Recommendation 53

Changes to Care Quality Commission by evolution

Any change to the Care Quality Commission’s role should be by evolution – any temptation to abolish this organisation and create a new one must be avoided.

There are no plans to abolish the Care Quality Commission. The Care Quality Commission has set out a new strategy for the next three years, and has a new Board in place, with five new Non-executives and its three Chief Inspectors.  The Care Quality Commission has begun a process of fundamental change, begun in the hospital sector and to be rolled out to the other services that it regulates.

On 1 October 2013, the Secretary of State for Health announced the intention to give the Care Quality Commission greater independence.  Under the proposals, the Secretary of State for Health will relinquish a range of powers to intervene in the operational decisions of the Care Quality Commission.  This means that the Care Quality Commission will no longer need to ask for Secretary of State for Health approval to carry out an investigation into a hospital or care home.  It will also remove the Secretary of State’s power to direct the Care Quality Commission on the content of its annual report. The government proposes to make these changes via the Care Bill, by amending the Health and Social Care Act 2008, under which the Care Quality Commission was established. The Care Bill will also put the chief inspectors’ posts into statute to ensure their longevity.

In April 2013 the Care Quality Commission published its future strategy document in Raising Standards, putting people first – our strategy 2013-16. In this it sets out how it will work better with partners in health and social care, build relationships with the public and those it regulates, and build a high performing organisation.

A change programme is underway for the Care Quality Commission to develop into a strong, independent, expert inspectorate whose evidence based, professional judgements are welcomed and instructive.  The chair and board is reviewing governance structures throughout the organisation to ensure that decisions are taken by the right people at the right time.

In A new start – Consultation on changes to the way CQC regulates, inspects and monitors care the Care Quality Commission consulted a new approach to hospital inspections. On 17 October 2013, it published the responses to the consultation, A new start: Responses to our consultation on changes to the way CQC regulates, inspects and monitors care services, which showed that there is broad agreement with the new approach.  The new Chief Inspector of Hospitals is leading the new inspections which started in September 2013. Chief Inspectors of General Practice and Adult Social Care took up their posts in October 2013, and will similarly spearhead the extension and development of new approaches to monitoring and inspecting standards of care in those sectors.


The Care Quality Commission has a programme of transformation focussed on developing its new regulatory approach, and on ensuring that the organisation is structured, skilled and supported to deliver this. Key elements in the overall transformation delivered since November 2013 include:

  • The reorganisation of the Care Quality Commission’s inspection workforce into three inspection directorates from April 2014, each led by a Chief Inspector;
  • New waves of inspections in adult social care, primary medical services, mental health and community health, which were rolled out from April 2014- with full rollout in the acute hospitals sector;
  • Provider handbooks published for all sectors;
  • Senior leadership and management posts competed for and largely filled;
  • The Scheme of Delegation changed to reflect the new structure and roles;
  • The Academy (for training and development) up and running delivering induction courses, training for new approach waves;
  • And a learning management system for staff on track to be live in autumn 2014.

In 2015, the Care Quality Commission will focus on i) developing and using an overarching operating model with supporting business processes to drive value for money into its approaches; ii) learning from its inspection waves and ensuring a sustainable approach; iii) transforming its registration approach; iv) implementing its new regulatory powers from the Care Act; v) relooking at its approach to handling and using complaints, concerns and whistle-blowing; and vi) embedding the changes made in 2013/14 to ensure they become and remain mainstream accountabilities.