• Despite continuing challenges around demand, funding, and workforce shortages, Care Quality Commission's (CQC) annual assessment of the quality of health and social care in England demonstrates that overall, quality has been largely maintained, and in some cases improved, from 2016/17.
• However, the assessment finds that people's experiences of care varies depending on where they live; and that these experiences are often determined by how well different parts of local systems work together. The most visible impact of this is the pressure on emergency departments as demand continues to rise.
• Ian Trenholm, chief executive of CQC, said: "We've seen some examples of providers working together to give people joined-up care based on their individual needs. But until this happens everywhere, individual providers will increasingly struggle to cope with demand – with quality suffering as a result."
• CQC add that a threat to effective collaboration between health and social care is the continued fragility of the adult social care market, with providers closing or ceasing to trade and contracts being handed back to local authorities. Unmet need continues to rise, with Age UK estimating that 1.4 million older people do not have access to the care and support they need.

Responding to the Care Quality Commission State of Care 2017/18, the head of policy at NHS Providers, Amber Jabbal, said:

"It is a testament to hard working frontline NHS staff that, despite the financial and staffing challenges that providers face, patients and the public can still expect good care when they need it.

"As State of care makes clear this pressure across the health and care system is leading to record breaking demand for NHS emergency care. These pressures, once reserved for winter, are now a year round phenomenon.

"To meet growing demand and support the move to integrated care, we need to see investment in other parts of the health and care system. In particular we have to be able to attract and keep the staff we need in social care, mental health, ambulance and community services. This will allow people to access the care they need closer to home and should help to ease pressure on A&E services.

In particular we have to be able to attract and keep the staff we need in social care, mental health, ambulance and community services. This will allow people to access the care they need closer to home and should help to ease pressure on A&E services.

 "CQC has highlighted that joined up health and care services are already bringing benefits to patients in some areas, but this should not depend on where people live. Our recent report Making the most of the money: efficiency and the long term plan also showed how trust leaders regarded better system working as the most promising route to improving long term efficiency. We must therefore ensure that all local health and care systems are receiving the support they need to improve care for their local populations. 

Our recent report showed how trust leaders regarded better system working as the most promising route to improving long term efficiency. We must therefore ensure that all local health and care systems are receiving the support they need to improve care for their local populations.

 "A key task for the NHS long-term plan is to address these challenges, alongside commitments to improve health outcomes and recover performance. This plan must be realistic. Alongside this, we need the Green Paper for social care to set out proposals to put the sector on a sustainable footing. Missing these opportunities risks storing up problems for the future."