The CQC – Losing and Hopefully Now Finding Its Way

Estimated reading time: 3-4 minutes

I recently attended a Care Quality Commission (CQC) event in London to “explore and co-develop the CQC Way.” The programme for the day was designed to engage stakeholders in co-designing a new framework for the CQC’s purpose, vision, goals, values, behavioural expectations and regulatory principles.

The backdrop to this event is of course the recent turmoil that the CQC has experienced following the publication of two reviews of the organisation in 2024, which identified a number of very serious shortcomings in its operational and regulatory effectiveness. As a result, some senior leaders left the organisation and a new CEO, Sir Julian Hartley, has been appointed.

The event was attended by around 300–400 people from a myriad of care providers and NHS trusts as well as other organisations that the CQC serves, not least service users and carers.

Regulatory Failures and Leadership Changes

Sir Julian Hartley painted a pretty bleak picture of his inheritance at the CQC. This is regulatory failure writ large, with numerous issues relating to a lack of published assessments, few inspections being undertaken and a large backlog of Information of Concern notifications—notifications that should provide intelligence to the CQC about risks and concerns across the health and social care providers it should be monitoring. Taken together, this represents a colossal failure. Hence, heads have rolled and a new CEO now sits at the helm of the CQC with the huge task of trying to fix these interconnected problems in short order.

Sir Julian deserves credit for his frank assessment of the CQC’s current state and his honesty in making clear that fixing these issues will not be straightforward. He refused to over-promise and over-commit which is understandable.

The Risks of Co-Designing Regulation

This event was billed as a day to co-design the “CQC Way.” That was always ambitious given the complexity of the challenges and issues to discuss. There was limited time to explore these issues in any depth and even with the aid of a real-time app, the feedback gathered could only capture snippets of the various discussions.

In any case, I am not clear why the CQC feels the need to “co-design” its frameworks with stakeholders. Yes, they should listen and commit to consulting widely. But co-designing, if done genuinely, runs the real risk of allowing the CQC’s framework to be shaped by an audience made up largely of those it regulates—many of whom will inevitably have a vested interest in ensuring that compliance standards are not too onerous.

This is a regulatory capture, and it must be avoided if high standards are to be maintained. As Malcolm K. Sparrow notes in The Regulatory Craft:

“Regulators, under unprecedented pressure, face a range of demands, often contradictory in nature: be less intrusive – but more effective; be kinder and gentler – but don’t let the bastards get away with anything; focus your efforts – but be consistent; process things quicker – and be more careful next time; deal with important issues – but do not stray outside your statutory authority; be more responsive to the regulated community – but do not get captured by industry.”

The CQC would do well to heed these words and avoid regulatory capture in its drive to engage.

What Needs to Happen Now

Sir Julian provided what I thought was an excellent analysis of the problems the CQC faces. What we need now is real urgency and focus on fixing them. And yes, the CQC should consult all relevant parties, making a proactive effort to reach those with fewer resources such as organisations representing patients, service users and carers, but co-creation is a step too far in the desire to engage.

The health and social care sector needs more than ever a strong, robust and independent regulator—one that listens and has real authority. The problems have now been identified; the focus and effort must be on finding effective solutions to resolve the myriad of failings Sir Julian highlighted on the day.

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