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

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 2025/26.

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

This report is also based on our review of and analysis of external data, research and evidence. 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 We also analyse unpublished cuts of health and care datasets to allow further interrogation of key issues and trends.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 and for better readability we have rounded many of these figures.

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, inspectors, 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 about the evidence used in this report.

People’s experience and what they have told us

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

• Adult inpatient survey 2024
• Adult inpatient survey 2025
• Community mental health survey 2025
• Maternity survey 2025.

For the hospital sector, we analysed 1,377 free text comments from the NHS Adult inpatient survey 2024. The sample was drawn from patients who had stayed as an inpatient at any of the 21 hospitals where we inspected emergency departments during the winter of 2025/26 (see Regulatory and strategic projects below for more information).

For mental health, we reviewed all free text comments from the 2025 Community mental health survey from people who also had a stay in hospital as an inpatient in the last 12 months that lasted 7 or more days. We identified quotations that helped to illustrate themes identified through other analyses included in the mental health chapter.

We looked at comments submitted through our online Give feedback on care service about people’s experiences in both the adult social care sector and the primary and community services sector.

For adult social care, we sampled and reviewed 145 comments submitted between 1 April 2025 and 24 July 2026. For the primary and community care sector we sampled and reviewed 630 comments submitted between 1 April 2025 and 31 March 2026. We identified relevant experiences from people that would help to illustrate themes identified through other analysis for each sector in this report.

Providers of health and care services

We conducted targeted analyses of:

• information from our provider information returns for adult social care services
• adult social care market trends using our Health and Social Care Act Directory.

We have also drawn on findings from a sample of our published inspection reports of registered providers during 2025/26 and used the data and insight gained through our routine engagement with these providers.

For mental health, we analysed a total of 85 inspection reports, including:

• 41 inspection reports for mental health services published between April 2025 and March 2026. These included the services: acute wards for adults of working age and psychiatric intensive care units, wards for people with a learning disability or autism, and child and adolescent mental health wards. Inspection reports were for services rated as either requires improvement, inadequate, or outstanding.
• 15 inspection reports from our adult community mental health inspection programme, for community mental health services for adults of working age, and crisis services and health-based places of safety, published between April 2025 and April 2026. These reports were analysed to understand patient safety in services.
• 20 inspection reports for mental health services published between April 2025 and March 2026, where we looked at both outstanding and poor practice around the environment. As well as the service types described above, we also included wards for older people with mental health problems and residential substance misuse services.
• 9 additional inspection reports for community mental health services for adults of working age, and crisis services and health-based places of safety, published between April and August 2026.We reviewed these to look at evidence of implementing the Patient and Carer Race Equality Framework.

For the other sectors, we analysed:

• 48 inspection reports for GP services published between April 2025 and May 2026, which were for providers rated as either requires improvement or inadequate, and where we found a breach of regulations.
• 9 inspection reports for community health services for children, young people and their families, which were published between 2023 and 2025.
• 25 inspection reports for urgent and emergency care services published between April 2025 and June 2026, for services rated as either outstanding, good, requires improvement, inadequate and no approved rating.
• 47 inspection reports for adult social care services published between April 2025 and March 2026, which we reviewed for the ‘safe’ question, where providers were rated as either inadequate or outstanding.

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 types of services we regulate are provided in the data appendix of this report. Some ratings data is also used in the body of the report. The ratings data are from inspection reports published under our current assessment framework, as at 4 August 2026. We began implementing our current assessment framework in January 2024, so the ratings in the appendix, for more than 8,400 services and providers, shows our growing picture of the quality of care under the current framework from that point in time.

Throughout the report and ratings appendix, we do not compare current and previous ratings for the following reasons:

• Our assessment activity during this time has been predominantly 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 the quality and safety of people’s care.
• For some services, the numbers of assessments completed using the current assessment framework are still too low to be representative of all services in that sector.
• Alongside the introduction of the current assessment framework, we also changed some aspects of our assessment methodology, including the levels at which we rate providers. Read the full detail of the different levels of ratings on our website.

In the section on adult social care, we also used our internal data systems to analyse scores for quality statements that underpin the well-led key question.

Our report includes analysis of NHS consultant-led referral to treatment waiting time data. This data presents monthly counts of incomplete pathways at the end of each month. Our analysis includes annual averages of this data to present a high-level picture of waits across the year. It should be noted that as the NHS data is a count of incomplete pathways on one day in a month, the average is a simplification. There will be variation within each month that is not seen in the data. The same pathway may appear in multiple months of data.

We also include analysis of published demographic data from the Waiting list minimum dataset. This data is considered management information and is therefore subject to less validation than an official statistic.

We used a variety of methods to better understand safety in maternity services.

We used responses to the NHS Staff Survey from midwives and our ratings for the safe key question for maternity services to explore whether there is a relationship between measures of staff experience and safety ratings for maternity services. To do this, we used descriptive statistics to compare results from midwife respondents at each NHS trust with our ratings for maternity services at that trust. Where a trust has more than one maternity service at different locations, the staff survey represents the experience of staff across those locations as one value.

However in reality, staff experience at different locations may vary. By applying that trust-level staff survey score to the different maternity service locations in that trust, we are assuming that single score is a relevant comparison to the rating for each location. This is a simplification, and we plan to improve our analysis further over time. Additionally, because we used descriptive statistics, it can only relate to the relationship between these specific survey responses and ratings, rather than inferring a relationship for all midwives and all maternity services.

We also used Hospital Episode Statistics (HES) to analyse changes in maternal readmissions within 6 weeks of discharge from hospital, and how these have changed over time, by mode of delivery and by the mother’s ethnicity. The analysis uses a long-standing CQC indicator based on HES. For this report, NHS England's maternity analysis team reviewed the code, which led to minor changes with no material effect on the results. Our analysis uses data from the first quarter of 2022/23 up to, and including, the first 2 quarters of 2025/26 (April to September 2025). This was the latest data available to us during the analysis period for this report, and we note that the data for 2025/26 is still provisional.

Figures from this analysis are not directly comparable with maternal readmission rates published by the National Maternity and Perinatal Audit (NMPA). Unlike the NMPA indicator, our analysis does not exclude planned readmissions or transfers, or readmissions lasting less than one day. Where combinations of ethnicity and delivery method resulted in counts of 8 or fewer deliveries or readmissions, these were supressed, meaning they were not included in the data and subsequent analysis. Although suppressions do have an impact on analysis results, they are important to protect people’s privacy. To simplify presentation of the analysis we have excluded ‘Not known’ and ‘Not stated’ ethnicity values from our analysis. Instrumental deliveries, for example using forceps, and breach deliveries have been excluded from the ethnicity and delivery method analysis because the rates per 1,000 deliveries were low for some groups, and therefore volatile.

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 2025 and 31 March 2026 on the outcome of an application to deprive a person of their liberty under DoLS in hospitals and care homes. Due to changes in our systems, we cannot exclude applications made through the 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, we conducted a qualitative analysis of 130 comments received through our online Give feedback on care service received between April 2025 and February 2026. Using a targeted keyword search, we identified and analysed comments relating to people’s experiences of DoLS.

We also conducted focus groups with 19 CQC adult social care inspectors in April and May 2026. Discussions explored levels of understanding and identification of DoLS among staff, care planning and risk management, and the impact of waiting times and wider system pressures.

In addition, we analysed inspection reports across adult social care, urgent and emergency care, and mental health services, published between April 2025 and March 2026. We used a targeted keyword search to identify reports that referenced DoLS and to explore common themes and issues.

We drew on insights from the local authority assessment programme, including analysis of 32 assessment reports, to examine issues relating to delays and waiting times, record management, and staff knowledge and understanding of DoLS.

To provide further context for these findings, we analysed the Department of Health and Social Care's DoLS data for 2024/25 (the most recent data available). This enabled us to explore regional variation in the number of DoLS applications and associated waiting times.

Regulatory and strategic projects

Over 2025/26, we have continued our programme of assessing all 153 local authorities in England that have adult social care responsibilities. We have also conducted focused regulatory work on:

• urgent and emergency care services
• adult community mental health services
• Independent Care (Education) and Treatment Reviews (IC(E)TRs).

Insight gathered through these projects has informed our reporting in 2025/26, alongside research commissioned from the Nuffield Trust on priorities for integrated care boards (ICBs).

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.

The recently published report, Local authority assessments 2023 to 2026: Emerging themes and findings, drew on a combination of both quantitative and qualitative evidence generated through our local authority baseline assessment activity, which is described in the Context section of that report.

Urgent and emergency care

During the winter of 2025/26 we carried out inspections in 21 hospitals to look at the emergency departments and medical wards within these providers. We also conducted patient pathway tracking interviews across 16 of these sites. 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 data from patient pathway tracking interviews for 9 out of the 16 sites. We also analysed free text responses from patients who attended the 21 hospitals and who responded to the Adult inpatient survey 2024. We triangulated outputs from these with the 25 inspection reports for urgent and emergency care services, referenced in Providers of health and care services above, to draw out themes about the quality and safety of care in these services.

Senior members of our staff who specialise in mental health supported 14 out of the 21 inspections. Following these inspections, we conducted 10 telephone interviews with leaders in mental health services to discuss the adult acute pathway flow. We used this evidence to establish themes around the care provided to people with mental health needs presenting at emergency departments, and to understand the pressures on adult acute mental health pathways.

We also conducted a qualitative analysis of a sample of reports from the Learning from Patient Safety Events service, which records patient safety incidents. These reports related to liaison psychiatry and people with mental health needs presenting at emergency departments, submitted by the providers that were part of the urgent and emergency care inspections and associated mental health work. The sample consisted of 356 reports that were submitted by 31 providers, between 1 April 2025 and 31 March 2026. This analysis has also been used to inform our work around adult community mental health services.

Adult community mental health care

In 2024, our rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) highlighted specific concerns about the systemic issues within community mental health care. In 2025 we started a comprehensive programme of inspections of community mental health services for working-age adults, and crisis care (including health-based places of safety). To date, we have inspected over a third of community-based mental health services for adults of working age as well as mental health crisis and health-based places of safety.

We have continued to gather evidence to support this programme of work and held 2 engagement sessions with providers in November 2025. These explained our inspection programme and explored how services have been designed and implemented differently across providers, specifically with the aim of meeting the needs of those with severe mental illness and more intensive needs. Representatives from 35 providers of community mental health services for adults of working age and crisis care (including health-based places of safety) participated.

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

Between May 2024 and March 2026, we carried out 88 IC(E)TRs.Our recently published report, Learning from Independent Care (Education) and Treatment Reviews (IC(E)TRs) in 2024 and 2025, shares findings from these reviews. DHSC has asked us to continue to run these reviews for a further 2 years, which we started in April this year.

The published report is based on analysis of a range of both qualitative and quantitative evidence sources, including national data, IC(E)TR reports, focus groups with subject matter experts and follow-up evidence from individuals, providers and families. Full details are described in the report.