Regulator’s new 2021 strategy for the health and care sector

Care Quality Commission aims for a ‘dynamic and flexible’ approach to regulation

The CQC’s new strategy commits to adopt a more proportionate and risk-based approach to regulation – a model NHS Providers say will be welcomed by Trust leaders, particularly if this leads to less reliance on inspections and reduces the overall burden.

Following consultation with the public, providers of health and social care services, charities and partner organisations, the CQC has published its strategy from 2021 for the next five years. You can read the document, A new strategy for the changing world of health and social care here.

As readers will be aware from the consultation document (you can read our earlier article here), the CQC’s approach focused on four main themes:

  • People and communities
  • Smarter regulation
  • Safety through learning
  • Accelerating improvement

Running through each theme are two ambitions, which are assessing local systems and tackling inequalities in health and care.

The CQC aims to regulate in a “more proportionate and consistent way” which supports services to improve and prioritise safety. Under the new approach, CQC will assess how well local health and care systems are working together, which is likely to be underpinned by legislation in the forthcoming Health and Social Care Bill (you can read our earlier blog on system level regulation here following the Secretary of State’s view that the CQC should have a “crucial role” in ICS oversight).

We set out the key headlines from the CQC’s new strategy:

  • Assessments of quality will be different. While on-site inspections will remain, there will be a move away from relying on a set schedule of inspections to a more flexible, targeted approach using a range of tools and techniques to assess quality and generate an up-to-date picture. It explains that inspections will happen where there is a “clear need to do so” and where they are responding to risk in circumstances where they have limited data or need specific information, for example.
  • A new digital platform will form the basis of better assessment of data. The watch dog plans to use innovative analysis, artificial intelligence and data science techniques to support “robust and proportionate decision-making” based on the best information available.
  • Ratings will be more dynamic and meaningful – they will be updated when there is evidence that shows a change in quality, it said. It will not always need to carry out an inspection to change a rating.
  • There will be more and better ways to gather views from a wider range of people reaching out to people who are the most disadvantaged in our society, have had distressing or traumatic experiences, and those who are more likely to experience poor outcomes and inequalities. CQC aims to change the way they record and analyse people’s feedback to make it easier to identify changes in the quality of care – both good and bad.
  • There will be increased scrutiny of how providers encourage and enable people to feedback and how they act on this to improve their services.
  • It plans to improve the registration of services by expanding the definition of what CQC consider to be a provider of care and what it means to carry on a regulated activity. This it explains will make sure that they register all the parts of an organisation that are responsible for directing or controlling care. It also plans to move away from long inspection reports, making information and data on services easier to understand and more accessible.
  • New data portals will be used to coordinate data collections to reduce duplication and workload for services collecting and submitting data to CQC. It aims to connect with services digitally, starting from the point of registration, making it easier for services to provide information and update it.


This is an ambitious strategy that involves complex work that will take time to deliver over the next five years. The final page of the strategy document includes 12 outcomes the CQC intends to achieve across the four core themes of people, regulation, safety and improvement.

During a webinar launching the strategy, Ian Trenholm, CQC chief executive, said: “We very much recognise that there is a lot of work to do to deliver on these ambitions… but I hope you will see some practical changes over the next year as part of a multi-year programme of work.”

The UK Homecare Association welcomes the aspiration in CQC’s new strategy with Policy Director, Colin Angel commenting:

“Placing greater emphasis on the experience of people who use services, and adopting a more dynamic and flexible approach using data and updating providers’ quality ratings is extremely positive."
"As CQC developed its strategy, UKHCA said that the current system of inspection has been too heavily focused on documented processes, at the expense of assessing outcomes for people. We encouraged CQC to be clear about how it would deliver its aspirations in practice."
"We support CQC’s intention to evaluate the wider social care and health systems in which care is delivered. However, we recognise that CQC, currently, has limited powers to hold those systems to account.”

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