The state of health care and adult social care in England 2024/25

As more people are being diagnosed with dementia it is more likely than not that we will either experience living with dementia ourselves or provide care for a loved one with dementia in our lifetime.

The economic impact of dementia is forecast to rise from £42 billion to £90 billion in the next 15 years.

In May 2025, we published a report on health and social care support for people with dementia. This looked at what people were telling us, through surveys and feedback, about their experiences of living with dementia when using health and adult social care services, including the experiences of families and carers.

Our report set out the main themes that influence whether a person’s experience is good or poor, and what health and care services are doing to improve these experiences:

• Access to health and care support: People told us they were having to wait too long for a diagnosis, and about a lack of ongoing care and support for dementia in the community. However, people who had good support from their primary care services during their dementia journey described the positive effect this had on their wellbeing.
• Person-centred care is important: But staff in NHS acute hospitals do not always understand the specific care needs of people with dementia. Also, often adult social care staff were not adequately attending to people’s day-to-day care needs, including support with nutrition and hydration.
• Staffing and training: Providers have recognised that staff need to improve their knowledge of effective dementia care. Key stakeholders say there is a need for a clear baseline understanding of dementia for everyone who works in health and social care, at all levels.
• Family and unpaid carers: Despite their important role, family and carers told us that communication with staff and management could be poor, and there was an over-reliance on them for intervention and advocacy when their loved ones were using health and care services.
• Inequalities: Key stakeholders told us that inequality was a root cause of the challenges facing people living with dementia. Persistent misunderstandings and stigma associated with dementia can also lead to inequalities in how care is delivered and commissioned. We also saw limited consideration for the combined impact of dementia and other protected characteristics when carrying out the analysis for our report.

Recent inspections

Findings of poor quality care

Many of the findings in our report on care for people with dementia are also reflected in recent inspections. Inspectors told us in focus groups that they are finding staff have a poor understanding of the specific needs of people with dementia, and that providers and staff do not always have the knowledge of person-centred approaches and dementia-friendly environments, which could affect people’s safety.

For example, in a 2025 inspection of a care home that cares for people with dementia (which we rated as inadequate), we found that the service’s leaders were failing to manage risks to people’s health and safety. Incident reports showed that three-quarters of falls happened during the night shift, but staffing levels hadn’t been reviewed. Also, some staff didn’t understand their role in safeguarding people and protecting them from the risk of abuse.

In a previous inspection of this service, we found that people were at risk of sexualised behaviour from other residents and this was still the case. Safeguarding concerns hadn’t always been referred to external agencies for investigation, and one member of staff thought it was their manager’s responsibility to report concerns. We found 5 breaches of legal regulations relating to safe care and treatment, safeguarding, staffing, recruitment, and how the service was managed, and we imposed urgent conditions on the home to restrict accepting any new residents without prior agreement from CQC.

At another care home, which we placed in special measures, our inspectors saw exposed nails in walls and an exposed electrical wire in a light directly above a person’s bed, as well as trip hazards elsewhere. This is particularly dangerous as the service was caring for people with dementia, who may be less able to recognise risks to their own safety.

Findings of good quality care

By contrast, at a care home that we rated as outstanding, leaders continually assessed people’s changing support needs. For example, a person with dementia was becoming increasingly anxious, therefore with their and their family’s full consent, the provider trialled a series of tailored adjustments to the person’s environment, particularly during mealtimes, to foster a sense of comfort and security, and to reduce their anxiety. As a result, there was a significant improvement in the person’s overall wellbeing, including more restful sleep, which has been recognised as an essential factor in positive health outcomes for people living with dementia.

At a different care home, which we inspected in 2025 and rated as outstanding, the provider had recently opened a ‘wellbeing suite’, with a working kitchen, dishwasher, oven, sink, and washing machine so people with dementia could take part in day-to-day activities that they might miss from their lives before moving to the home.

This addition was driven by significant evidence that, for people living with dementia, engaging in familiar daily activities can enhance their quality of life, cognitive function, and emotional wellbeing. One person with dementia often became distressed in the afternoon. She had a long history of baking with her family, which was a source of comfort and routine. Staff recognised this and integrated it into her care plan. Whenever she became distressed, staff engaged her in baking simple recipes, which was a calming intervention that fostered positive engagement with staff and other people, and improved her overall mood. Feedback from family members confirmed that the person was happier and more settled.

Another care home, which we rated as outstanding following an inspection at the end of 2024, had employed a dementia specialist consultant who worked extensively with people and their families to maximise their understanding of people’s needs and preferences. They ensured that everyone’s voices were heard, and that they were supported to overcome potential barriers to living a fulfilling life. For example, the provider told us that after members of the public had raised concerns about noise from the home, they had invited local residents to look around the home to meet people. This gave people the opportunity to increase their understanding of how a care home worked and what it was like to live with dementia.