The Care Quality Commission’s annual State of Care report shows that children are waiting longer than adults for community appointments and reveals stark regional health inequalities. 

More than 80,000 children and young people in England have waited over a year for a community health appointment, the Care Quality Commission (CQC) has revealed. 

This figure is almost 11 times the number of adults waiting for an appointment, the regulator’s annual State of Care report found. 

While there have been improvements in other areas, such as more GP appointments, children and young people are experiencing some of the sharpest increases in need and waiting times, with stark regional health inequalities apparent. Around 32% of five-year-olds in the most deprived communities have tooth decay, compared with 14% in the least deprived. Hospital admissions for children and young people with diabetes are also higher than the England average in the North East and Yorkshire. 

The CQC warned that falling numbers of health visitors and school nurses, despite rising demand for such services, are weakening early intervention and safeguarding.

Meanwhile, the number of children waiting for their first contact with mental health services has risen by 31% in two years. This comes amid wider concerns about rising mental distress among young people over the past three decades, highlighted in the recent government review by psychoanalyst Peter Fonagy. 

Andy Bell, chief executive of the Centre for Mental Health, said such long waits for support put children at risk of struggling at school and “reaching crisis point before their needs are met.”

The King’s Fund also warned that the decline in specialist roles providing early intervention, alongside growing demand for mental health services, was leaving children waiting too long for support “at a critical point in their lives”. 

Patchy and fragmented social care

Turning to social care, the CQC warned that the market is changing rapidly, without a clear plan for how services should develop. Homecare is fragmenting, with more small providers entering the market, inspectors found. Care homes, meanwhile, are consolidating, with more beds concentrated in larger homes and institutional investors increasingly acquiring services.

The regulator said financial pressures and local authorities’ differing abilities to plan and commission services were driving these changes. Some providers are increasingly seeking customers who can pay for their own care to remain financially viable, reducing the capacity for poorer people who rely on council-funded support.

The report also highlighted the decline in access to publicly funded care, with around 223,000 fewer adults receiving such long-term funding than two decades earlier. The financial threshold for state-funded care remains at £23,250, despite inflation, meaning more people must pay for care themselves or rely on unpaid support.

Chris Badger, the CQC’s chief inspector of adult social care and integrated care, called for “a clearer vision” for the sector, backed by sustainable funding and better commissioning. He also stressed the need to invest in leadership to deliver safer, better care.

Camille Oung, fellow at the Nuffield Trust, said the report revealed a “fractured and patchy system that too often locks people out of publicly funded support”. Oung added it was crucial to bolster the care sector workforce, while system-wide reforms, which could take years, are in the works. 

The CQC did identify some improvements. For example, staff vacancy and turnover rates have fallen slightly, although leadership remains an area in need of improvement.

The regulator said funding, workforce planning, commissioning and prevention must be addressed cohesively. Without a more joined-up approach, pressures in one part of the system risk undermining care elsewhere, the CQC warned. 

The Department of Health and Social Care said the document showed the “scale of challenges” the government inherited when elected in 2024. A spokesperson said that while the CQC recognised signs of progress on waiting lists, cancer care and general practice, patients rightly expect faster improvements, with the secretary of state committing to “go further to end corridor care, transform support for mothers and children, and deliver a new national care service.”