On the 24th October 2025, the Care Quality Commission (CQC) published its latest report on the State of Care in England, which highlights areas of good quality practice and points of concern that require improvements within the health and social care system.
While there are some encouraging case studies featured within the report, in general, the report paints a dim picture of the struggles and strains within the system, with large waiting lists, lack of investments, and staff shortages affecting all areas of practice. This has knock-on effects on the mental and physical health of vulnerable people, some of whom move into crisis due to lack of support, thus added further to the pressures and risks within the system – creating a vicious cycle.
We have summarised some of the key findings from the 205-page report below.
Key findings
Mental Capacity Act
- Many inconsistencies between knowledge and application in practice, even when training is provided.
Deprivation of Liberty Safeguards (DoLS)
- Continued rise in applications, with a 15% increase from the previous year, and ongoing delays.
- Concerns around the application of DoLS in hospitals, particularly for older persons, including those with dementia.
- Wide variations in how Local Authorities (LA) are managing applications and the degree of backlogs.
- Although there are some areas where certain hospital providers report good working communications with families around DoLS and certain LAs state no backlogs, the broad picture of application in practice is a struggling system.
- Ongoing delays to the updated Code of Practice and Liberty Protection Safeguards has been highlighted as having an ongoing negative impact.
The issues with the DoLS system are highlighted by one particularly pertinent quote from a hospital provider:
DoLS is resource/admin heavy and as a result, we have created a system that rather than protecting people’s human rights, leaves them vulnerable to unlawful deprivations and no recourse to public funds to challenge. Those that work within the world of DoLS are demoralised working in a broken system that no-one has the appetite to fix.
State of Care 2024/25: 152
Issue with restrictions
One area of particular concern highlighted within the report is the issue of some staff not recognising restrictions for what they are, and so failing to implement the necessary safeguards:
We have also seen cases where staff did not always recognise restrictions, such as locked bedroom doors or people not being able to leave where they live without support from staff. When services stop recognising restrictions there is a risk that they become part of the culture. At one adult social care service, we observed staff applying restrictions on multiple residents without lawful justification:
State of Care 2024/25: 158
“One person was walking with purpose and appeared content when they were repeatedly physically redirected to sit in a chair. There were no supporting assessments, consent forms, or best interest decisions in their care records to justify this practice. Multiple people were routinely kept in bed throughout the day and night with no recorded rationale or any indication this was people’s own choice. Two members of staff and multiple relatives told us they had raised these concerns with the registered manager, but no action was taken.”
Conclusions
Clearly, there is still a lot to do. We can only hope that the new consultation coming up in 2026 will lead to actions moving forward to help address these areas of concern and needs for improvements.