The Care Quality Commission (CQC) — England’s health and social care regulator — stands at a decisive moment. In October 2025, it published its annual State of Care report, launched a major consultation on regulatory reform, and saw the resignation of its Chief Executive, Sir Julian Hartley. 

These events have prompted many to reflect where the regulator has come from, where it is now, and what kind of inspection regime we must demand for the future.

We should also bear in mind that the report only covers up to 2024 — and as we all know, things in the NHS seem to have been getting worse, not better. There is a great deal to do.

The CQC has acknowledged widespread concerns about delays in registering new services, publishing reports, and acting on statutory notifications. In response, it has committed to foundational improvements in governance, technology, and regulatory consistency.  

Consultation on Rating System Overhaul

Following backlash against the 2024 rollout of the Single Assessment Framework (SAF), the CQC launched a new consultation — Better Regulation, Better Care. It proposes returning to the five key questions (Safe, Effective, Caring, Responsive, Well-led) and reintroducing rating characteristics instead of numerical scoring. This is a tacit admission that the SAF has failed to deliver clarity or fairness.

Reinstating Named Inspectors

A pilot scheme is underway to reintroduce named inspectors — a welcome response to complaints about the loss of personal relationships and sector-specific understanding under the SAF.

The Past: Origins, Ambition, and Persistent Shortcomings

Created in 2009, the CQC was tasked with inspecting and rating hospitals, care homes, GP practices, and local authority adult social care services. Its remit was wide, and its responsibilities consequential. Yet its historic failures are well documented:

• Delayed responses to whistleblowers and inconsistent inspection outcomes have undermined public confidence.
• Over-reliance on self-reported data and variable inspection practice have led to patchy assurance.
• The SAF, introduced in 2023 to bring coherence, has proved difficult to interpret and unevenly applied — confusing providers and inspectors alike.

CQC inspections were — and still are — feared. In my view, it seems to assume we are all guilty of poor service and must prove our innocence. That culture of fear is corrosive. Regulation that loses clarity and consistency risks becoming a box-ticking exercise rather than a tool for improvement.

The State of Care 2024/25: A System Under Pressure

Published on 24 October 2025, the State of Care report offers a sobering view of England’s health and social care system:

• Access to Care:
• 59% of adults reported difficulty accessing GP appointments.
• Over 5 million people waited more than two weeks for a GP appointment in March 2024; 1.4 million waited over four weeks.
• 23% faced challenges accessing dental care.
• Increased Demand:
• GP registrations rose by 5% from March 2020 to March 2024.
• Patients waiting more than two weeks increased by 18%.
• Social Care Challenges:
• 45% of delayed hospital discharges in April 2024 were due to waits for care home beds or home-based care.
• New requests for adult social care support that resulted in no service increased by 27% over five years.
• Mental Health Services:
• Demand rose 15% since 2022/23, especially among children and young people.
• 1 in 5 young people is estimated to have a mental health disorder.
• Concerns persist about inpatient bed availability and ward safety.
• Workforce Shortages:
• Vacancies in social care are three times higher than in other NHS sectors.
• Maternity Care:
• Nearly half of inspected locations were rated as requiring improvement or inadequate.
• Inequalities:
• Persistent disparities in access and outcomes, especially at transition points between services.

Better Regulation, Better Care: A Consultation with Consequences

Launched on 16 October 2025, this consultation proposes:

• Sector-specific frameworks.
• A return to the five key questions.
• A holistic evidence approach to the 34 Quality Statements.

Responses are invited by 11 December 2025 – follow the link here to respond. This is a critical opportunity to shape the future of regulation.

Leadership, Inspection, and the Moral Weight of Accountability

On 23 October, Sir Julian Hartley resigned as CQC Chief Executive following scrutiny over his previous role at Leeds Teaching Hospitals NHS Trust, now under independent inquiry for maternity care failings. In his statement, Hartley acknowledged that his position had become “incompatible with the important conversations happening” about care during his tenure at Leeds.

This is not a footnote. It is a signal.

Leadership in regulation must be more than operational competence.

It must carry ‘institutional memory’ — the ability to acknowledge past harm, learn from failure, and model ethical reform. Transparency is not optional. Accountability must be active, not reactive. Credibility depends on moral clarity.

The CQC must now rebuild its leadership culture around integrity, humility, and historical awareness.

Irregular Inspections: A Blind Spot We Must Remedy

Some services have not had a full inspection for many years. In my 21 years in the NHS, I experienced only one on-site inspection and one online update. That is not regulation — it is a tick-box exercise at a cost of time, pressure, and money.

This irregularity is unacceptable for safety, equity, and public trust:

• Long inspection gaps allow problems to persist unseen.
• Stale ratings mislead patients, families, and commissioners.
• Irregular inspection deprives the system of shared learning when exemplary practice is isolated.

Regulation must guarantee that no service is left uninspected for years. A predictable, risk-calibrated cycle with assured minimum coverage is essential.

What Inspections Should Be: Supportive, Proportionate, and Improvement-Oriented

Inspection should not be an experience of fear and dread for professionals who care for people. A humane, constructive inspection culture will produce better care than an adversarial one.

• Inspections must acknowledge and publish examples of good practice to enable replication.
• The default orientation should be improvement and support, with staged interventions and clear pathways to help services address shortfalls.
• Enforcement must remain available and decisive for serious or wilful failures — but it should not be the dominant or sole outcome.
• Inspectors must be consistent, transparent about evidence, and clear about success criteria.

A system that rewards learning and shares improvement will raise standards more effectively than one that only punishes.

The Future: Principles for a Regulatory Model That Improves Services Nationwide

The CQC’s next chapter must be governed by three operational principles that bind national consistency to local intelligence:

• Predictable Coverage — no service left uninspected for years.
• Systematic Learning — integrate inspection findings with workforce and commissioning data, local authority assurance, and user feedback.
• Proportionate Response — clear thresholds for support, escalation, and enforcement.

This requires targeted improvement programmes, not isolated reports. It demands integration, transparency, and a regulator that acts as a steward of care — not merely a judge of compliance.

October 2025 is a turning point for the CQC. We must demand an inspection regime that is consistent, timely, and constructive — one that reduces dread, recognises excellence, and drives measurable improvement across the country.

Having Faith in a System of Stewardship, Not Surveillance

Inspection is not just a technical process. It is a cultural signal — of what we value, what we fear, and how we learn.

• Fear-based inspection creates defensiveness.
• Punitive inspection isolates failure.
• Supportive inspection builds capacity, shares good practice, and fosters professional pride.

We must move from a culture of surveillance to a culture of stewardship.

I will be submitting a response to the Better Regulation, Better Care consultation, highlighting inspection frequency, supportive enforcement, and the systematic sharing of good practice.

This is an opportunity for all of us to make our voice heard and shape the way CQC inspects and integrates with services.

References and Sources

• Care Quality Commission (2025). The State of Health Care and Adult Social Care in England 2024/25. Published 24 October 2025.
  CQC State of Care Report
• Care Quality Commission (2025). Better Regulation, Better Care: Consultation Document. Launched 16 October 2025.
  Consultation Overview and PDF Download
• Care Quality Commission. Inspection Reports and Ratings. Includes local authority assessments for Stockton-on-Tees, Bradford, East Riding of Yorkshire, and Calderdale.
  Find Care Home Ratings
• Care Quality Commission (2023). Single Assessment Framework: Overview and Implementation Guidance.
  SAF Guidance
• Health Service Journal (2025). Coverage of Sir Julian Hartley’s resignation and related scrutiny.
  Search “Julian Hartley resignation CQC 2025” on HSJ
• Leeds Teaching Hospitals NHS Trust. Information on the independent inquiry into maternity care failings.
  Leeds NHS Trust Website
• Author’s Personal NHS Experience. Based on 21 years in NHS leadership roles, including direct experience with inspection irregularity.
•  Business plan 2025/26 - Care Quality Commission