This report was commissioned by the Care Quality Commission (CQC) as part of the evaluation of CQC’s five-year strategy, and aims to provide an in-depth assessment of the relationship between CQC’s regulatory approach, and improvement in quality of health and social care. This includes looking at how CQC works with provider organisations and other system partners involved in health and social care. The report builds on existing evidence about CQC’s impact on quality, and takes this one-step further, by recognising more explicitly how CQC’s contribution interacts with other influencers on quality.

The report seeks to support CQC in delivering its purpose by identifying areas where it can improve its approach. It does this by elucidating theories of change and associated evidence, encapsulated in simple diagrams, which CQC can use as the basis for redesigning its activities and for organisational and staff development. Crucially, these theories also highlight external conditions which need to be in place for CQC to have an impact. Some of these conditions relate to provider organisations and others to the wider health and care system. They suggest a challenging agenda for CQC to engage more productively with providers and system stakeholders to achieve on-going quality improvement, supported by learning from further research and evaluation.

Consultation with CQC senior managers identified three priority topics for investigation of CQC’s impact:

1. Interactions between CQC inspectors and provider staff. A substantial amount of inspector time is spent interacting with provider staff, so this needs to be effective, but there is little evidence about the impact of interactions. This project sought to identify interactional practices that support provider improvement, to investigate the impacts that such practices have, and to explore how feasible it is for inspectors to adopt these practices.

2. CQC assessment frameworks and guidance products. Many respondents in CQC’s annual provider survey say that CQC products have encouraged or enabled them to improve. However, there is little evidence about how exactly the products are helpful. This project sought to understand the accessibility of CQC products, how providers use them to support improvement, and what impacts result.

3. Registration assessment and decisions. It is technically difficult to assess some impacts of registration, and there is relatively little evidence. This project sought to identify impacts arising from registration which could contribute to quality improvement, and to understand how those impacts came about, with a view to informing future monitoring and evaluation.

This report focuses on these three priority topics.