State of Care – 2022/2023


The CQC’s annual ‘State of Care’ report was published on October 20th. The report is an annual assessment of health care and social care in England.

The summary of this year’s report finds that ‘the combination of the cost-of-living crisis and workforce pressures risks ‘unfair care’, with longer waits, reduced access and poorer outcomes for some.’

The report highlights ongoing issues with access to care, which has also been raised in previous State of Care reports.

Inadequate capacity in adult social care continues to contribute to delays in discharging patients from hospital. The report states that ‘As at August 2023, the number of patients waiting in hospital who no longer met the criteria to reside was nearly 12,000. This is down from a peak of 14,000 in January 2023.’

The report mentions that, in a recent survey by the Association of Directors of Adult Social Services (ADASS), 99% of respondents agree that ‘increased pressures on the NHS will result in additional pressures for adult social care in the next year.’

According to the report, services funded by local authorities are finding it increasingly difficult to meet demand. The number of new requests to councils for adult social care support increased by 3% between 2020/21 and 2021/22 to almost 2 million requests. More than half a million of these requests did not result in extra support, an increase of over 4%.

Continued staffing and monetary issues in both residential and community services are affecting the quality of care that people are receiving, with some at higher risk of not receiving the care they need.

The report highlights that in adult social care, some providers are finding it extremely difficult to pay their staff a wage in line with inflation.

More than 50% of respondents to the CQC’s survey of adult social care providers in England said they were experiencing challenges with recruiting new staff, and 31% said they were experiencing challenges in retaining them. Despite these statistics, there has been a consistent decrease in staff vacancy rates for care homes, from 11% in January to March 2022 to 7% in April to June 2023.

In 2022/23, roughly 70,000 people arriving to work in the UK from overseas began direct care roles in the independent adult social care sector, in comparison with approximately 20,000 in 2021/22. Providers of adult social care services have informed the CQC that recruiting staff from overseas has ‘enhanced the diversity and skills of their team and helped resolve staffing issues.’

The report highlights that the way in which health and social care works in England has altered greatly over the past year, with new integrated care systems now formalised.

Local authorities are addressing workforce issues in adult social care and attempting to work on gaps in care as they plan ahead for the future. They will, however, need to demonstrate understanding and preparation for the changing and complex needs of local populations.

The report states that assessing carers’ needs is crucial. Carers, including many unpaid carers, are a vital element of all local care systems yet they are not always receiving the support they need. There is variation across the country and many carers are facing monetary problems.

The experience of those in urgent and emergency care remains poor and the problems are highlighting issues that need a local system level response.

In response to the State of Care report, Professor Martin Green OBE, Chief Executive of Care England, said:

“The ‘gridlock’ which characterised the health and social care system last year has been aggravated by new pressures for care, including inflation, the cost of living and ongoing challenges with the workforce. Despite 70,000 new international workers in the care sector across 2022 – 2023, resulting in a net reduction of 13,000 vacancies, we have lost 57,000 domestic workers. This is not sustainable. Without central Government intervention, we may not be looking at gridlock next year, but a total impasse.

With a general election on the horizon, these concerns must not be lost. Social care must be seen as an essential part of national infrastructure. The social care sector is brimming with talent and provides essential support for our citizens. We need a government that understands the importance of social care and sets about creating an environment where it flourishes, rather than struggles.”

To address the funding and workforce issues that are so prevalent in the State of Care report, Care England is calling for a number of solutions in ‘Care For Our Future’, including a fully-funded minimum £15 wage for care staff, to mandate the professional registration of adult social care staff in England, and a £1,500 hospital discharge tariff. This can be viewed at: Care For Our Future: The roadmap to a sustainable future for adult social care - Care England

At Social Care TV, we fully support the call for these solutions. It is evident that addressing the urgent need for improved pay and conditions is necessary to stabilise the sector. Mandating professional registration of adult social care staff would provide a much deserved sense of status, encouraging fewer to leave and more to join the inspiring and selfless workforce we are lucky enough to have.

The full State of Care report can be read at:
State of Care 2022/23 - Care Quality Commission (