The Care Quality Commission’s (CQC) latest State of Care report paints a mixed picture: services are improving in places, but not fast enough to keep pace with rising need. The state of health care and adult social care in England 2025/26, published on 23 October, notes encouraging signs in GP access, digital services and elective care waiting lists.
It also highlights persistent concerns about access to care, growing demand, mental health services, workforce pressures and deep-rooted health inequalities.
At Public Voice, these are not abstract findings. We manage four Healthwatch services, Healthwatch Barnet, Healthwatch Croydon, Healthwatch Haringey and Healthwatch Hounslow, which gives us a close view of how health and care are experienced across four London boroughs. Residents tell our teams how hard it can be to navigate services, how barriers fall hardest on marginalised communities, and how long waits for support affect their lives.
Our teams are also hearing directly from carers who are exhausted and overwhelmed. That diminishes their ability to advocate for themselves and the person they care for, and many are not fully informed of their rights or of how to access support.
The CQC report highlights several themes that are particularly familiar to our Healthwatch teams and to the views shared by residents. Here are three areas it mentions where Healthwatch Barnet, Croydon, Haringey and Hounslow have made a difference locally.
1: Access to care remains a major concern
The CQC describes access as an overarching theme, with ongoing difficulty getting GP appointments, long waits and growing demand across the system. Residents in our boroughs describe the same barriers, and our teams use what they hear to push for practical change.
Hounslow: The Healthwatch Hounslow Enhanced Patient Access to GP Practices report explored how residents book appointments and use primary care. Participants described long telephone waits, difficulty securing appointments, concerns about online and telephone consultations, and the well-known “8am rush”. The report called for better telephone systems, equitable access regardless of age or digital confidence, and patient experience data alongside operational performance measures. Its findings helped inform local efforts to offer enhanced opening hours and more flexible appointment options.
Haringey: Healthwatch Haringey’s report, GP Access in Haringey: Learning from GP practices to help improve services, set out to understand the specific challenges and to suggest recommendations that fit the reality of GP services. Interviews with practice managers and practice case studies showed disparities between the east and west of the borough. Practices needed to improve the telephone appointment experience, communication with patients (including those whose first language is not English), and staff wellbeing and development.
Challenges included reaching seldom-heard communities, engaging patients, and misinformation and rumours about the practice. Healthwatch Haringey recommended strategic collaboration across the borough to improve patient experience and share best practice, including for reception staff and clinicians. It also asked practices to give clear information on staff roles and to share good news stories that showcase improvements.
Listening to people’s experiences helps identify the specific barriers they face and generates practical ideas for improving services. Working with decision-makers, our teams turn that insight into changes residents can notice.
2: Rising demand for neurodiversity and mental health support
The CQC raises significant concerns about children and young people’s services, particularly increasing waits for neurodevelopmental assessments and mental health support. It reports that the number of children and young people waiting over a year rose by 129% in 2024-26, many of them waiting for a diagnosis of conditions such as autism and ADHD.
Croydon: Healthwatch Croydon’s 2025 research, Neurodiversity and Healthcare Access: Croydon Patient Perspectives, found strikingly similar issues for adults. Participants reported long waits for diagnosis, unclear referral pathways, difficulty getting support after diagnosis, and frequent overlap between neurodiversity and mental health conditions. Many described sensory, communication and organisational challenges that made healthcare hard to navigate.
Healthwatch Croydon helped identify the need for better communication throughout diagnostic pathways and more comprehensive post-diagnostic support. It also called for healthcare systems designed around different communication and sensory needs.
3: Health inequalities continue to shape people’s experiences
The CQC links where people live to access, waiting times, quality of care and outcomes, which are often poorer in deprived areas. Our teams’ research with particular communities echoes this.
Hounslow: Healthwatch Hounslow’s report on improving the ability of BAME individuals to access and obtain support from health and social care services found difficulties booking appointments, using digital services and accessing translation. Many participants preferred face-to-face GP appointments. Evidence showed mistrust of services, and many residents believed greater BAME representation in the sector would help reduce health inequalities in Hounslow.
Community organisations and members also described discomfort discussing mental health. Some were reluctant to seek support because they feared Social Services involvement could disrupt families or lead to children being taken away. Healthwatch Hounslow recommended better information in community languages, including Somali, on mental health, diabetes and family planning. It also recommended wider BAME representation, better access to translators, employability training and, where funding allows, spaces and activities for BAME community groups.
Barnet: Healthwatch Barnet’s report, Access to exercise for people with long-term health conditions, points the same way. Exercise benefits physical and mental health, but people with long-term conditions report barriers to being active, and increasing physical activity is a national and local policy aim. The team researched what would help residents with long-term conditions, particularly those in financial hardship, to exercise more. This included how the Long Term Conditions Locally Commissioned Service appointments offered by North Central London GP surgeries since October 2023 could help.
All survey participants were Disabled people and/or had long-term conditions. The team also gathered data on GLL Better Gym Healthwise referrals, those appointments, and toilets in Barnet parks. The report recommends removing barriers to physical activity, reflecting the Social Model of Disability: people are disabled by societal barriers, not by impairments or health conditions.
Croydon: The CQC-funded report on Croydon’s vulnerable migrants’ experiences of health and care services found similar patterns. They surveyed and interviewed migrants from 24 countries, including Iran, Afghanistan, Sri Lanka, Cameroon, Honduras and Trinidad and Tobago, who were living in migrant accommodation while awaiting immigration decisions. Most registered easily with a GP, usually through Rainbow Health Centre, a dedicated GP service for people who are homeless and asylum seekers, and valued their care. Few knew of the Safe Surgeries initiative.
Most reported hospital and specialist waits and limited dental access. Some faced poorly understood mental health needs, medication difficulties and long emergency waits. Healthwatch Croydon’s recommendations to the CQC included faster access, clearer guidance beyond GP care and better mental health support.
Haringey: Healthwatch Haringey’s report, Access to Health and Social Care Services for the Latin American Community in Haringey (March 2026), identified significant barriers. These included language difficulties, limited awareness of services, challenges navigating the system and unmet mental health needs. Participants also noted differences between the UK health system and those in their countries of origin, which could make access more complicated.
The research called for more inclusive and accessible services, better information and communication, greater cultural awareness and stronger recognition of the specific needs of underserved communities.
Listening to local voices
The voices of local communities remain one of the most valuable tools for shaping better health and care services. Too often, the people in greatest need are not at the table, and they need support to be represented and heard.
That is why Public Voice exists: to translate the insights and needs of people into actions that improve public services and reduce inequalities. Running four Healthwatch services lets us listen closely in each borough, spot the themes that recur across them, and bring that evidence to commissioners and system leaders.
Read the CQC’s full report: CQC State of Care.
