Quality, timeliness and consistency of inspections

Improving the quality, timeliness and consistency of inspections will be critical to rebuilding the CQC’s credibility with trusts. So far, however, most trust leaders are yet to see meaningful progress.

Quality
Almost two thirds said the quality of inspections had not changed (46 per cent) or got worse (19 per cent) in the last 12 months. Three in ten (30 per cent) reported improvement.

Timeliness
Almost three quarters said the timeliness of inspection reports had either not changed (43 per cent) or got worse (30 per cent) in the last 12 months. Just 19 per cent reported improvement.

Consistency
Seven in ten reported the consistency of inspections had not changed (43 per cent) or got worse (28 per cent) in the last 12 months. Just 16 per cent reported improvement.

Inspection quality

Interviews and free-text responses help explain why a limited number of trust leaders have perceived improvement in inspection quality. A central concern was whether inspectors have sufficient knowledge and experience of the services they assess, alongside wider concerns about quality assurance.

Some leaders also questioned whether local inspection teams have a sufficiently clear understanding of the CQC’s changing regulatory approach and what it means for trusts in practice.

Trust leaders also continue to report factual inaccuracies in inspection reports, with subsequent difficulties resolving these in a timely or consistent manner.

Improved frameworks will not on their own lead to better quality inspections. As they are introduced, the CQC must rebuild specialist expertise, strengthen inspector training and ensure reports are robustly reviewed by staff with relevant sector knowledge.

Timeliness

Interviews also provided insight into why few leaders reported experiencing improvements in the timeliness of inspection reports and ratings. We heard multiple examples of organisations still waiting over a year to receive their results following an inspection.

These delays have consequences beyond the uncertainty and stress they create for trust leaders and staff. When findings take months to emerge, concerns about the quality and safety of care can go without timely regulatory scrutiny, while trusts lose valuable time to respond to findings and make improvements. Long delays also risk reports and ratings being out of date by the time they are published, including not reflecting improvements that have been made since inspection.

Although in the example cited the decision to reinspect was welcome, having to do so because the original findings had become outdated represents a significant waste of CQC and NHS time and resources. It is a concerning example of the consequences of excessive delays and why improving report turnaround must remain a top priority.

Consistency

Trust leaders described ongoing variation and inconsistency in the CQC’s approach, including in how different inspection teams apply the frameworks and guidance, discrepancies between the narrative of reports and the ratings awarded, and a lack of clarity around regulatory action.

For trusts, this variation creates uncertainty about what good looks like and what the CQC expects of them. More fundamentally, it undermines trust that comparable organisations and services are being assessed against the same standards and that regulatory judgments are being reached objectively. A broader lack of trust in the objectivity of inspection results was notable among free-text responses.