The state of health care and adult social care in England 2025/26

Key points

• 7 out of 10 of the 3,783 care homes we have assessed are rated as either good (67%) or outstanding (3%), while the remaining care homes required improvement (27%) or were providing an inadequate service (3%).
• Leadership is a key area for improvement in care homes, particularly in relation to governance, systems of accountability and clarity of roles and responsibilities, as around a third of care homes were rated as either requires improvement (31%) or inadequate (3%) for the well-led key question.
• 8 in 10 of the 2,121 homecare services we have assessed are rated as either good (76%) or outstanding (4%), while 18% were rated as requires improvement and 2% as inadequate.
• Despite recent increases in funding and provision, the long-term sustainability of local authority-funded social care is uncertain. More than three-quarters of council budgets go towards social care for adults and children, and across England they are over-spending on their annual adult social care budgets by nearly £750 billion.
• Around 223,000 fewer adults were receiving long-term council-funded social care support at the end of 2024/25 compared with 20 years earlier, and no further action beyond providing information, was recorded for 70% of new requests for council-funded social care support. As the financial means test to receive state-funded care has been capped at £23,250 for the last 15 years, fewer and fewer people are eligible to receive fully state-funded care and so need to either fund care themselves, rely on care and support from unpaid friends and family, or go without.
• The social care market is changing shape – it is moving towards a more diverse and fragmented community-based sector, and the care home market is consolidating, with more of the available care home beds now located in large care homes. There is also an increase in institutional investors acquiring homes. This can lead to better experiences and outcomes for those able to access community-based services, as they can be supported to live with greater independence in their own homes and communities. However, risks such as more complex commissioning processes can present challenges for providers.
• Potentially driven by financial pressures, social care services are increasingly looking towards the growing numbers of people who will be self-funding their care, particularly in care homes. While the majority of social care delivered remains state-funded, our data shows the proportion of self-funded care is increasing and varies across the country.
• While staff vacancy and turnover figures continue to reduce in the sector, they remain high. In services rated as inadequate for the safe key question, we identified issues around recruitment processes and ensuring a safe and sufficient level of staffing, which resulted in breaches of regulations, and had an impact on the delivery of safe, high-quality care and staff wellbeing. International recruitment has played a vital role in reducing staff vacancy and turnover pressures in adult social care. However, as the numbers of staff recruited internationally continues to reduce, the stability of the workforce is a key concern. As a result, more work is needed to strengthen recruitment and retention strategies.
• Staff training and qualifications are also an area of concern. We found that services rated as inadequate for the safe key question did not always ensure staff had the necessary skills, knowledge or competence to safely meet people’s needs. Data from Skills for Care suggests that only 38% of staff directly providing care to people had completed training in dementia care. While most (83%) social care employers highlight the importance of qualifications for career progression into management positions for care workers, the cost and time to train staff were identified as the most common barriers to investing in developing the skills of staff.
• Local authorities are broadly performing well in the face of significant challenges, with 3% rated as outstanding, 59% rated as good, 37% rated as requires improvement, and 2% rated as inadequate for their provision of adult social care and support.
• The quality of partnerships in an area is important, and results in positive benefits where the voice of adult social care is respected and understood. But, in too many instances, people were waiting too long for their care to be negotiated, and for assessments, reviews, services and equipment to be arranged. Nationally, 1 in 8 delays in discharging people who had been in hospital for 14 days or longer in 2025/26 were a result of delays in completing transfers between hospitals and social care services.