Who regulates health and social care services in the UK?

Health and social care services in the UK are some of the most closely scrutinised and regulated in the world. With millions of people relying on them daily, whether in hospitals, care homes, GP practices, domiciliary settings, or children’s services, regulation is vital for protecting safety, promoting quality, and ensuring accountability.

In this comprehensive guide, Dr Richard Dune explores the major regulators across England, Scotland, Wales, and Northern Ireland, their functions, powers, and how they shape the delivery of health and social care. Whether you’re a provider, commissioner, or frontline professional, understanding who regulates your service is essential to achieving and maintaining compliance.

Why regulation matters

Health and social care regulation is not merely about compliance, but is fundamentally about protection and public assurance. Regulation ensures:

• Safety for service users and staff

• Accountability of providers and professionals

• Consistency in standards and service delivery

• Transparency through inspection, reporting, and enforcement

• Continuous improvement and learning.

Cases like Mid Staffordshire NHS Trust and Winterbourne View scandals underscore what happens when regulation fails. Regulators exist to ensure that such incidents are never repeated, and that poor care is detected, addressed, and prevented.

A devolved but coordinated system

Health and social care are devolved matters in the UK, meaning each nation has its own regulatory authorities. These national regulators work alongside UK-wide bodies that oversee medicines, professional standards, and the regulation of the workforce.

England – Care Quality Commission (CQC) and Ofsted

Care Quality Commission (CQC)

The Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England, established under the Health and Social Care Act 2008. It regulates:

• NHS Trusts and independent hospitals

• GP and dental practices

• Care homes and homecare services

• Mental health and community services

• Specialist clinics and supported living providers.

CQC’s core functions

These are the core functions of the CQC:

• Registration - Providers must be registered before delivering regulated activities

• Inspection - Based on five key questions: Are services safe, effective, caring, responsive, and well-led?

• Ratings - Public assessments (Outstanding, Good, Requires Improvement, Inadequate)

• Enforcement - Powers to issue warning notices, suspend or cancel registration

• Safeguarding - Joint working with local safeguarding partnerships.

Since 2023, CQC has operated under a Single Assessment Framework (SAF) with a shift towards continuous monitoring and digital evidence submission.

Ofsted

Ofsted regulates and inspects:

• Children’s homes and early years providers

• Local authority children’s services

• Fostering and adoption agencies

• Schools and colleges.

It ensures that children and young people are safeguarded and receive high-quality support, learning, and care. Ofsted also publishes detailed inspection reports, triggers enforcement where needed, and monitors compliance with national standards.

Scotland - Care Inspectorate and Healthcare Improvement Scotland (HIS)

Care Inspectorate (CI)

Known also as SCSWIS, the Care Inspectorate regulates:

• Adult and children’s care homes

• Childminding and day care services

• Homecare and housing support

• Secure accommodation.

Responsibilities

The responsibilities of the Care Inspectorate include:

• Registration and ongoing inspection

• Improvement support based on quality frameworks

• Joint working with Education Scotland and Healthcare Improvement Scotland.

Healthcare Improvement Scotland (HIS)

Healthcare Improvement Scotland (HIS) ensures healthcare services meet national standards, both in the NHS and the independent sector.

The following are HIS’s key roles:

• Inspecting hospitals and private healthcare

• Infection prevention and clinical governance reviews

• Running the Scottish Patient Safety Programme

• Supporting boards and clinicians in quality improvement.

HIS and the Care Inspectorate often carry out joint inspections of integrated services.

Wales – Care Inspectorate Wales (CIW) and Healthcare Inspectorate Wales (HIW)

Care Inspectorate Wales (CIW)

The Care Inspectorate Wales (CIW) regulates:

• Adult and children’s social care

• Early years and childcare settings

• Local authority social services.

CIW’s powers

CIW has the following power:

• Registration and inspection under the Regulation and Inspection of Social Care (Wales) Act 2016

• Complaints, investigations and enforcement

• Collaboration with HIW for joint oversight of integrated services.

Healthcare Inspectorate Wales (HIW)

The Healthcare Inspectorate Wales (HIW) inspects and regulates:

• NHS Wales organisations

• Independent hospitals, clinics, and dental practices.

HIW focus areas

The following are HIW’s focus areas:

• Safety and patient experience

• Compliance with clinical standards and policy

• Special powers under the Ionising Radiation (Medical Exposure) Regulations 2017

• Oversight of midwifery supervision and governance.

Northern Ireland - Regulation and Quality Improvement Authority (RQIA)

The Regulation and Quality Improvement Authority (RQIA) is Northern Ireland’s regulator for:

• Hospitals and clinics

• Mental health services

• Care homes and domiciliary care

• Children’s homes and supported accommodation.

RQIA’s key duties

The following are RQIA’s key duties:

• Registration and monitoring of providers

• Annual inspection cycles

• Review of mental health services under Northern Ireland’s Mental Health Order

• Complaint investigations and quality improvement recommendations.

Workplace safety - Health and Safety Executive (HSE)

The HSE enforces workplace safety law across health and social care, including:

• Trip hazards, scalds, manual handling, and unsafe premises

• Failures in risk assessment and fire safety

• Serious accidents reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR).

Although the HSE often defers to clinical and care regulators (e.g. CQC, CIW), it will investigate where:

• There is a systemic failure in management controls

• A non-clinical incident has caused death or serious injury

• Employers fail to meet well-established safety standards.

The HSE collaborates with care regulators through Memoranda of Understanding (MoUs).

UK-wide regulators

Medicines and Healthcare Products Regulatory Agency (MHRA)

The Medicines and Healthcare Products Regulatory Agency (MHRA):

• Ensures the safety and efficacy of medicines, medical devices, and digital health tools

• Issues Medical Device Alerts (MDAs)

• Investigate harmful incidents involving regulated products.

Professional Standards Authority (PSA)

The Professional Standards Authority (PSA):

• Oversees all health and social care professional regulators

• Ensures regulators meet public protection standards

• Reviews the regulator’s performance and fitness-to-practise decisions.

Professional and workforce regulators

Table 1 - Profession and regulator for professional and workforce regulators.

Each professional body:

• Maintains a register

• Sets education, training, and conduct standards

• Investigates fitness to practise and supports revalidation.

What does this mean for providers?

To remain compliant, providers must:

• Register with the appropriate regulator

• Maintain up-to-date policies and procedures

• Ensure mandatory training and supervision

• Keep accurate audit trails, incident logs, and service user records

• Be inspection-ready at all times

• Respond promptly to feedback, enforcement, and improvement recommendations.

Common regulatory principles across the UK

Regardless of the regulator, all systems focus on:

• Safety first - Preventing harm to people who use services

• Evidence-based inspection - Using data, complaints, and service feedback

• Person-centred care - Promoting dignity, independence, and rights

• Workforce development - Qualified, trained, and supervised staff

• Transparency - Public accountability and published outcomes.

Key legislation underpinning the regulation

These are the key legislation underpinning regulation:

• Health and Social Care Act 2008 (England)

• Care Standards Act 2000

• Children Acts 1989 & 2004

• Mental Capacity Act 2005

• Social Services and Well-being (Wales) Act 2014

• Public Services Reform (Scotland) Act 2010

• The Regulation and Inspection of Social Care (Wales) Act 2016.

Providers must align their governance, policies, and procedures with these laws to stay compliant.

Emerging regulatory challenges

As the landscape evolves, regulators must address the following:

• Integrated Care Systems (ICSs) - Cross-sector regulation must reflect integrated commissioning and delivery

• Digital health and AI - New technologies require updated safety frameworks. The MHRA, NICE, and ICO are actively shaping these

• Global workforce mobility - Ensuring consistency and accountability for internationally recruited staff is essential

• Digital compliance and culture - Platforms like ComplyPlus™ help providers manage training, policies, audits, and inspections proactively, supporting a strong culture of compliance.

Final thoughts - Who safeguards care quality?

Regulators ensure the health and social care system remains safe, effective, and accountable. Understanding who regulates your service, what they require, and how to align your systems is vital, whether you're a large NHS provider, a small care agency, or a children’s home.

This isn’t just about passing inspections. It’s about delivering care that meets the highest standards, every day.

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