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

Our 2025/26 report presents a mixed picture across health and adult social care services that people in England use every day.

The demand on health and adult social care services in England continues to grow and in some areas, including community mental health services, people who need care have increasingly complex or advanced needs. However, there are some green shoots of recovery. We see improvements in how the system responds to demand – for example, a better experience of contacting GPs, benefits of digital solutions, and shorter waits for elective care.

But it is difficult for this improvement to keep pace with the increased need for care – and this is set against a backdrop of persistent and localised inequality. Where you live can make a big difference to the quality of care you might experience, especially for those living in relatively deprived places.

We are concerned for children and young people where we see rapidly increasing levels of demand and people having to wait longer – especially for community health services. While the length of waits is improving overall for most adult services, the opposite is happening for children’s services.

Workforce pressures can affect people’s access to care – and the quality of care. Although we have seen some improvement in the stability of the workforce in the adult social care sector, we remain concerned about the potential impact on reductions in international recruitment for the sector. Our inspections of adult social care show that where staffing is well managed, with the right skill mix, people are more likely to receive safe, person-centred care. However, from the 6,294 inspection ratings for adult social care services that we have published under our current assessment framework, the area needing greatest improvement is under our well-led key question.

Gaps in staffing within GP services can lead to challenging workloads and less capacity to care for people, as well as less time for staff to complete the right training and upskilling. In community health services, we continue to see a decline in the number of health visitors and school nurses.

While the move towards greater community provision and prevention activity is recognised as necessary, we have heard from some integrated care board leaders who are concerned about the feasibility of these shifts. Across care pathways, we are concerned about how people move between services and the effects of delayed discharges from hospital into community and care services.

There is increasing concern about the fragility in the funding model for local authority provision in adult social care services – and the market in which they operate. Our programme of local authority assessments has highlighted variation in both the quality and practice of commissioning in adult social care services across England.

While the overall number of care homes is reducing, large care homes are making up more of the market, which means the market is becoming more consolidated. However, in homecare, the market is fragmenting, with more smaller providers being established. What – if any – impact these divergent emerging trends in social care have on the quality of care is a question that will need careful attention.

Access to care

Access to health and adult social care services remains a serious problem for many people who need care – and is a challenge for the services providing care.

The issue of access to care is probably the most persistent problem throughout the years that we have reported to Parliament on the state of care in England. This is evident in 2025/26 in all the sectors we regulate.

In adult social care, fewer and fewer people are eligible to receive fully state-funded care. At the end of 2024/25, it was estimated that around 223,000 fewer adults were receiving long-term council-funded social care support compared with 20 years ago.

The financial means test to receive state-funded care has been capped at £23,250 for the last 15 years and many people must either try to fund care themselves, count on support from unpaid friends and family, or go without. For 70% of new requests for council-funded social care and support no further action is taken, beyond providing information.

There is pressure on mental health services across the care pathway and demand continued to rise in 2025/26. In community mental health, the number of people in contact with services has increased by 34% over the last 3 years. This pressure is compounded by a rise in the number of people with severe mental illness who are accessing care.

In the hospital sector, urgent and emergency care services remain under sustained pressure. In 2025/26, there were just under 19.9 million calls to NHS 111, nearly 14 million 999 ambulance calls, and 28 million attendances to urgent and emergency care services – this is over 608,000 more attendances than in 2024/25.

The operation of Deprivation of Liberty Safeguards (DoLS) over the last decade has been characterised by an increasing volume of applications and sustained backlogs. Our notifications data suggests a continued increase in the use of DoLS in 2025/26.

Problems with getting access to care affect people’s experience of care. And long waits for care remain common for many people – there is unmet need across the system, and those who need care often rely on unpaid carers who provide billions of pounds’ worth of care every year.

A growing number of people are waiting for community health services. The number of adults waiting over a year has reduced, but the number of children and young people who have been waiting over a year increased by 129% in the 2 years to March 2026. The majority of these very long waits are for community paediatric services, including diagnosis of neurodevelopmental conditions, such as autism and ADHD. Our joint inspections with other agencies have shown the profound impact that delays in assessment and care are having on children and their families.

More children and young people need mental health care, and we are also concerned about the long waiting times for these mental health services. Between 2023/24 and 2025/26, the number of children waiting for their first contact with services at the end of the reporting period rose by 31% from a monthly average of 237,590 to 311,070.

People in crisis are struggling to access the mental health care and support they need. Only 25% of very urgent referrals are receiving care within 4 hours. And those seeking help from urgent and emergency care services are facing long waits for assessment by psychiatric liaison services, although this has improved over the last 2 years.

A lack of community placements, incomplete information sharing, or poor representation from social care at planning meetings are creating challenges with discharging patients from secondary mental health services into the community. This can lead to delayed discharge, longer inpatient stays, relapse or readmission, and increased pressure on the whole system.

In 2025/26, the number of people waiting 4 hours at type 1 emergency services to be either admitted to hospital, transferred or discharged, has improved slightly with 60.9% of attendances (10.4 million) seen in under 4 hours. However, more people who need to be admitted to hospital are facing long waits, with more than 1,500 people a day on average waiting longer than 12 hours from the decision to admit to actual hospital admission in 2025/26. Our urgent and emergency care inspections show how this is creating significant operational challenges for emergency departments, with some people facing prolonged waits.

Bed availability, hospital processes and challenges in the wider system can all affect patient flow through the hospital, and we continue to see ongoing challenges with hospital discharge delays. On average, on any given day in 2025/26, nearly 13,000 people remained in hospital when they were ready to be discharged. This is up from 12,700 in 2024/25.

Year-on-year, the average number of incomplete pathways for elective care or treatment has fallen: in 2025/26, the average size of the waiting list stood at 7.3 million, down from 7.5 million incomplete pathways in 2024/25. Most people are also receiving a diagnosis or having cancer ruled out within 28 days of referral. But we remain concerned for the people waiting too long to start treatment once they have a diagnosis of cancer. In 2025/26, 69.4% people with an urgent referral started their treatment within 62 days – the target is 85%.

For some people, access to services appears to be improving. In primary and community care services, since the requirement from October 2025 for GP practices to keep online consultation tools open during core hours, there has been a significant rise in the use of online consultation systems by patients (a 67% increase in online requests per 1,000 patients between March 2025 and March 2026).

More patients are finding it easier to contact their GP practice: 73% of people described their last experience of contacting their GP as ‘good’, compared with 70% in 2025 and 67% in 2024. This coincides with an increase in people saying they contacted their practice online. Across the key questions that we use to assess how effective, caring and responsive services are, we have rated over 9 out of 10 GP practices as either good or outstanding.

The health and care workforce

Workforce pressures affect people’s access to care as well as the quality of care. We have seen that where staffing is well managed, people are more likely to receive safe, person-centred care.

There is considerable regional variation in workforce numbers across integrated care board (ICB) areas. For example, in GP practices, the number of GPs per 100,000 patients ranges from 38 to 56, and for nurses it is between 13 and 45. Among GP practices, London has some of the lowest staffing rates, while the South West has some of the highest.

We see the impact of persistent gaps in staffing at GP practices that are rated as requires improvement and inadequate – including increased workloads for existing staff, an inability to keep up with important training and longer waiting times for appointments.

While staff vacancy and turnover figures continue to reduce in the adult social care sector, they remain high. Our assessments of services rated as inadequate for the safe key question identified issues around recruitment processes and ensuring a safe and sufficient level of staffing – this resulted in breaches of regulations and had an impact on the delivery of safe, high-quality care as well as on 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. Our assessments of adult social care services rated as inadequate for the safe key question found that they did not always ensure staff had the necessary skills, knowledge or competence to safely meet people’s needs. Social care employers responding to the adult social care workforce skills survey highlighted the cost and time to train staff as the most common barriers to investing in developing their skills.

Through our joint inspections with Ofsted of services across education, health and care for children and young people with special educational needs and disabilities, we saw how health visiting and school nursing services remain central to early identification of needs, safeguarding and access to wider health support. Despite demand growing for these services, staffing levels continue to decline with the added pressures of an ageing workforce.

Inequalities

Inequality pervades across health and adult social care in England in 2026. Where you live influences whether you can access care, how long you might wait for care, the quality of care you receive and the outcomes from it. People living in more deprived areas often experience poorer access and outcomes.

Primary and community care services play a vital role in the clinical areas highlighted in NHS England’s Core20PLUS5 approach. This aims to support the reduction of health inequalities at both national and system level, including severe mental illness (SMI), which includes schizophrenia and bipolar disorder, and hypertension.

For adults living with SMI, the risk of dying prematurely is almost 5 times higher compared with others. There is huge variation in annual health checks for people on an SMI register by ICB area – ranging from only 53% of people to 81%.

In March 2026, 80% of people aged 14 and over who were on their GP’s learning disability register had received a health check in the previous 12 months. These figures also vary by ICB area, from 70% to 86%. But, as at March 2024, it was estimated that only around a quarter of the 1.3 million people with a learning disability in England were recorded on their GP’s learning disability register.

As demand increases for mental health services, we continue to see that people who live in the most deprived areas and people from ethnic minority groups have greater levels of need and contact with community mental health services. But not everyone is able to access the care they need when they need it.

In hospitals, we have been clear about the need for a faster pace of improvement nationally in maternity services, particularly around the safety of services and the inequalities faced by certain groups of people with protected equality characteristics.

Our analysis of maternal readmissions this year highlights variation in rates of maternal readmission within 6 weeks of birth. The highest rates are for women from Black ethnic groups.

Our focus on health and care services for children and young people shows that where people are born and where they live can have a dramatic influence on their health outcomes. There are large variations depending on the area and levels of deprivation. The Core20PLUS5 for children and young people includes asthma, diabetes and oral health as 3 of its clinical areas of focus. Although hospital admission rates for diabetes in children and young people have been reducing, there is regional variation – the North East and Yorkshire have higher rates of admissions for diabetes in children and young people, while rates in London have been consistently lower than the England average since 2013/14.

Among examples of variation is the condition of bronchiolitis – a common cause of hospitalisation in children under 2 years. Although admission rates for bronchiolitis have reduced slightly in the last 2 years, rates in 2024/25 remain over 50% higher than a decade earlier. There is also a distinct national divide – regions in London and the South East have lower admission rates than regions in the North.

Oral health outcomes for young children continue to show substantial geographic and socioeconomic variation across England. Children living in the most deprived communities experienced, on average, more than twice the level of tooth decay compared with those living in the least deprived communities.

Improving access to children and young people’s mental health services for 0 to 17-year-olds is one of the 5 clinical areas of focus in the Core20PLUS5 approach for children and young people. Our work with the Nuffield Trust to find out more about the work of ICBs to improve health and social care services found that mental health was most consistently rated as a clinical priority for children and young people, as 11 out of 13 ICB leaders who responded to a survey said it was a high priority.

Variation is also evident in the way health and adult social care services apply and understand Deprivation of Liberty Safeguards (DoLS). We have identified issues around how services manage training for staff and record-keeping, as well as recognising and reviewing restrictions.

Systems

Local health and social care systems are focused on the ‘three shifts’ encouraged by the government in the 10 Year Health Plan for England, including a drive to move care closer to people's homes and local neighbourhoods – from hospital to community.

We have seen that GP appointment rates have increased – appointments per 100,000 patients rose by 2.4% in 2025/26 since the previous year, and by 9.7% since 2022/23.

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.

We are seeing an increase in the number of homecare hours delivered, which can lead to better experiences and outcomes for those able to access services – more people supported to live in their own homes and communities. But there are risks. Fragmentation can lead to more complex commissioning processes, and can present challenges for care providers.

Local authorities have a pivotal role and influence on people’s experience of adult social care – and we now have a strong view about the way they are working to meet their legal duties under Part 1 of the Care Act (2014). Our assessments allow us to provide independent assurance and our first report on local authorities, in 2026, provides a baseline view.

We found that local authorities are broadly performing well in the face of significant challenges, with 59% rated as good, 37% rated as requires improvement, 3% rated as outstanding and 2% rated as inadequate.

In this State of Care report, we have drawn on those findings and highlighted the importance of the quality of partnerships in an area – and how some people will be experiencing the positive benefits of living in a place where the importance of adult social care is valued and understood. But in too many instances, people wait 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) came from delays completing transfers between hospitals and social care services.

There are examples of local innovation, including neighbourhood models and integrated teams. There is also some good use of population health data – and outreach to communities affected by inequalities.

In particular, we have seen changes in the way community mental health services are commissioned and delivered. Through our engagement events held with mental health providers, we heard positive examples of providers working more closely with the voluntary, community, faith and social enterprise sector to remove barriers and deliver care in the community. However, providers at our events also raised issues about a lack of guidance around safe staffing levels, medicines management, caseload management, and a lack of focus on a proactive and longer-term approach to preventative care and recovery.

Findings from the State of the Provider Sector Survey, from NHS Providers, and feedback from attendees at our provider engagement event have pointed to concerns around funding and the need for investment in order to scale up successful pilot projects. Figures from the NHS Providers Survey show that 19% of mental health providers have deprioritised spending on transformation initiatives, and a further 32% are considering doing so because of financial pressures.

We are also concerned about what happens to some people with mental health needs following discharge from hospital. Some people with complex needs and who present with a high risk of harming themselves or others, including specific groups of people who are more likely to disengage with services or are seldom heard, are being lost in the system and not receiving appropriate support.

As well as our findings from inspections, this report reflects what we hear from people who use services. We use our Experts by Experience programme and we take feedback from Share for Better Care. People’s voices are an essential part of our insight and we continue to use all the networks we can – everything from our own surveys to social media – to ensure our work is well-informed. The feedback helps us focus on issues that matter to people.

Throughout the year, we have continued to use our unique position to influence improvement for people who need health and social care services. We provide examples of this in this report, including our ongoing commitment to encouraging services to embed the Patient and Carer Race Equality Framework, and checking how services use the framework as evidence to inform our assessments. And we have encouraged services to learn from one another by promoting the successes we have seen – there are real examples of excellence, identified through our day-to-day work.

In March 2026, we published research on what good practice looks like in caring for people living with dementia, highlighting the importance of having staff who know about dementia and know how to provide proactive support. From here, we will co-produce statutory guidance for providers across health and social care on delivering care for people living with dementia. And we will continue to voice our concerns for people who are subject to restrictive practices – particularly autistic people and people with a learning disability. Our Independent Care (Education) and Treatment Reviews will continue for a further 2 years, highlighting the importance of person-centred, trauma-informed care, and how the skills and knowledge of staff can have a direct impact on the quality of care that people receive.

While we have improved our operational performance and the number of our inspections over the past year, there is much more to do. We are determined to not only maintain this progress but to accelerate it, drilling down into the areas that give us cause for concern, drawing on what we see through our regulatory work and what we hear from people who use health and care services, and their families and carers.