Care Quality Commission (CQC) State of Care Report 2025/26 – CBF response

On 23^rd October, the Care Quality Commission (CQC) published their most recent ‘State of Care’ report.

The report highlights that there are still serious issues with support for people with learning disabilities, spanning all areas of health and social care. People with learning disabilities:

• experience more difficulty contacting their GPs and have worse experiences at their GP surgeries than people without learning disabilities
• are being ‘endangered’ by providers failing to seek appropriate learning disability and autism training for their staff, despite this being a legal requirement
• continue to experience inappropriate restrictive practices in mental health hospitals and face systemic barriers that delay discharge and prolong their stays
• experience restrictive practices in adult social care without a clear rationale, leading to the abusive use of these practices

These are issues which have been highlighted time and time again, by CQC and by others. While CQC found some evidence of progress, it is deeply concerning that these problems persist, leaving people with learning disabilities at risk of experiencing care that harms them.

Restrictive practices in adult social care

People with a learning disability and autistic people continue to be subject to high levels of restrictive practices. CQC found that staff in adult social care “did not always recognise” restrictive practices, and that in many cases, restrictive practices were being used without assessing whether they were in the person’s best interests and without “clear rationale or legal authority”. They also found that the Mental Capacity Act is often misunderstood; given the recent changes to the definition of deprivation of liberty, it is essential that the Mental Capacity Act is properly understood and applied so that the rights of people with learning disabilities are upheld.

Mental health hospitals

The report also draws on learning from CQC’s work on Independent Care (Education) and Treatment Reviews (IC(E)TRs), finding that people with a learning disability and autistic people in long-term segregation in mental health hospitals become ‘stuck’ because:

• unsuitable environments lead to the person becoming distressed, which in turn is used to justify keeping them in detention
• staff do not always have the right skills or training to support or communicate with them
• there is a “lack of leadership” in clinical teams

These issues with long-term segregation, and with other care within hospitals, show once again the importance of moving away from a model of inpatient care for people with learning disabilities and autistic people – a model which is well-recognised as harmful and inappropriate – and instead enabling people to get the right support within their communities.

Read our response to the IC(E)TR report

Read more about the Transforming Care agenda

Transition to adulthood

A key point raised in this report is the issues that young people face during the transition to adult services. The issues that they highlight – including failures to start transition planning early, poor communication with young people and their families, and a lack of joined-up working between both children’s and adult services and between different teams – are all issues that families have told the CBF that they face. Our recent report, ‘Building a Bridge: How to end the cliff edge of transition between children’s and adult services for young people with learning disabilities in England’, sets out the barriers to good transitions, the impacts that they have on young people with learning disabilities and their families, and how they can be overcome.

Read our Transition report here

Find out more about our work on Transition

Calls to action

In their launch event for the report, CQC made four calls to action:

• Measure success by how well health and care work together
• Look at prevention through a health inequalities lens
• Address commissioning, funding, workforce, and leadership through the government’s reforms to social care
• Focus on early identification of need for children and young people

The CBF supports all of these calls. It is vital that children, young people and adults with severe learning disabilities, and their families, are able to access the right support, early, through an integrated and holistic system. People with learning disabilities face serious health inequalities – as highlighted by the recent LeDeR report, among others – and it is essential that addressing these is at the heart of the government’s prevention agenda.

Much of what is covered in this report is not new. What it does show is that there is a need for the government to commit to a new national learning disability strategy, co-produced with people with learning disabilities and their families.

Through its future work – including the extension to the IC(E)TR programme, changes to its assessment frameworks, and engagement with government around health and social care reforms – CQC must take a leadership role in ensuring that the issues identified are addressed in partnership with stakeholders across the system.

Support from the CBF

Resources on our website

The CBF has information available for anyone who has concerns about poor support or abuse which can be found here:

Family Support Service

If you have been affected by any of the issues raised in this report, you can call the Family Support Service on 0300 666 0126

Or email us at support@thecbf.org.uk

We are open at the following times:

Monday – Thursday: 9am – 5pm
Friday: 9am – 3pm

We offer information about challenging behaviour to anyone who provides support to a child, young person or adult with a severe learning disability. We can also signpost you to other specialist organisations and sources of information.

Please note we are a small support service so you may not be able to get support straight away. We will support families with urgent concerns as a priority.

Professionals are also welcome to contact the CBF.