Dr Dash’s review identified a significant reduction in CQC activity. The number of inspections conducted dropped sharply, with only 6,700 inspections completed in 2023–2024 compared to 15,800 in 2019–2020. Additionally, a backlog of provider registrations and re-inspection delays have undermined the CQC’s ability to provide up-to-date assessments. Some providers have gone several years without a re-inspection, leading to outdated ratings and an incomplete picture of care quality.

For providers, this means that regulatory oversight may not reflect the current state of their services, creating potential gaps in improvement initiatives and service development.

The introduction of the SAF came with a new regulatory platform and provider portal, both of which have been plagued by technical issues. Providers have faced difficulties uploading documents, and delays in resetting passwords have added to frustrations. These IT challenges have hampered the roll-out of the SAF and delayed regulatory processes, causing significant headaches for both providers and CQC staff.

This presents an ongoing challenge for providers, particularly those waiting for new registrations or updated assessments. The CQC has committed to addressing these IT issues as a priority.

One of the most concerning findings from both reviews is the delay in publishing inspection reports. Providers sometimes have had to wait months for their reports, adding stress and creating uncertainty. Moreover, the quality of these reports has been inconsistent, with some containing contradictory findings between summaries and main sections.

For providers, timely and accurate reporting is essential for maintaining quality standards and making improvements. The delays and inconsistencies have created an environment of uncertainty, hindering effective service management and planning.

The CQC’s 2023 internal restructuring aimed to create Integrated Assessment and Inspection Teams (IAITs) by replacing sector-based directorates with local teams that oversee both health and social care services. However, this restructuring has diluted sector expertise, leaving inspectors without the in-depth knowledge they once had. Providers have reported a noticeable decline in the quality of engagement and understanding from CQC inspectors.

The reviews recommend reinstating sector-specific chief inspectors, which would restore the expertise needed to conduct meaningful inspections and rebuild trust between providers and the regulator.

The SAF, designed to create a more dynamic, risk-based approach to assessments, has failed to live up to expectations. Both reviews highlight its complexity, which has led to confusion among inspectors and providers alike. The framework’s reliance on data that is often outdated or incomplete has further compounded the problem. There is also a lack of clarity on what good care looks like, making it difficult for providers to benchmark their services effectively.

The SAF’s shortcomings have added unnecessary complexity to providers' regulatory processes. The reviews recommend simplifying the framework and making the rating system more transparent, which should make future assessments more straightforward.

The introduction of Integrated Care System (ICS) assessments, mandated by the Health and Care Act 2022, has added another layer of complexity to the CQC’s remit. However, both reviews recommend pausing these assessments for six months to allow the CQC to focus on improving its existing processes. The reviews also raised concerns about the overlap between ICS and provider assessments, suggesting that the CQC must refine its approach to avoid duplication.

For providers operating within ICSs, this pause offers a window of opportunity to prepare for more streamlined assessments once they resume.

The CQC has committed to increasing the number of inspections it conducts and reducing the backlog in provider registrations. Providers can expect more frequent assessments and quicker feedback through reports.

The reinstatement of sector-specific chief inspectors will ensure that providers are assessed by professionals with in-depth knowledge of their services. This change is expected to improve the quality of inspections and rebuild trust between providers and the CQC.

Providers can expect a more streamlined SAF, with clearer rating descriptions and an emphasis on care outcomes and innovation. The CQC will also stop scoring individual evidence categories, simplifying the overall assessment process.

The CQC is addressing technical issues through its provider portal and regulatory platform. Once these improvements are made, providers should find the registration and inspection processes more efficient and less frustrating.

For Integrated Care Systems (ICS) assessments, the CQC has agreed to pause these reviews for six months. This pause gives the regulator time to refine its assessment approach and free up capacity to address the backlog of provider assessments. Providers involved in ICSs will benefit from this pause, allowing them to focus on their quality improvements without the additional pressure of ICS evaluations.

One of the most persistent concerns raised in the reviews is the lack of transparency in how ratings are calculated. Both Dr Dash and Professor Richards pointed out that the current system aggregates data from outdated assessments, leading to ratings that do not reflect a provider’s current performance. The CQC has committed to making the ratings process clearer and more straightforward, which will help providers better understand how they are being assessed and what improvements they need to make.

The loss of sector-specific expertise and the weakening of relationships between the CQC and providers were major themes in both reviews. In response, the CQC has pledged to restore these relationships by increasing the frequency of engagement with health and social care leaders and ensuring that inspections are conducted by experts who understand the complexities of the services they are assessing.

For providers, this means that future interactions with the CQC should be more constructive, with a greater emphasis on collaboration and shared learning. Rebuilding trust between the regulator and the sector will be crucial to improving the quality of care across the country.

Both reviews emphasised the need for the CQC to place greater focus on care outcomes, innovation, and resource use. The current SAF framework has been criticised for its lack of attention to these areas, with providers often left uncertain about how to innovate while maintaining compliance. By placing a stronger emphasis on outcomes and innovation, the CQC aims to support providers in delivering more effective, patient-centred care.

Providers should prepare for assessments that look beyond compliance to how well they are improving outcomes for patients and service users. This shift represents a more forward-thinking approach to regulation that could encourage greater creativity and improvements in care delivery.

As the CQC reinstates sector-specific chief inspectors, providers should take the opportunity to engage more closely with these experts. Open lines of communication with the CQC can help ensure that inspections are collaborative and provide meaningful insights for improvement.

With the commitment to increase the number of inspections, providers should be prepared for more regular visits from the CQC. Ensuring robust systems for ongoing quality improvement will help avoid surprises during inspections.

The CQC’s increased focus on care outcomes means that providers should prioritise not only regulatory compliance but also the effectiveness and impact of their services. Demonstrating a commitment to innovation and continuous improvement will likely become a key factor in future assessments.

With improvements to the CQC’s IT infrastructure on the horizon, providers should ensure that their own systems for documentation and compliance are as efficient as possible. A smoother, more reliable regulatory platform will allow providers to focus less on administrative burdens and more on delivering quality care.

While the CQC has paused ICS assessments, these evaluations will resume in the near future. Providers should stay up-to-date with any developments in the methodology for assessing ICSs to ensure they are prepared when the time comes.