadequate for well-led.	Test whether oversight, accountability and improvement systems work.
Workforce development	Skills for Care data cited by CQC suggests 38% of direct care staff had completed dementia care training.	Match capability and training to people’s needs.
Funding and sustainability	CQC estimates 37% of people residing in care homes were self-funders in 2025/26.	Plan for local funding patterns and realistic operating costs.
System coordination	One in eight discharge delays for people hospitalised for at least 14 days involved transfers to social care.	Strengthen communication and transition arrangements.

These are different measures with different populations and data sources. Full detail is available in CQC’s adult social care findings and the related report chapters.

Leadership and governance remain critical priorities

Leadership and governance stand out as some of the most actionable findings for providers. CQC reports that 70% of the 3,783 care homes it assessed were rated good or outstanding overall. Yet 31% were rated requires improvement and a further 3% inadequate under the well-led key question.

This difference matters. A service can show strengths in the care it delivers and still have weaknesses in management oversight, accountability or quality assurance. CQC highlights governance arrangements, systems of accountability and clarity about roles and responsibilities as areas for improvement.

Policies and procedures are important, but they are only the foundation. Leaders also need to show that the arrangements operate effectively in practice. In particular, providers should be able to demonstrate:

• Clear management responsibilities, reporting lines and escalation routes.
• Quality assurance and audit activity that identifies risks and leads to measurable action.
• Safeguarding and risk management that respond to concerns promptly and proportionately.
• Regular monitoring of care quality, incidents, complaints and feedback.
• Evidence that learning leads to changes in everyday practice.
• Oversight of staffing, competence, supervision and how care is delivered.

What this means for providers: Governance arrangements should be proportionate, clearly documented and embedded in daily management, whether a service is newly established or well established. For a deeper practical framework, see Delphi’s guide to care home governance.

The adult social care market is changing

The adult social care market is changing in two different directions. CQC observes that care homes are consolidating into fewer, often larger establishments, while homecare and other community-based services are becoming more diverse and fragmented. This brings opportunities for more personalised support at home, but it can also complicate commissioning and coordination.

Care home bed numbers have remained broadly stable in recent years, while the ageing population has grown. CQC reports that available care home beds per 100,000 adults aged 65 or over were nearly 450 lower in April 2026 than in April 2019. Capacity should therefore be understood in relation to the population and the kind of care people need, not simply the number of registered beds.

For prospective domiciliary care, supported living and residential care operators, a credible service plan should consider:

• Local population needs, demographic trends and gaps in provision.
• The needs of the intended client group, including specialist and complex care.
• Local authority commissioning priorities and referral arrangements.
• Recruitment availability, training needs and leadership capacity.
• The costs and financial resilience of the intended service model.

What this means for providers: A commercial opportunity alone is not a sufficient basis for a safe care service. Registration, staffing, governance and funding need to work together from the outset.

Financial pressures and sustainable care provision

Financial sustainability remains a central challenge. CQC reports that just over 672,000 adults were receiving long-term local authority-funded care at the end of 2024/25, around 25% fewer than at the end of 2003/04. CQC also estimates that 37% of people living in care homes in England in 2025/26 were funding their own care.

These figures illustrate the changing balance between publicly funded care, self-funding and unpaid support. Providers face the practical task of balancing staff costs, quality and regulatory responsibilities with an operating model that is sustainable over time.

For new services, business planning should reflect the actual resources needed for safe care. This includes staffing levels, management capacity, training and supervision, safeguarding, quality assurance, premises and the ability to respond to unexpected pressure.

What this means for providers: Financial planning should not be separated from care quality. If an organisation cannot consistently resource the commitments it makes, people using the service may ultimately experience the consequences.

Workforce competence matters as much as recruitment

CQC identifies some improvement in adult social care vacancies and staff turnover, but concerns remain about workforce stability, safe staffing and capability. Its report cites Skills for Care data indicating that only 38% of staff directly providing care had completed training in dementia care.

Numbers alone do not show whether the workforce can meet people’s needs. Staff must have knowledge, skills, supervision and support suited to their roles and to the complexity of care delivered. This is particularly important as providers respond to an ageing population and people with increasingly complex needs.

A robust workforce plan connects recruitment with effective induction, role-specific learning, competency assessment, supervision and continuing development. Registered Managers should be able to explain how they know staff are ready for the work they undertake, not simply whether a course has been completed.

What this means for providers: Review your training strategy against actual needs and risks. Delphi’s resources on assessing staff competency and CQC staff training requirements provide practical ways to strengthen the evidence of safe practice.

Access to care and health inequalities

The report identifies persistent inequalities in access to appropriate care. Where a person lives, the services available locally and their individual circumstances can make a significant difference to the care they receive.

CQC highlights particular pressures on children and young people. Its report says more than 80,000 children and young people had been waiting over a year for a community health appointment. It also reports that the number of children waiting for first contact with mental health services rose by 31% between 2023/24 and 2025/26. This is an increase in the number of people waiting, not a 31% increase in individual waiting times.

Although these findings extend beyond adult social care, they underline the importance of access, communication and timely support throughout the system. Person-centred care should consider geography, disability, communication needs, affordability and service availability.

What this means for providers: Evaluate people’s actual experiences alongside operational indicators. Equity and accessibility should influence service design, reviews and improvement priorities.

Integrated working and hospital discharge

The relationship between hospitals, community services and adult social care is another important theme. CQC reports that 571,000 people in 2025/26 waited more than 12 hours between the decision to admit them to hospital and their actual admission. This is a measure of hospital admission waits, not discharge delays.

Separately, CQC found that one in eight delays in discharging people who had already been in hospital for 14 days or longer involved delays in completing transfers between hospitals and social care services. Difficulties in one part of the system can therefore affect the experiences of people elsewhere.

For domiciliary care organisations, supported living services, care homes and specialist providers, effective working with hospitals, local authorities, health teams, families and other professionals is essential to continuity of care.

What this means for providers: Care plans and operating procedures should support clear communication, appropriate referrals, safe transitions and timely responses to changing needs.

Prevention and early intervention

CQC recognises promising neighbourhood-based and multidisciplinary approaches, while also pointing to the challenge of making prevention and integrated care consistent across the system.

For care providers, prevention is a practical discipline. It includes recognising deterioration, identifying risk early, supporting independence and responding before avoidable problems escalate. These responsibilities need to be reflected in care planning, staff competence, management oversight and partnership arrangements.

What this means for providers: Have clear responsibilities and procedures for early action, and review whether those arrangements lead to better experiences and outcomes for people using the service.

What should care providers do following the report?

The findings are an opportunity for leadership teams to test whether their arrangements remain fit for purpose. Rather than treating the report as another document to file, Delphi recommends starting with five questions:

• Leadership and governance: Are management responsibilities, quality assurance systems and accountability arrangements sufficiently robust?
• Workforce: Do recruitment, training and supervision reflect the complexity of care being delivered?
• Care quality: Is care consistently responsive to people’s assessed needs, experiences and preferences?
• Partnership working: Are effective arrangements in place for communication, referrals and transitions?
• Sustainability: Does the service have the financial, operational and workforce capacity to maintain safe, high-quality care?

For each question, identify the evidence you already have, the areas where assurance is weaker, a named person responsible for action and a sensible date to review progress. These questions are as relevant to established organisations as they are to businesses preparing to enter the regulated care sector.

Preparing for CQC registration in a changing care environment

For organisations planning CQC registration, the report reinforces the importance of building a service that is ready to operate safely, not simply preparing an application. Prospective providers need to understand the regulated activities they propose to deliver and how their governance, staffing, safeguarding, risk and quality systems will support that service.

The report is not a new registration framework

The State of Care report describes trends and findings across the sector. It does not itself introduce a new set of registration requirements. Applicants must follow the current CQC application process and the legal and regulatory requirements that apply to the service they intend to operate.

Prepare the systems behind the application

This includes considering leadership responsibilities, the proposed client group, staffing and competency arrangements, policies, safeguarding, quality assurance and the service’s Statement of Purpose. CQC’s published guidance explains that all registered providers must keep an accurate, up-to-date Statement of Purpose describing what they do, where they provide it and for whom.

What this means for providers: Good preparation gives an applicant a clearer, evidence-based account of how the proposed service will operate. Read the current CQC application guidance and explore Delphi’s CQC registration support when specialist input would be helpful.

Frequently asked questions

What is the CQC State of Care report?

It is CQC’s annual assessment of the quality, experiences and pressures affecting health and adult social care in England. It combines inspection and assessment evidence with other data and the experiences of people using services.

What were the main findings in State of Care 2025/26?

The report points to rising demand, persistent inequalities, pressure on funding and workforce capacity, a changing adult social care market and the importance of stronger leadership, governance and coordination between services.

What does the report say about care home governance?

Leadership is a notable improvement area. Of 3,783 assessed care homes, 34% were rated requires improvement or inadequate for well-led, highlighting the need for effective accountability, oversight and quality assurance.

Does the report change CQC registration requirements?

No. The report provides sector insight rather than creating new registration rules. Prospective providers must follow the applicable CQC registration guidance and legal requirements for their service.

What should a Registered Manager do after reading it?

Review governance, staff capability, people’s experience, partnership arrangements and service sustainability. Identify evidence gaps and agree prioritised action with clear ownership and follow-up.

Sources and further reading

What next for care providers?

The central message of State of Care 2025/26 is not that every provider needs more paperwork. Safe, sustainable services depend on leadership that understands its risks, governance that works day to day, a skilled workforce and arrangements that respond to the changing needs of individuals and communities.

The useful next step is to assess whether those foundations are strong in your own service, identify where evidence is missing and take proportionate action before problems become embedded.