One of the primary concerns raised by the review was the CQC’s operational performance. Providers have consistently reported issues with the Provider Portal, the platform through which they interact with the CQC. There were multiple complaints about the portal being unfit for purpose, including its poor functionality and the lack of reliable communication channels.

Moreover, the review found that the SAF had not effectively integrated within the CQC’s broader operations. Teams across the organisation struggled with the new regulatory platform, resulting in inspection delays, inconsistent reporting, and a lack of transparency in assessment processes.

The review revealed a concerning loss of expertise within the CQC, particularly at senior leadership levels. Since the introduction of the SAF, the number of experienced professionals within the CQC has declined, leaving the organisation less equipped to handle complex assessments across the diverse range of health and social care sectors it regulates. The review recommended the appointment of more senior clinicians and care professionals with sector-specific knowledge to rebuild the CQC’s credibility.

This gap in expertise also impacted relationships with providers. The review found that trust between CQC and the sectors it regulates had eroded, with providers feeling that the regulator no longer had a deep understanding of their specific challenges.

Another critical area of concern was the lack of transparency around how CQC ratings are calculated. The SAF uses a more data-driven approach than previous frameworks, but many providers reported that they were unsure how ratings were being determined. The use of multi-year inspections further complicated the process, making it difficult for providers to understand how they could improve their ratings or appeal any decisions.

The review recommended clearer descriptors for each quality statement and evidence category and greater transparency regarding how ratings are formulated.

Interestingly, the review also found that CQC’s approach under the SAF had unintentionally stifled innovation in some areas. Providers, particularly in the NHS, felt that the SAF did not sufficiently recognise innovative models of care or the effective use of resources. The framework’s focus on compliance often overshadowed efforts to improve service delivery in more creative ways.

The review called for rebalancing the framework, emphasising effectiveness, outcomes, and innovation rather than purely regulatory compliance. It highlighted the need for CQC to work with other partners, such as the Healthcare Quality Improvement Partnership (HQIP), to build better outcome measures into the assessment framework.

A new responsibility for CQC under the SAF has been assessing local authorities’ delivery of adult social care functions. The review found that while CQC had made some progress in this area, there were significant issues with how these assessments were conducted. Local authorities reported that the process was unclear and that the data being used to assess them was not robust.

The review recommended further improvements to the process of local authority assessments, with greater emphasis on outcomes for service users rather than administrative processes or systems.

• The CQC needs to rapidly improve its internal systems, particularly the Provider Portal and regulatory platform, to ensure more efficient and reliable interactions with providers.
• Timeliness and quality of reports should be improved, with clear performance targets set in collaboration with the Department of Health and Social Care (DHSC).

• CQC should prioritise rebuilding its expertise, particularly by appointing senior clinicians and care professionals with a deep understanding of regulated sectors.
• A programme should be established to encourage top-performing managers and clinicians to become CQC assessors for short periods, creating a more sector-informed approach.

• The SAF needs to be fundamentally enhanced by reviewing its quality statements and placing greater emphasis on effectiveness, innovation, and resource use.
• Clear definitions should be established for each quality statement, with examples of what constitutes “outstanding,” “good,” “requires improvement,” and “inadequate” for each evidence category.

• CQC should clarify how ratings are calculated and ensure this information is easily accessible to providers and the public.
• The use of multi-year assessments should be reconsidered, and more transparency should be given to how these assessments are used in the rating process.

• CQC should continue to evolve its approach to assessing local authorities, ensuring that feedback from local authorities and service users is incorporated into the assessment process.
• The focus should be on outcomes and the quality of care being provided rather than simply on administrative processes.

• The review recommended that Integrated Care Systems (ICS) assessments be paused temporarily to allow for greater alignment with the NHS England Oversight Framework.
• This would enable the CQC to focus its resources on improving the SAF and addressing the challenges raised in the review.

CQC and the DHSC should work closely to strengthen the sponsorship arrangements between the two organisations, ensuring that CQC remains accountable to the public and operates as efficiently as possible.