Background

In 2021, the CQC launched a major transformation programme to modernise its approach to regulation. It aimed to move from periodic inspections towards more continuous, data-led assessment, underpinned by an organisational restructure, a new digital regulatory platform and a single assessment framework.

Implementation proved very challenging. Subsequent reviews by Dr Penny Dash and Professor Sir Mike Richards in 2024 identified declining inspection activity, delayed reports, unclear rating criteria, inadequate technology and a loss of sector expertise. The single assessment framework was also found to be too complex and inflexible, while the organisational restructure and digital platform compounded the issues described.

The CQC has since initiated a major programme of change and sought to involve the sector closely in its recovery. This has included engagement on how it assesses, inspects and rates providers through the Better Regulation, Better Care consultation, and further engagement on its draft sector-specific assessment frameworks.

This recovery has taken place against a backdrop of leadership instability, following the unexpected departures of the CQC’s previous chief executive and chair. Emily Miles and Baroness Neuberger took up their respective roles in October 2026, joining an established team of chief inspectors. This report examines trusts’ experience of the CQC’s recovery so far and the scale of the challenge now facing its new leadership.