CQC inspections are still not fit for purpose

NHS leaders say a continuing credibility gap is undermining essential work carried out by the health and care regulator, the Care Quality Commission (CQC).

A report by the NHS Alliance, which speaks for organisations across the health and care system, shows that more than two years into the regulator’s “recovery”, many of the problems that prompted reform remain unresolved or have got worse.

Rebuilding trust in the CQC: regulation survey 2026 demonstrates the scale of the challenge facing the CQC’s new chief executive and chair, including inspectors lacking relevant expertise, lengthy delays and factual inaccuracies in inspection reports.

There are pockets of progress emerging.

More stable relationships, better informal engagement, faster reporting and greater sector expertise are reported by some, but are not yet the norm.

One trust leader said, "the CQC used to add value - it doesn't anymore and has lost credibility."

For many trust leaders, the CQC still needs to improve on the basics of inspection.

Almost two thirds said inspection quality had not changed or had got worse in the past year, with inspector expertise and factual inaccuracies persistent concerns.

Inspection reporting also remains too slow in most cases. Almost three quarters of leaders said timeliness had not changed or had deteriorated, with some trusts still waiting more than a year for reports.

Such delays risk findings becoming outdated and can slow action on issues identified through inspection that could improve care sooner.

The findings come as health leaders seek to maintain and improve the quality and safety of care in the face of rising demand, severe financial pressures and the need to transform the way services are planned and delivered.

In the survey, just one in five (21%) believed the CQC is making changes that will improve its long-term performance as the regulator of care quality.

Other findings included:

- Only 13 per cent agreed that the benefits of their most recent CQC inspection justified the cost to their organisation, while 50 per cent disagreed.

- 38 per cent said the CQC supported improvements in care – 31 per cent disagreed.

- Almost two thirds said the quality of inspections had not changed (46 per cent) or deteriorated (19 per cent). Three in ten (30 per cent) had seen an improvement.

- Almost three quarters said the timeliness of inspection reports had either not changed (43 per cent) or had deteriorated (30 per cent). Just 19 per cent had seen an improvement.

- 38 per cent rated CQC’s understanding of local pressures as good while 33 per cent said it was poor, including 13 per cent as very poor.

- 27 per cent of leaders agreed that the current CQC approach reflected the needs of their sector, compared with 41 per cent who disagreed.

Responding to the findings, the chief executive of the NHS Alliance, Sir Ciarán Devane, said:

"A strong, independent regulator is essential to protecting people who use health and care services, providing assurance to patients, families and the wider public over the quality and safety of care.

"Inspection should identify failure and support improvements, helping local organisations and the wider health and care system to raise standards.

"Too often that’s still not happening.

"Two years into the CQC’s recovery, these findings show it still faces a worrying credibility gap that is – at times – undermining its essential work.

"Pockets of progress have not yet translated into widespread confidence among trust leaders.

"The central challenge for the CQC is one of delivery as much as direction: ensuring tangible and consistent improvements in the quality and timeliness of regulation that is proportionate to the risks.

"We want the CQC to succeed and do not doubt its commitment to change. We also look forward to working with its leadership to meet that challenge, but there is still a very long way to go."