The state of health care and adult social care in England 2024/25

Published: 24 October 2025 Page last updated: 24 October 2025

Evidence used in this report

This report sets out the Care Quality Commission’s (CQC’s) assessment of the state of health care and adult social care in England in 2024/25.

To inform our view of the quality of care in this report, we use evidence from our inspection and registration activities and the experiences of people who use services, their families and carers, as well as evidence from our regulatory and strategic projects.

This report is also based on our wider horizon scanning and analytical activity. We have reviewed reports published by our stakeholders, drawn on findings from national surveys, and analysed publicly available datasets to inform our understanding of the challenges facing health and social care today and the experiences of people using services. We also analyse unpublished cuts of health and care datasets to allow further interrogation of key issues and trends. Where we have used data from other sources, these are referenced within the report. For better readability we have rounded many of these figures, so they may not match exactly with the published source.

To ensure that the report represents what we are seeing in our regulatory activity, analytical findings have been corroborated, and in some cases supplemented, with expert input from our Chief Inspectors, colleagues in our Regulatory Leadership directorate, specialist advisors, analysts and subject matter experts. Our analysis is also supplemented with expert input from our Clinical Fellows and National Professional Advisors.

Here, we provide further detail relating to the evidence used in this report.

People’s experiences and what they have told us

Our view of quality and safety has been informed by information that people have shared with us through our online Give feedback on care service (GFOC). People’s experiences and comments submitted in this way were analysed to inform our understanding of the following areas:

Secondary and specialist care services: a thematic analysis of 866 comments from April 2024, July 2024, and January 2025. We extracted a total sample of 2,185 comments and analysed the data until no new and significant information emerged.
GP services: a thematic analysis of a sample of 293 comments from 1 April 2024 to 31 March 2025. We initially analysed a sample of 240 comments to update our view of themes identified in previous analyses (such as those conducted for State of Care 2023/24) and then extracted a further sample of 53 comments based on keywords to focus on experiences of frail and/or older people.
Dental services: a thematic analysis of comments from 1 April 2024 to 31 March 2025. We initially analysed a sample of 216 comments and extracted a further sample of 133 comments based on keywords to focus on experiences of those entitled to free NHS dental care. We used the analysis of the keyword sample to provide an updated view of themes identified in analyses conducted for our previous State of Care report.

We also conducted 3 focus groups with 28 Experts by Experience to understand people’s experiences of community adult social care services for older people. These Experts by Experience had recent experience of supporting our homecare inspections as well as lived experience of using or caring for someone using these services.

As in previous years, we have also used findings from our published surveys to understand what people think about the NHS services they use. This includes the:

As well as using published findings, we conducted a thematic analysis of free text responses to the 2024 NHS Urgent and emergency care survey. This analysis was based on a sample of 651 respondents of people aged 66 and older who were also classified as being frail.

Providers of health and care services

We conducted targeted analyses of:

information collected through our surveys
data from statutory notifications received
information from adult social care provider information returns.

We have also drawn on findings from our published inspection reports of registered providers during 2024/25 and used the data and insight gained through our routine engagement with them. This included 28 maternity inspection reports published between January 2024 and June 2025, which were not part of the National Maternity Services Inspection Programme and 21 inspection reports for hospice services for adults published in 2024/25.

This report also provides an analysis of data submitted to us by providers in our Market Oversight scheme, as well as information and insight gained from our engagement with providers that participate in the scheme. The scheme covers providers with a large local or regional presence which, if they were to fail, could disrupt continuity of care in a local authority area.

Aggregated ratings for the main sectors and services we regulate are provided in the data appendix of this report. The ratings data are from inspection reports published under our single assessment framework, as at 1 August 2025. We began implementing the single assessment framework in January 2024 so these ratings, comprising more than 3,900 services and providers, are our growing picture of the quality of care under this new framework from that point in time.

The rating charts presented in this report are not directly comparable to previous years because:

Our assessment activity during this time has been based on risk to people using these services so it is unlikely to be representative of all services in a sector. This means that we have prioritised assessing services where our data indicated there may be greater risk to quality and safety for people.
For some services, the numbers of assessments completed using the single assessment framework are still too low to be representative of all services in that sector.
Alongside the introduction of the single assessment framework, we also made changes to some aspects of our assessment methodology. One of these changes was differences in the levels at which we rate providers. Read the full detail of the different levels of ratings on our website.

Statutory responsibilities for Deprivation of Liberty Safeguards

Evidence in this report, alongside our annual report and accounts, enables us to fulfil our legal duties to report on equality issues and on the operation of Deprivation of Liberty Safeguards (DoLS). Our DoLS monitoring activity is also an important part of our role as a National Preventive Mechanism.

We report on our data from notifications received between 1 April 2024 and 31 March 2025 on the outcome of an application to deprive a person of their liberty under DoLS. This excludes applications through the Court of Protection and notifications from primary medical services, but due to changes in our systems, we cannot exclude Court of Protection from other DoLS notifications. This number may include duplicate submissions from providers for an individual DoLS application or where the DoLS applies to a dual registered care home.

To supplement this evidence, in May 2025, we conducted a qualitative analysis of 30 notifications to explore people’s experiences of DoLS. We also conducted 2 surveys of CQC inspectors in October 2024 and May 2025, which received 20 responses. We asked inspectors what they considered to be the main challenges affecting providers when managing DoLS and to provide examples of how DoLS (including a lack of a DoLS authorisation) has changed people's experiences of care. In addition, we asked inspectors to comment on how some groups of people may be disproportionately affected by the DoLS system, based on what they had seen during inspection activity.

As well as the 2 surveys, we conducted a small online internal focus group with 3 adult social care and secondary and specialist care inspectors in June 2025. Topics included the outcomes of delays for DoLS assessments, staff understanding of DoLS and the outcomes for people who use services.

In May and June 2025, we ran a survey among Mental Capacity Act (MCA) leads working in hospitals. We worked with national NHS leads to share the survey with MCA leads in NHS and independent hospitals and members of the independent provider safeguarding network. We conducted a thematic analysis of comments from 45 respondents to understand their experiences of managing DoLS and the challenges they face. We also reviewed 30 reports from our local authority assurance assessments, focusing on findings on how local authorities managed safeguarding risks in their local area in relation to DoLS.

To help illustrate the impact of DoLS on people, their family members and/or carers, we include 2 case studies from interviews with members of the public, which reflect their personal experiences and perspectives. They were collected to understand how people can experience a DoLS, rather than as part of our assessments of services and of what constitutes good practice.

Regulatory and strategic projects

During 2024/25, we conducted focused regulatory work on:

urgent and emergency care services
adult community mental health services
dementia care
Independent Care (Education) and Treatment Reviews (IC(E)TRs)
Black men’s experiences of mental health services.

We also published our National review of maternity services in England 2022 to 2024. We have undertaken strategic projects, including work on inequalities in health for autistic people and people with a learning disability, and the use of artificial intelligence in general practice. For this State of Care 2024/2025 report, we also specifically commissioned primary research with National Voices and Nuffield Trust. Over the year, we have also continued our programme of assessing all 153 local authorities in England. Insight gathered through these projects has informed our reporting in 2024/25.

Local authority assurance

In 2022, CQC was given new responsibilities to assess how local authorities meet their duties under the Care Act (2014). In December 2023, we started an assessment programme for all 153 local authorities in England with adult social care responsibilities, to be assessed within a 2-year period.

This year, we have analysed 32 reports from our programme of local authority assurance assessments with a focus on how local authorities are working with partners on prevention, hospital discharges and reablement services. We wanted to understand how reablement and homecare services are being used to support avoidable admission to hospital and support people to live independently for longer.

Urgent and emergency care

During the winter of 2024/25 we carried out inspections in 8 hospitals looking at the emergency departments and medical wards within these providers. This was to gather information to understand the performance of systems across the urgent and emergency care pathways for the population they serve, share innovative practices, and identify blockers and barriers facing providers and systems. We analysed patient pathway tracking records from these providers as well as 7 of the 8 inspection reports. We also conducted 3 focus groups with inspectors involved in this work. From these, we were able to draw out themes about the quality and safety of care in these providers.

Community mental health care

Last year, our rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) highlighted particular concerns about the systemic issues within community mental health care. This year, we started a comprehensive programme of inspections of community mental health services for working-age adults, crisis services, and health-based places of safety (HBPoS). We have gathered a range of evidence to support us in shaping this programme of work, including:

An information request sent to all 51 NHS providers of community mental health services to ask trusts about their self-assessments of issues raised in our rapid review of NHFT and their actions following the publication of the review (August 2024). Analysis completed on responses from 45 trusts.
A literature review commissioned from the University of Birmingham focusing on what is currently known about community mental health services, which was developed with peer reviewers with lived experience and clinical expertise (December 2024).
3 provider engagement sessions about our inspection programme and what good care looks like in the community mental health sector. Representatives from 45 providers of community mental health services and crisis care (including health-based places of safety) for adults of working age participated (November and December 2024).
Focus groups with Experts by Experience including 17 Experts by Experience with a range of experiences of using and/or supporting those they cared for to use community mental health and/or crisis services. The sessions focused on the challenges for people using these services and improvements that could be made (January 2025).
Research on optimisation of psychotropic medicines in the community. We commissioned Ipsos to explore what good care looks like in this area from the perspective of a range of professions and organisations that support prescribing in the community. The research combined 314 survey responses with 13 in-depth interviews (January to April 2025).
Two focus groups with inspectors involved in the first 4 inspections of adult community mental health trusts. These focused on testing our insights around community mental health services for this report (June 2025). We have continued to work closely with these inspectors as we develop this report.

Black men’s mental health

In last year’s State of Care report, we highlighted the longstanding health inequalities faced by Black or Black British people, and our specific concerns around Black men’s mental health. To develop our understanding of how Black men experience mental health care, we commissioned Queen Mary University (QMU) and University College London (UCL) to carry out a rapid review of what ‘good’ looks like in relation to access, experience and outcomes for Black men. The work included a rapid evidence review and semi-structured interviews with 23 participants, including Black men who use mental health services and their carers and family, providers, mental health advocates and people working in charities. The interviews explored Black men’s experiences of accessing and receiving mental health services, as well as the experiences of participants delivering and/or planning care. In addition, the research team worked with a community engagement group – the Black Men’s Health Taskforce – throughout.

Independent Care (Education) and Treatment Reviews (IC(E)TRs) programme

CQC was commissioned by the Department of Health and Social Care to undertake a series of Independent Care (Education) and Treatment Reviews (IC(E)TRs). The IC(E)TR programme undertakes reviews for autistic people and people with a learning disability who have been detained in long-term segregation in hospital. To inform early findings around the programme, we undertook thematic analysis of:

A sample of 16 early reports of reviews dated May to November 2024. These reports look at different areas of people’s care in long-term segregation such as quality of life, future planning, and recommendations for providers and stakeholders involved in a person’s care to improve their care and help them to move out of long-term segregation.
A focus group with 5 IC(E)TR Panel Chairs (May 2025). Panel chairs are responsible for reviewing people’s care through the IC(E)TR process. This was undertaken to increase understanding and confidence in themes identified in the analysis of the reports and included discussion points such as drivers and barriers to leaving long-term segregation, and adjustments and adaptations for people.

Inequalities in health for autistic people and people with a learning disability

In last year’s State of Care report, following compelling feedback from our expert advisory group, we introduced our priority area of exploring the challenges and barriers experienced by autistic people and people with a learning disability when accessing their GP practice. We held 4 online focus groups with 12 people with a learning disability and autistic people (recruited by Choice Support) between September and November 2024 to hear about their experiences of accessing and receiving primary care.

To understand the wider context of the barriers to accessing primary care for these people, we analysed 552 provider information returns from adult social care services from a 6-month period (December 2023 to May 2024). The analysis focused on 2 questions: barriers to providing good quality care and working in partnership with other specialist services.

Experiences of follow-up care after discharge from hospital

To understand people’s experience of care following their discharge from hospital we commissioned research from National Voices. This centred on 4 key areas:

transitions from hospital to the community
support mechanisms for staying well at home
barriers to accessing quality health and social care in the community
the impacts of unmet care needs.

A questionnaire was sent to 704 people who had responded to the 2023 Adult inpatient survey and who had agreed to be re-contacted. In total, 144 people responded and 17 people were identified for follow-up interviews to gain a more in-depth understanding of their experiences, including 8 people at risk of experiencing health inequalities.

Integrated care systems

For the second year running, we worked with the Nuffield Trust to survey integrated care systems (ICSs) to understand how they are trying to help people who need care, and the barriers and enablers to this work. In 2025 we asked systems for their own views of their progress against 3 priority areas: reducing health inequalities, shifting services into the community, and supporting older and frail populations.

The Nuffield Trust survey was for people with a strategic role in developing community-based care or in leading health inequalities work in an ICS or local partnership. Specific groups invited to respond included staff with a responsibility for population or public health, transformation or strategy, adult social services, place-based partnerships, primary care or community care, and patient and public involvement. Analysis was based on 49 responses from 30 unique ICSs (71% of all 42 ICSs in England). In some cases, multiple people from the same ICS submitted responses, which will have skewed results. All NHS regions were represented in the responses, although some were more represented than others – partly due to differences in response rates and the number of ICSs within a region.

While more than two-thirds of ICSs are represented, not all ICSs are included, and a small number of responses were received overall, so the results may not represent the whole picture and small changes in the answers will have significantly changed the proportions. It should also be noted that response rates varied across questions (denominator range: 34 to 49 respondents) as some respondents indicated that certain questions were not applicable to their role or system.

The Nuffield Trust also carried out 8 semi-structured qualitative interviews with director-level roles across integrated care boards (ICBs). Interviews examined how strategic decisions were made, detailed descriptions of activities and initiatives in the 3 key areas, and enablers and barriers to progress in last 12 months. Interviewees represented 6 of the 7 NHS regions.

Use of artificial intelligence (AI) in general practice

We have drawn on work that was carried out to inform our regulatory approach to the use of AI in general practice. In April 2025, we surveyed GPs to find out their views and experiences of using AI, which received 156 responses. This sample provides some indicative insights but due to the small numbers involved, it is difficult to tell whether these answers represent a broader picture. As such, the results should be interpreted with caution.

To understand people’s views on the use of AI in GP practices, we commissioned an online survey by the market research company OnePoll of 2,000 people in March 2025. Analysis of responses focused on key themes around people’s knowledge of and feelings towards AI, confidence in the use of AI by GPs and perceptions around the potential benefits.