Rebuilding trust in the CQC: regulation survey 2026

Key points

> This report presents findings from the NHS Alliance’s first governance and regulation survey, which demonstrate the scale of the challenge facing the Care Quality Commission’s (CQC’s) new leaders.

> Two years into the CQC’s recovery, trust leaders are still encountering many of the issues described in 2024 by the Dash and Richards reviews and our previous regulation survey.

> While most trust leaders believe the CQC still has much to do, there are signs of progress. Stabler local relationships, better informal engagement, faster reporting and improved report quality are reported by some, but are not yet the norm.

> 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, with some trusts still waiting more than a year for reports.

> The return to sector-specific regulatory frameworks is welcome, but deeper sector expertise must be balanced with joined-up regulation that reflects how care and risk often span organisational boundaries.

> Some trust leaders continue to report an adversarial and fault-finding inspection culture, with the CQC not yet consistently experienced as a regulator that supports improvement and learning.

> Just 21 per cent of trust leaders believe the CQC is making the changes needed to improve its performance longer term. Leaders broadly support the direction of key policy changes but are not yet convinced these will translate into change on the ground.

> The CQC’s challenge is now to turn promising policy changes and pockets of progress into consistently better regulation.

> This report shares the survey findings from engagement with 166 NHS leaders across 116 trusts and recommends areas of focus for the CQC.