In this update, we share more details on how we’re prioritising our activity to enable us to carry out more assessments and to tackle some of the issues around aged ratings and services that have never been assessed.
We continue to be on track to meet our target to publish reports for at least 9,000 assessments across all sectors by September 2026.
What this means for providers of health and social care
Across all the sectors we regulate, we act quickly where we find extreme and very high risk. To reflect the specific needs and risks of each sector and regions, we are prioritising our activity in the following areas:
Adult social care
- Services with urgent, emerging risks that inspection teams have identified.
- Services that have not been assessed since registration where the data we hold identifies as very high risk.
- Services registered for over a year that have not yet been assessed.
- Services with a rating over 6 years old.
In addition, and to increase the number of assessments, we will shortly be rolling out an approach for adult social care services that:
- are currently rated as good in all 5 key questions
- have a registered manager
- have ratings over 6 years old
- show no significant risk in the data we hold
- have no ongoing enforcement activity.
The approach enables us to focus more on people’s experiences and outcomes, supported by observation and targeted, risk-based review of records. It means we will be able to increase regulatory contact in a proportionate way with services that may not otherwise receive a routine assessment. If concerns arise during planning, we will revert to the usual approach.
Mental health care
- Services rated as inadequate that haven’t been assessed for over 12 months.
- Services registered for over 2 years that have not yet been assessed.
- Services with a rating of outstanding over 8 years old.
- Services with a rating of requires improvement over 3 years old.
- Services with a rating of good over 5 years old.
- Services assessed as part of our adult community mental health programme.
Hospitals, secondary and specialist care
- Services that have not been assessed for a significant period of time and where our monitoring indicates a need to be re-inspected to support regulatory judgements and assurance.
- Services that are registered and have never been assessed, prioritised by the length of time since registration.
- Providers applying for NHS advanced foundation trust status without a recent assessment as above.
- Increased focus on services in the independent sector, reflecting the level of unknown or emerging risk, and the increasing volume of NHS-commissioned activity they are delivering.
From September 2026, our broader approach to NHS assessment activity will include:
- The roll out of a longer-term programme of trust-level assessments
- Close oversight of the impact of winter pressures, targeting our focus on discharge pathways end of life care.
Primary care and community services
- Services with urgent risk
- Services that have been identified as high risk and not assessed
- Services that have been registered for one year or more that have not been assessed
- Services with previous enforcement action assessed for follow up
- Services with ratings older than 7 years
In March we also began our Returning to Good and Outstanding programme of focused assessments of NHS GP practices considered as lower risk with a current rating of good or outstanding, whose last inspection report was published between 2017 and 2022.
This means that we can return to lower risk services in a proportionate way, reviewing non-clinical quality statements safely and robustly.
If we identify concerns at any stage, inspectors will consider whether we should carry out a full, rather than focused, assessment.
What does this mean for my service?
While we cannot specify when we will assess an individual service, the priorities outlined above for each sector give an indication of when we may assess.
We are currently asking for feedback on our draft assessment frameworks, but until we implement the new regulatory approach later this year, please continue to refer to the current published guidance on how we assess quality and performance.
Using specialist advisors and executive reviewers
We are recruiting more specialist advisors and executive reviewers to strengthen the insight and support available. These roles support our inspectors by providing specialist advice and expertise to support our judgements. To improve how we work with them, we are:
- being clearer about their role, ensuring shared understanding of expectations and how their input supports consistent, well-evidenced judgements
- improving how we recruit and engage, so they feel valued, included and connected to our work and purpose
This will help ensure that their expertise is used effectively to enhance decision making, strengthen confidence and further embed equitable regulation in practice.