The Care Quality Commission’s latest State of Care report for 2024/25 paints a picture of continuing fragility across health and social care, with staffing shortages, rising demand, and system interdependence identified as the most significant risks to service sustainability. Despite examples of local improvement, the regulator concludes that “the health and care system remains under consistent strain.”

Covering 29,000 providers, the report highlights that nearly half of NHS acute trusts were rated as Requires Improvement or Inadequate for safety—virtually unchanged from last year. Maternity services and urgent care remain the weakest-performing areas, driven by high staff turnover, recruitment difficulties, and gaps in leadership capacity. Adult social care saw similar pressure, with 84 per cent of providers reporting difficulties filling essential posts. The CQC also warned that coordination between health and care remains inconsistent, delaying discharge and worsening bed pressures.

“When demand outpaces capacity, the effects are felt system-wide,” said Ian Trenholm, CQC Chief Executive. “Sustained staffing shortages and fragile local partnerships mean people are still experiencing variable access, quality, and safety depending on where they live.”

Independent analysts from The King’s Fund described the findings as “unsurprising but deeply concerning,” pointing to the cumulative effect of workforce shortages, outdated estates, and financial deficits.

For NHS boards and integrated care leaders, the report reinforces several enduring priorities:

• Workforce resilience: maintaining safe staffing in maternity, theatres, and emergency care remains the primary risk mitigation lever.
• Governance and culture: effective oversight of safety and learning is as vital as raw capacity.
• System coordination: seamless flow between hospitals, community, and social care is essential to reducing handover delays and readmissions.
• Targeted improvement: regulatory focus will increasingly fall on leadership quality and consistency of service improvement plans.

ProMedical View

“The State of Care findings reflect what many providers already know—staffing is the decisive factor in safety and resilience. Structural reforms and digital innovations can support improvement, but no model can function without sufficient, competent, and supported staff on the ground. Building sustainable workforce pipelines, supported by flexible deployment, is central to stabilising fragile services. In practice, that means blending substantive recruitment with responsive temporary capacity, ensuring that safety and access are maintained even under extreme operational pressure.”

While the CQC notes encouraging progress in individual services, the overall picture remains one of systemic fragility. Addressing that will require more than new policies—it will require durable workforce solutions and genuine cross-sector collaboration.

References

• Care Quality Commission: State of Care 2024/25 (October 2025).
• HSJ: “CQC: ‘Persistent fragility’ continues to define system performance.”
• The King’s Fund: “CQC report highlights widening gap between demand and capacity” (2025).