Transforming the CQC – does the answer lie beyond the English border?
Keeping up with the Joneses (and the MacDonalds and the Maguires)
Over the last year, England’s adult health and social care regulator, the Care Quality Commission (CQC), has suffered an unceremonious fall from grace, marred by severe internal failings and widespread public criticism.
Jenny Wilde and Beverley Jones, senior lawyers in health and social care at Acuity Law, delve into recent developments and highlight future transformation opportunities for the CQC.
The independent review led, by Dr. Penny Dash and published in full in October 2024, exposed stark deficiencies in the regulator’s operations, including reduced inspection levels, inconsistent assessments, and a worrying lack of clinical expertise among inspectors.
These failings have significantly weakened the CQC’s ability to assess and assure the quality of health and social care services across England.
Health and Social Care Secretary Wes Streeting responded with frank concern, declaring: “It’s clear to me the CQC is not fit for purpose.” His statement reinforced the urgency of reform to restore public confidence in the regulator.
That urgency was amplified by the revelations of a failed £99-million transformation programme – an expensive misfire riddled with technical issues and a poor user experience, which caused widespread operational disruption rather than progress.
In October 2024, the newly appointed Chief Executive, Sir Julian Hartley, took the helm, inheriting a regulator in crisis. He has since openly acknowledged the CQC had “lost its way” and committed to regaining public trust by rebuilding the organisation’s credibility and performance.
Part of that work has involved collaborating with providers and sector leaders, such as the Care Provider Alliance, to map out what a reformed CQC should look like and how it should behave. The transformation is, at last, underway.
A sceptic (or perhaps a seasoned lawyer) might view these listening sessions as strategic PR, intended to project an image of reform and responsiveness. The real test lies in whether those views are heard, taken on board and reflected in the final product.
But in this moment of reform and introspection, is the CQC missing an opportunity to look outward, beyond England, and learn from its counterparts in the devolved nations?
Practical lessons from beyond the English border
Each devolved nation has its own regulator: Care Inspectorate Wales (CIW), the Care Inspectorate in Scotland, and the Regulation and Quality Improvement Authority (RQIA) in Northern Ireland. Lawyers and providers operating across these borders often speak of clear cultural and procedural differences – most notably a more collaborative and constructive approach to regulation.
Take CIW, for example. It has a reputation for working alongside providers, offering guidance on training, promoting best practice, and fostering supportive environments to improve care. Inspectors are more likely to offer concrete advice or signpost resources when concerns arise.
Compare that with the CQC’s more rigid model: a tick-box inspection, a grade, and often radio silence when providers ask how they might improve. The CQC’s long-held stance – that it is not there to advise providers – feels increasingly unhelpful in a sector that relies on practical improvement and learning.
Clients have reported that dealing with Care Inspectorate (Scotland) is like interacting with a fellow care provider and there is no “us and them” approach. The Care Inspectorate’s mission is that “everyone in every community, experiences high quality care, support and learning, tailored to their rights, needs and wishes”.
The tone is such that “we” (the Care Inspectorate and the care provider) are for the same reason: to help promote a better outcome for people living in care. There is clear collaboration, and Scottish clients are extremely heartened by the Care Inspectorate’s support.
The Scottish regulator also has a “Quality Improvement Team”, which creates excellent resources that are shared on the website and in the weekly newsletters runs. It offers workshops – some virtual, to widen access, some in-person and even provider-specific.
For example, a client reported an increase in complaints, so the Care Inspectorate arranged a face-to-face workshop that was attended by all of the provider’s Scottish home managers, and three other colleagues per home.
During the workshop, they discussed the client’s complaints process, gave suggestions on what it could do to make it better, and completed coaching with colleagues.
The aim of the session was to try and upskill colleagues working on the floor to manage and recognise complaints before they become formal.
English providers can only dream of this type of engagement.
Since Ian Trenholm’s appointment in 2018, the CQC has leaned into a model of enforcement, often accompanied by harsh press releases that spotlight failure rather than enable recovery.
Of course, action must be taken against unsafe providers, but what if the CQC followed the lead of its neighbours and used inspections as an opportunity to guide, not just judge?
What if it embraced a more transparent, less adversarial model?
We’ve seen CIW and the Care Inspectorate in Scotland share examples of excellent care between providers, encouraging dialogue and improvement across the sector. That kind of openness fosters a climate where providers welcome inspection and feedback rather than fear it.
CIW, Care Inspectorate Scotland, and RQIA show that it’s possible to regulate firmly while still being fair and supportive. Their inspectors are present, personal, and pragmatic.
And while no regulator is perfect, their approach feels more aligned with the sector’s ultimate aim: improving the lives of those who use services.
There’s a cautionary tale in all this, not just for the CQC, but also for the regulators in the devolved nations as well. CIW has recently adopted a rating system similar to the CQC’s, in an effort to promote transparency and aid customer choice and decision making.
However, we hope it resists the temptation to drift into the same trap as CQC: chasing statistics and ratings to justify its existence, rather than focusing on meaningful assessments and sector relationships, and improving outcomes for the people supported.
Regulators that try to win headlines risk losing the confidence of those they oversee. Confidence is hard to earn and easy to lose. And for the sake of the people who rely on these services, it’s vital that regulators inspire partnership, not paranoia.
Look outward, listen inward
As the CQC embarks on its transformation journey, now is the perfect moment for the CQC to look to its neighbours – not just for inspiration, but for real, structural learning. There are three alternative models of care regulation operating within the United Kingdom that offer a more human, more effective blueprint.
The question is, does the CQC have the humility and courage to take note?
We hope so. Because regulation done well isn’t just about holding services to account – it’s about lifting them up and improving services across the sector.
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