The Care Quality Commission (CQC) has launched its “Better regulation, Better care” consultation, inviting views on proposed reforms to how health and care services are assessed, inspected, and rated in England.
This consultation follows the 2024 rollout of CQC’s Single Assessment Framework, which introduced a scoring-based system to standardise how judgements and ratings were applied across all service types - whether a GP provider, care home operator or NHS Trust. However new proposals outlined in this consultation reflect a move to sector-specific assessment frameworks and supporting guidance.
This consultation is a key step in modernising the regulatory framework to better reflect the realities of care delivery and support improvement across the sector.
Why now?
This initiative builds on insights from the Dash review, feedback from the Care Provider Alliance, and extensive engagement with stakeholders. It also complements the Richards review, which called for a return to sector-led inspection models and stronger professional accountability. Together, these reviews have shaped a vision for a simpler, clearer, and more trusted regulatory system.
What’s changing?
The consultation sets out several key reforms aimed at improving clarity, consistency, and usability:
- Reintroducing rating characteristics – offering clearer descriptors for each rating level to help providers and users understand what “good” or “requires improvement” looks like in practice
- Replacing quality statements with assessment questions – similar to the former Key Lines of Enquiry (KLOEs), these will guide inspections and judgements
- Sector-specific frameworks – tailored guidance for different care settings, supported by consistent cross-sector core elements
- Simplified content – removing duplication, clarifying language, and making expectations more practicable
- New rules around the frequency of assessment and updating rating judgements – with changes not affected by evidence or other ratings that are out of date
Rethinking ratings and judgements
The CQC is also consulting on changes to how ratings are determined:
- Judging at the key question level – moving away from sub-scores to direct judgements based on rating characteristics
- Changes to NHS Trust ratings – including reintroducing overall trust-level ratings and potentially removing site-specific ratings
- Strengthening professional judgement – expanding the role of inspectors’ expertise in decision-making
There are no plans to move away from the current single-word ratings - such as outstanding, good, requires improvement or inadequate - despite many care home operators favouring a narrative judgement.
What this means for the sector
These reforms aim to reduce uncertainty, align expectations more closely with practice, and empower providers to focus on delivering high-quality care.
The CQC is also planning targeted engagement sessions with people with lived experience and sector practitioners to explore sector-specific proposals in more depth.
After the consultation closes, the CQC will analyse feedback and publish its response, showing how input has shaped final decisions.
Get involved
This is a pivotal moment for health and social care regulation. Providers, stakeholders, and service users are encouraged to share their views and help shape a more responsive and effective oversight system.
To contribute, complete the online consultation form. The deadline for responses is 11 December 2025.
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