| Our annual assessment of the state of health care and adult social care in England has published. State of Care looks at the trends, shares examples of good and outstanding care and highlights where care needs to improve. "This yearâs State of Care describes issues with access to and quality of care and the impact on people who use health and care services - with particular focus on the many children and young people who are not getting the care they need when they need it. The health and wellbeing of a nationâs children has been described as the best predictor of its future prosperity; failing to ensure good, safe care for our children today also risks failing their future.â 
Ian Dilks, Chair, CQC
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 More people are struggling to get appointments to see a GP, and the number of people registered with a GP has increased. Between March 2020 and March 2024, the number of patients registered with a GP in England has increased from 60 to 63 million. Pressures from demand and capacity on NHS primary dental services contribute to problems in access to care and deterioration in peopleâs oral health. Schoolchildren living in the most deprived areas of England were more than twice as likely to experience tooth decay than those living in the least deprived areas. We continue to see a need for social care, including when people are discharged from hospital, which cannot always be met as supply has not always kept pace. Waits for care home beds and home-based care accounted for 45% of delays in discharging people from acute hospital stays for 14 days or more, with nearly 4,000 people delayed a day on average. Staff vacancies in care homes at the end of 2023/24 were at their lowest rate for the last 3 years. Increases in international recruitment showed signs of levelling off and there has been a steep fall in the number of overseas workers applying for health and care worker visas. Outstanding adult social care providers are, despite the challenges they face, putting people at the heart of all decision making. The demand for mental health services, for adults and more increasingly for children, continues to grow. Access to these services also continues to be a challenge for many people. Those who live in deprived areas, women, and people from âotherâ ethnic minority groups are more likely to attend urgent and emergency care departments. We have found evidence of people having to wait several months for treatment in the community, and in some cases even several years. The mental health workforce has grown, but problems with staffing and skill mix remain. The safety of mental health wards continues to be a concern, and lack of resources, ageing estates and poorly designed facilities can lead to issues around privacy and dignity for patients, as well as compromising the safety of both patients and staff. There is high demand for services and ongoing pressure that means many people, including children, are struggling to get the care they need leading to a deterioration in peopleâs health conditions, which then need more intensive support and treatment, and results in longer stays in hospital. The performance of services to meet the need for care is below the expected standard, and in some cases is deteriorating. There is a risk that it becomes normal to accept care that is below the expected standard. People are facing long waits for diagnostic tests and waiting lists are increasing. People also continue to experience delays in referrals and diagnostics for cancer. There is variable considerable between types of cancer and between regional health and care systems. People are waiting too long for Deprivation of Liberty Safeguards (DoLS) authorisation, despite the efforts by local authorities to reduce backlogs and ensure sustainable improvements. We are concerned about the people at the heart of the DoLS system and we continue to see people in vulnerable circumstances without legal protection. There will need to be substantial intervention or these challenges will continue.  Finance, joint forward-planning and workforce depletion are some of the main challenges for integrated care boards while people struggle to access care. Urgent and emergency care services in crisis are a symptom of complex system problems that need resolving, by providing more services for people away from hospitals. Systems are focused on tackling health and care inequalities and need to understand their populations to address issues that affect everyone, from children who need dental care to older people with dementia, but they face financial pressures and competing priorities. However, there are mixed views among integrated care systems (ICSs) about their capability to address local health inequalities. There are challenges and barriers around data and analysis skills, governance and accountability, and capacity and capability in the system. CQCâs formal work on ICS assessments is currently paused. Carers play a vital role in the lives of millions of people. There is work needed to identify carers, and raise awareness that carers are entitled to an assessment and services to support them in their role. Local authorities have taken steps to address inequalities and understand the demographics of local populations, but there is a need for better engagement with the voluntary sector and community groups.  Areas of specific concern highlighted in this yearâs report involve issues around safety, quality, workforce, and inequalities, including: - Too many women are still not receiving the quality of maternity care they deserve.
- We have concerns that children and young people are not always able to access services in a timely way.
- The number of health visitors has declined by 45% over the last 9 years.
- Only around a quarter of people with a learning disability were recorded on the disability register.
- The average waiting time to start an assessment for an autism diagnosis reached a peak of nearly a year, despite the target being 3 months.
- People in Black or Black British ethnic groups are over 3 and a half times more likely to be detained under the Mental Health Act than people in white ethnic groups.
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