We would like to thank everyone who responded to our consultation, Better regulation, better care, which closed on 11 December 2025.
We received 1,703 responses, representing a broad range of health and care providers, professionals, stakeholders, people who use services, and the public. The quality, depth and volume of feedback demonstrates strong engagement with the health and care sector and a shared commitment to improving regulation and the quality of care.
The consultation had 2 areas of focus:
- How we are proposing to develop our frameworks and guidance for assessing providers
- How we propose to change our methods for inspecting, assessing and awarding ratings to health and care services.
Feedback was extremely positive across both our proposals on the assessment framework and the methodology we use to assess and rate services:
- Around 95% of respondents agreed or strongly agreed with each of our proposed changes to the assessment framework.
- Around 80% agreed or strongly agreed with the proposed changes to our approach to assessing and inspecting providers and awarding ratings.
Our initial steps in response to the consultation
In response to the very positive feedback received, we intend to start work to implement the proposals in our consultation.
1. Re-introducing sector-specific assessment frameworks
Respondents very strongly supported our intention to move away from a single framework covering all types of providers. Instead, we are planning to re-introduce separate assessment frameworks for each main health and care sector that we regulate.
Alongside this response, we are publishing 4 draft assessment frameworks for consultation covering the following sectors:
- adult social care
- mental health care
- primary care and community services
- secondary and specialist care (hospitals)
Our 4 Chief Inspectors have been leading the work on the frameworks for each sector. The draft frameworks have been developed using extensive feedback received during our internal and external engagement and consultation work over the last year, as well as the recommendations from the independent reviews carried out by Dr Penny Dash, Professor Sir Mike Richards and the Care Provider Alliance.
At this stage, we are continuing to engage and gather feedback to support the consultation to enable further development of the content and structure of the 4 assessment frameworks. Following refinements, we will also be testing and piloting the draft frameworks over the coming months.
We will be actively exploring whether we should change the scope of the frameworks and how many we need to develop. For example, whether some frameworks such as that for primary care and community services would work better as 2 separate frameworks.
2. Re-introducing rating characteristics
We will re-introduce rating characteristics within each sector-specific assessment framework. The draft frameworks include our proposed rating characteristics, which aim to provide greater clarity and transparency for providers, the public and CQC colleagues about what care looks like under each of our 4 rating levels of: outstanding, good, requires improvement and inadequate.
We are seeking feedback on the content and level of detail of these rating characteristics and how they can be supported with additional guidance.
3. Changing quality statements to supporting questions
Rather than using quality statements, our assessment frameworks will include a set of new supporting key lines of enquiry, which will clearly indicate the areas we look at during assessments and inspections.
4. Removing scoring from our assessment methodology
We will remove scoring from our assessment approach. Future rating judgements will be made holistically using the professional judgement of our inspection teams, informed by evidence and with reference to the rating characteristics and supporting guidance.
5. Making rating judgements directly at key question level
We will no longer make formal judgements below the level of our 5 key questions (safe, effective, caring, responsive and well-led). We will award ratings directly at key question level based on a review of evidence across the whole question, using structured professional judgement.
Further work on ratings for NHS trusts and independent hospitals
Our consultation also asked for feedback on how our current rating model is working for NHS trusts and independent hospitals, and whether we should change the approach. We included examples of changes we might make to these ratings, including:
- re-introducing an overall quality rating for an NHS trust
- re-introducing key question ratings at the trust level
- no longer awarding separate location-level aggregated ratings for NHS acute trusts and independent hospitals.
Feedback on our proposals for this approach was mixed. It highlighted both the challenges and benefits of our current rating model. While there was support for continuing to review the existing model, there is not yet a clear consensus on what should replace it.
On the basis of the feedback from the consultation, we therefore plan to keep our:
- single trust-level well-led rating, based on the trust-level assessment of the well-led key question
- location-level ratings for NHS acute trusts and independent hospitals.
We will engage with the NHS trust and independent hospitals sectors on the detail of how we assess within this model, in a way that best meets the needs of people using services and incentivises improvement. This work will focus on:
- how we define the services we want to assess and rate, within each sector, in a meaningful way
- how we select locations and services for assessment as part of a trust assessment
- how we take account of organisational quality and performance in awarding the trust-level well-led rating.
How we will use the detailed qualitative feedback
The consultation highlighted several cross-cutting themes that apply across all health and care sectors and all elements of our future regulatory approach. We set out our response to these themes as follows.
1. Reducing inequalities and advancing equality and human rights
Feedback emphasised both opportunities and risks for different groups of people, and respondents asked for greater clarity on how our new approach will address inequalities. In response, we will:
- embed equity and human rights considerations directly into the design of each sector-specific assessment framework
- use equality and human rights analysis from the consultation to refine our approach
- ensure the key lines of enquiry and rating characteristics highlight where inequalities must be addressed
- continue to test the frameworks with a diverse range of stakeholders and groups of people who use services to avoid unintended impacts.
2. Improving the timeliness, reliability and the quality of our own performance
Respondents highlighted the importance of more timely, consistent regulatory activity and improved organisational capacity. In response, we will:
- simplify processes and support quicker assessments by removing scoring and introducing key lines of enquiry
- invest in training our inspectors to strengthen confidence and improve consistency in professional judgement.
3. Strengthening our data and digital capability
Respondents emphasised the need for better data flows, more reliable systems to handle data and clearer reporting. In response, we will:
- ensure that our data and technology programme incorporates the necessary system requirements to manage these changes
- ensure our systems support new approaches to collecting evidence, making judgements at the key question levels and using rating characteristics
- work towards publishing more transparent, accessible reports for providers and the public.
4. Supporting inspectors and ensuring consistency of judgement
Given the proposed move to using professional judgement in making rating decisions, stakeholders stressed the importance of clarity, training and calibration. In response, we will:
- provide detailed guidance and tools for inspectors
- use the sector-specific assessment frameworks to improve clarity about what good quality care looks like in each sector
- develop enhanced induction, training, and quality assurance processes to support consistency.
5. Our approach to supporting integration and joint working
The consultation provided helpful feedback on how we can strengthen our role and improve how we can work collaboratively with providers and other organisations. This was particularly in relation to understanding variation in quality, tackling inequalities, and how different parts of the whole health and care system work together to deliver safe, effective and sustainable care.
Respondents emphasised the importance of CQC continuing to provide independent insight across sectors and they highlighted the value of our work to understand the quality of care beyond individual organisations, including pathways of care and interfaces across community, primary care, mental health, and acute hospital services. This supports the wider qualitative feedback we received on improving how we report, how we use data, and how we ensure our regulatory work supports improvement across providers at different levels and areas, including local neighbourhoods.
Other work
Some types of services registered with us are exempt from CQC’s legal duty to assess provider performance and give a rating, for example primary dental care providers and some independent healthcare services, and some services we inspect in partnership with other bodies. As part of the engagement and consultation on the content of our draft sector assessment frameworks, we will also work with those sectors that we do not rate, as we develop the detail on how we will assess these services for regulatory compliance and which assessment framework we will use to do this for each type of service.
Anyone intending to provide a regulated activity (as defined by the Health and Social Care Act 2008) in England must apply to register with CQC. We decide registration applications by referring to the relevant regulations and, in doing so, we use elements of our assessment framework. As we develop that approach to considering registration applications, we will ensure our approaches are aligned so that evidence gathered during registration remains relevant for ongoing assessment.
We will ensure that our framework for assessing local authorities remains aligned with changes to our wider assessment frameworks.
Our commitment
We are committed to delivering a regulatory approach that is clearer, more proportionate, and more able to support improvement in the quality of care. The cross-cutting themes identified in the consultation feedback will shape every phase of our development and implementation work, ensuring that the way we regulate is fair, consistent, and focused on what matters most to people who use services.
Next steps
We will:
- Consult on the 4 draft sector-specific assessment frameworks through feedback tools, meetings, events and other engagement activity.
- Continue to develop and refine the sector-specific assessment frameworks we have published, based on feedback from our testing, piloting and further engagement and consultation.
- Develop new guidance to support how we use the assessment frameworks in specific services within each sector.
- Continue to progress improvements to our operational systems, support for inspectors, organisational capability, and our ongoing commitment to reducing inequalities in health and care.
- Take forward related work to develop the detail for our assessment approaches for non-rated services, registration applications, and local authorities, in connection with the work on the sector assessment frameworks.
- Start work to consider CQC’s role in supporting service integration and joint working across providers, with a focus on neighbourhood working.
- Take forward further work on developing the detail of our approach to assessing and rating NHS trusts and independent hospitals, through engagement with those sectors.
- Publish a full response to the consultation during 2026, setting out what we have heard and how we are responding to the feedback we have received through our consultation and engagement activity.
You can read a more detailed report of the evaluation of feedback received through both the online consultation and in-person engagement activity and events. This was produced by Tonic, an external organisation commissioned by CQC for this project.