CQC ratings reveal the deeper systems that shape safety, culture and patient experience. In this blog, Dr Richard Dune examines why hospitals fall into an inadequate rating, what the CQC looks for when judging leadership and safety, and how services like Hull Royal Infirmary’s emergency department have begun turning fragile progress into meaningful improvement. He explores the structural issues that drive failure, from weak governance and unsafe staffing to poor IPC and medicines management, and shows how leadership, culture change and quality improvement can transform care. This analysis outlines what health and care leaders must prioritise to rebuild trust, strengthen compliance and move confidently from inadequate to good.