In the summer of 2023 NHS Providers published Improving regulation for the future, which detailed the findings of our annual survey exploring trusts' perceptions of regulation. The survey focuses specifically on trust leaders' experiences of regulation by CQC, NHS England (NHSE) and integrated care boards (ICBs).

While nearly 80 per cent of respondents supported the changes that CQC has been making (CQC, 2023) under its latest strategy (CQC, 2021), the results of the survey and our interactions with trust leaders indicate a decline in trusts' confidence in CQC's regulation. Several respondents queried whether the regulator had become too 'bureaucratic' and 'out of touch’ and whether it was 'fit for purpose'. Many expressed concerns over the skills and expertise of CQC inspection teams, the extent to which the regulator reflected the needs of different sectors, and its ability to support providers to improve and innovate.

Having identified a range of issues and concerns, we have set out to explore the purpose of regulation in health and social care and the positive role it can play. The purpose of this report is to consider how CQC can make sure it fulfils its role in a way that supports innovation and improvement and maintains the trust of those it regulates. As CQC resets its approach, with the rollout of its new single assessment framework, new provider portal and changes to the structure of its operational teams (CQC, 2023), we have made a set of recommendations for how it can build its relationship with providers, and strengthen their confidence in its activities and outputs. Our intention is to be constructive, and we hope this publication will be a helpful contribution to the ongoing debate about the future of health and care regulation in England.

This report is based on background research, and a series of in-depth conversations with trust chairs, chief executives and relevant stakeholders, undertaken between October and December 2023. It is also reflective of our 2023 regulation survey results and of the emerging themes from member events carried out throughout the past year.