This research set out to describe good quality regulation and to make recommendations for CQC on how it could improve, so it can play a positive role in the health and care system, while realising the potential of its new approach.

Right-touch regulation, responsive regulation, and academic reflections on the value of balancing the requirements to assure and improve care, provide a helpful framework within which to understand the gap between trusts' experience of regulation and a more optimal system, and show where CQC could helpfully focus its efforts. CQC's statutory regulatory purpose can comfortably co-exist with an increased emphasis on encouraging service improvement.

CQC's regulatory activities, including its inspections, reports and ratings, are changing under its new regulatory approach, and there may be scope to further consider other elements of its inspection regime, such as how single word ratings are used and presented. However, many of the key changes providers, and ultimately patients, would benefit from are as much behavioural as they are structural, including relationship management, and the conduct and expertise of CQC inspection teams.

CQC's new single assessment framework promises to provide a more dynamic picture of quality, and its new system assessments present an opportunity to 'join the dots' between services and to follow entire pathways of care. These opportunities must be fully seized: if they are not, CQC could risk undermining the credibility and success of its new approach.

It is vital that CQC regains the trust and confidence of those it regulates, by continuously engaging with providers, by staying true to its founding objectives, by observing the principles of good quality and safety regulation described in this report and, most importantly, by adopting an improvement-led approach to its own work.

We look forward to continuing our constructive dialogue with CQC and to helping them address our recommendations for change, alongside the introduction and evaluation of their new regulatory approach.