Our Response to the CQC Consultation: Better Regulation, Better Care

The Care Quality Commission (CQC) recently consulted on proposals to improve how it assesses and rates providers, through its “Better regulation, better care” consultation. As a representative body for social care providers, we responded to ensure the views and experiences of the sector were clearly reflected.

Overall, we strongly welcomed the CQC’s intention to improve clarity, consistency and collaboration in its regulatory approach. However, our response also highlighted areas where trust needs to be rebuilt, where further detail is required, and where the wider system context must be properly recognised.

Below we summarise the key themes from our consultation response.

Greater clarity and sector-specific frameworks

We agreed with proposals to publish clearer rating characteristics and to develop sector-specific assessment frameworks. Providers have consistently told us that the current approach does not always reflect the realities of delivering social care, and greater sector specificity is widely welcomed.

That said, we stressed the importance of equity between sectors. While frameworks should reflect different contexts, they must still fairly account for how each part of the system interacts and how this affects people’s experience of care.

Simplification and co-development with providers

We supported efforts to simplify the assessment framework and remove duplication. However, we were clear that whether simplification is genuinely achieved will depend on how the detail is developed in practice.

A central message in our response was the need for meaningful co-development with providers. Consultation alone is not enough. For the CQC’s approach to be credible, it must:

• Publish a clear and robust co-development methodology
• Show how provider input will actively shape the framework
• Allow time and space for the sector to respond to detailed proposals

This would help build confidence that changes are being developed with the sector, not just about it.

Ratings, feedback and fair judgement

We broadly agreed with awarding ratings directly at key question level, provided this supports a balanced and proportionate judgement.

Providers told us that while single-word ratings are inevitable, they can be deeply problematic if they:

• Fail to distinguish between isolated, remediable issues and systemic poor care
• Do not provide sufficiently detailed feedback on what needs to change

We emphasised the importance of clear, actionable feedback that enables providers to understand exactly where improvements are needed and what actions are required.

Inspection competence, trust and system impact

One of the strongest messages in our response related to confidence in the regulator. Providers continue to report low confidence in the CQC’s competence, particularly given:

• Ongoing inspection backlogs
• Previous findings of significant regulatory failings
• The financial and operational burden of delays, IT failures and framework changes

We highlighted that these issues directly contribute to financial strain on providers, which in turn affects care quality.

We also raised concerns about how the CQC will assess integration and wider system effectiveness. High-quality care depends on multiple parts of the system working well together, including assessment, discharge and funding arrangements. Providers should not be judged in isolation where system failures are a contributing factor.

We supported a shift towards inspections that seek to understand why standards are not met, rather than simply stating that they are not. This approach aligns with the CQC’s stated ambition to be a more collaborative regulator.

Staff wellbeing and the inspection process

We asked the CQC to give serious consideration to the impact of inspections on staff wellbeing, particularly for registered managers.

The sector was deeply affected by the findings following the death of Ruth Perry, and many providers recognise the descriptions of inspection-related stress contained in the coroner’s report. In an already pressured system, we believe inspections carry a real risk of contributing to harm if wellbeing is not actively safeguarded.

We urged the CQC to:

• Publish clear policies on managing anxiety during inspections
• Reflect on the impact of single-word judgements
• Consider how confidentiality requirements affect staff’s ability to seek support
• Set out specific, transparent actions to protect staff wellbeing during and after inspections

Evidence and follow-up

We agreed in principle with the proposed approach to following up assessments and updating ratings. However, we stressed that the CQC must be able to demonstrate that:

• Evidence relied upon reflects care being delivered at the time of inspection
• Providers can clearly see when secondary evidence has been used
• Providers have a fair opportunity to challenge evidence and judgements

Our ongoing role

We welcome the direction of travel outlined in the consultation, and our response makes clear that delivery will be key. Rebuilding trust with providers will require transparency, competence and genuine collaboration.

We will continue to engage with the CQC as these proposals develop and ensure that the voices of social care providers remain central to discussions about regulation, quality and improvement.