In 2013 the Care Quality Commission (CQC) introduced a new approach to inspecting and rating NHS acute hospitals. The change was triggered by several high-profile failures of care that raised questions about regulators’ ability to identify and act on poor performance. The new approach included in-depth inspections by larger, more expert teams and produced ratings and an inspection report for each provider.

This new approach was extended to other parts of the health and care system in 2015 and continues to evolve. CQC’s revised strategy for 2016–21 set outs their plans to further develop their regulatory model.

Alliance Manchester Business School and The King’s Fund undertook a mixed-method research study funded by the Department of Health’s Policy Research Programme. The researchers explored the impact of CQC’s approach to inspection and rating on providers in four sectors (acute care, mental health care, general practice and adult social care). To do this, they combined a literature review and qualitative fieldwork nationally and in six parts of England with quantitative analyses of national data on provider performance, ratings and activity. The qualitative fieldwork included 170 interviews with a range of staff from health and social care provider organisations, CQC, patient and public groups and other stakeholder organisations such as Healthwatch, NHS England and clinical commissioning groups (CCGs).

The researchers also developed a new framework that outlines eight ways in which regulation can affect provider performance. This framework will help regulators, providers and policy-makers to understand the impact of regulation. It shows that regulation has an impact before, during and after inspection and through interactions between regulators, providers and other key stakeholders.