Care Quality Commission (CQC)’s “Ofsted-style” inspection and rating regime is a significant improvement on the system it replaced, but it could be made more effective, according to a King’s Fund report. The first major evaluation of the approach introduced in 2013.

The report, funded by the National Institute for Health Research, found that the impact of the inspection regime came about through the interactions between providers, CQC and other stakeholders not just from an individual inspection visit and report. It suggests that relationships are critical, with mutual credibility, respect and trust being very important. The report calls on providers to encourage and support their staff to engage openly with inspection teams.

The report highlights a number of areas for improvement in CQC’s approach. It cautions that the focus on inspection and rating may have crowded out other activity which might have more impact. It recommends that CQC focus more on regular, less formal contact with providers. The report also argues that CQC should invest more in the recruitment and training of its workforce and

The evaluation found significant differences in how CQC’s inspection and ratings work across the four sectors it regulates. Acute and mental health providers were more likely to have the capacity to improve and had better access to external improvement support than general practice and social care providers. The report recommends that CQC think about developing the inspection model in different ways for different sectors, taking into account these differences in capability and support.

Ruth Robertson, report author and Senior Fellow at The King’s Fund said: ‘Although we have heard general support for their new approach, we also uncovered frustrations with the process, some unintended consequences and clear room for improvement.’

Kieran Walshe, report author and professor of health policy and management at Alliance Manchester Business School, the University of Manchester said:

‘CQC has already taken some of our findings into account in developing their approach to regulating health and social care.  Fundamentally, the purpose of regulation is to drive improvement – not just in poorly performing providers but across the board.  CQC can now build on its experience and database from the first full cycle of inspection and rating, to create a more targeted and responsive regulatory model’

‘But CQC cannot do this alone.  It is just as much up to health and social care providers, and other stakeholders like NHS England and NHS Improvement, to make regulation work in improving services for patients.’