This review explored how regulators can tackle inequalities experienced by those using services. It identified lessons from other sectors and countries.

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. CQC makes sure health and adult social care services provide people with safe, effective, compassionate, high-quality care and encourage care services to improve.

The study involved a rapid literature review, with analysis of 46 of the most relevant documents identified through a systematic three stage sifting process.

Findings:

The findings from this rapid literature review provide relevant insights, both for the Care Quality Commission (CQC), and other regulators seeking to tackle inequalities experienced by service users

Implementation:

• Approaches used to tackle inequalities are holistic. Regulators could consider how multiple interventions and approaches can be combined and embedded.
• Regulators could consider how to embed sustainable approaches to tackling inequalities. This includes amongst different service areas or user groups.
• Regulators could consider focusing on equality in their existing regulatory frameworks.
• It is important that regulators assign accountability for tackling inequalities within their workforce.
• It is important for regulators to communicate their vision for tackling inequalities. This includes to their own staff and the organisations they regulate.
• Regulators need to remain realistic about how far they can affect inequalities. They are one (or more) steps removed from service users.

Engagement:

• It is important for regulators to continue to share learning with other regulators.
• It is important that regulators work collaboratively to address inequalities. This includes with partners within the systems in which they work.
• Regulators need to demonstrate the characteristics they seek from providers in tackling inequalities.
• Dual ‘encouragement and enforcement’ functions can support engagement with providers. Regulators could consider how this can be most effective.
• It is important that regulators continue to assess the transparency of their communications. This will ensure clear expectations are set with a view to building trust and confidence.
• Regulators may wish to assess the extent to which providers use service user voices. This includes to inform continuous service improvement.
• Regulators need to reflect service user voices in their approaches to addressing inequalities.
• It is important that regulators ensure processes and communications are accessible. This includes within their own organisations and their providers.