This report outlines key areas for improvement to enhance support and constructive engagement between the UK Care Quality Commission and trust leaders' NHS England (NHSE) and integrated care boards (ICBs).

This report describes good quality regulation and to makes recommendations for the CQC on how it could improve, so it can play a positive role in the health and care system, while realising the potential of its new approach.

The report makes 10 recommendations for how CQC could modify its approach, or build on progress currently being made. Taken as a whole, these recommendations could help CQC add value to trusts and the services they provide, and may also improve CQC’s relationship with providers, and enhance their confidence in its activities and outputs.

• CQC fully embraces the principles of right-touch regulation.
• Given its important role in encouraging improvement and innovation, CQC makes the most of its privileged observer position by sharing good practice, engaging in improvement-focused conversations with providers, and working with organisations that have a direct role in improvement.
• CQC appreciates the value of supportive, consistent and stable relationships between local CQC teams and providers and actively encourages these. This will enable open, honest and collaborative dialogue.
• CQC continues to invest in improving the training, as well as the conduct and behaviour of its inspection teams, to ensure greater credibility, consistency and objectivity, and to allow for transparent, well-informed and constructive provider and system assessments.
• CQC better reflects operational circumstances in its inspections and reports, and highlights providers’ positive achievements alongside their shortcomings. Trusts would like to see CQC build on improvements it has made in acknowledging the operating context they are working in, as witnessed over the most recent winter period.
• While retaining its impartiality and objectivity, CQC could reflect on the tone and delivery of its inspection activities, including its inspections, reports and ratings, to make sure its outputs do not have an unintended adverse impact on providers.
• CQC re-evaluates the success of its single-word ratings against their intended purpose, and considers the addition of a narrative rating qualifier as part of its new provider assessments reports, in the context of the Ofsted inquiry findings.
• CQC fully delivers on the potential of its new single assessment framework, which promises to provide greater objectivity and a more ‘live’ picture of quality. Ratings, particularly for providers considered lower risk, should reflect this.
• CQC takes the opportunity to explore entire patient pathways, rather than only assessing individual care settings. CQC's new role in assessing integrated care systems and local authorities could make it possible to build a system-wide picture of the challenges that impact on services, and how these might be tackled.
• It is for CQC to act on feedback about its credibility and work with providers to regain their trust. It should consistently act with openness and transparency, meaningfully collaborate with those it regulates, and display a positive learning attitude.