The demand for quality in health care has never been higher. With growing numbers of people with severe and complex needs, and with the introduction of the new Care Act and changes in the Care Quality Commission inspection regimes, care providers are under a constant pressure to meet the specific needs of the population, while at the same time adhering to the quality standards set up by the regulators. A number of barriers to effective care were identified, including staff shortages, funding and effective communication. Further research is recommended to understand the challenges faced by the care providers to manage services for people with complex needs.