A lack of investment in community services threatens the 10-Year Health Plan’s goal of shifting care closer to home, according to the CQC.

This year's State of Care report finds a lack of integration between community mental health services and, despite rising demand, workforce shortages in community mental health, adult social care and primary and community care.

Dr Arun Chopra, interim chief executive of CQC, said: ‘Right now, community services tell us they're struggling because the way care is funded and organised is designed around hospitals. That's also true of how data about care is collected and how outcomes are measured. All these things make it harder to move towards care that keeps people well, delivered closer to home.'

Community mental health

One in three people wait over three months for community health services, with this rising to almost one in two for child and adolescent services. Over one in ten (14%) reported waiting over six months between their assessment and first treatment appointment.

Adult social care

Job vacancies are three times higher than the wider jobs market with homecare vacancies twice as high as those in care homes.

The CQC says ending overseas care worker recruitment adds to the need for a sector wide workforce strategy and effective fair pay agreement.

Primary and community care

In primary and community care, although the number of trained GPs per head has increased, the number of fully qualified GPs per head has fallen and finding an appointment remains a challenge for those living in the most deprived areas, autistic people and people with a learning disability, and people with a mental health condition.

One in 15 said they would go to A&E if they could not access their GP, with this higher in the most deprived areas.

The number of qualified district nurses per 10,000 people aged 65 dropped by 50% in the last 14 years with annual numbers of new trainees rarely more than half the number of staff leaving the profession.

NHS impact

In March 2025 almost six in 10 hospital patients experienced a discharge delay with homecare placements prevented by workforce shortages.

Meanwhile, hospital readmissions increased over the last 10 years with older people and those in deprived areas more likely to be readmitted within 30 days.

Reaction

Director of policy and research at The Health Foundation, Dr Hugh Alderwick, said: ‘Labour is right to talk about shifting care out of hospital and strengthening care in the community. But – a year in – our analysis shows how far the Government is from having a coherent policy agenda to make these promises a reality.'

Caroline Abrahams, charity director at Age UK and co-chair of the CSA, said: ‘The last sentence in the press release accompanying this report is arguably one of the most important: in it the CQC repeats its call for long-term sustainable funding for social care, an objective we strongly share.'

Nuffield Trust Fellow Camille Oung said ‘over a quarter of the system leaders we surveyed are not at all confident in their system's ability to deliver the Government's ambitions to move care from hospitals to community or shift care from sickness to prevention'.

Daniel Elkeles, chief executive, NHS Providers, said: ‘To look after the physical and mental health of an ageing population and to prioritise care for children and young people the need to support and value strong community services is clear.'

Sarah Woolnough, chief executive at The King's Fund, said ‘the focus of Government remains on hospital care and waiting times targets. For the shift to happen successfully, the Government must be clear that there will need to be trade-offs, with both more focus and more investment in primary and community services so that people can get the care they need to keep them living well wherever they live'.

A Department of Health and Social Care spokesperson said: ‘This Government is getting the NHS back on its feet, and we've made significant progress in just a year. Patient satisfaction with GPs is on the up – we have cut waiting lists by 206,000 in a year, recruited over 2,500 more GPs and taken action to end the 8am scramble.

‘We are setting out plans to launch a National Care Service, kickstarted by our independent commission into adult social care, and we are transforming mental health services with 8,500 more mental health workers and 24/7 neighbourhood centres. In September, we also announced the investment of £500m into a new Fair Pay Agreement to upgrade working conditions and boost pay for carers.

‘We know there is much more to do – we are working at pace to fundamentally reform services through our 10-Year Health Plan to build an NHS fit for the future.'

Lee Peart is editor of Hemming Group’s Healthcare Management magazine.