A new strategy for the changing world of health and social care - CQC's strategy from 2021

Page last updated: 22 November 2023

We’re changing how we regulate to improve care for everyone.

What we’ve learned from the past five years puts us in a better position for the future. Our new strategy combines this learning and experience and we’ve developed it with valuable contributions from the public, service providers and all our partners. It means our regulation will be more relevant to the way care is now delivered, more flexible to manage risk and uncertainty, and will enable us to respond in a quicker and more proportionate way as the health and care environment continues to evolve.

This new strategy strengthens our commitment to deliver our purpose: to ensure health and care services provide people with safe, effective, compassionate, high-quality care and to encourage those services to improve. Our strategy is purposefully ambitious, and to implement it we will need to work closely with others to make it a reality. We’ll review this strategy regularly so we can adapt to changes and be prepared for what the future holds.

Our purpose and our role as a regulator won’t change – but how we work will be different.

We set out our ambitions under four themes

  • People and communities: Regulation that’s driven by people’s needs and experiences, focusing on what’s important to people and communities when they access, use and move between services
  • Smarter regulation: Smarter, more dynamic and flexible regulation that provides up-to-date and high-quality information and ratings, easier ways of working with us and a more proportionate response
  • Safety through learning: Regulating for stronger safety cultures across health and care, prioritising learning and improvement and collaborating to value everyone’s perspectives
  • Accelerating improvement: Enabling health and care services and local systems to access support to help improve the quality of care where it’s needed most

Core ambitions

Running through each theme are two core ambitions:

  • Assessing local systems: Providing independent assurance to the public of the quality of care in their area
  • Tackling inequalities in health and care: Pushing for equality of access, experiences and outcomes from health and social care services

We’ll look at how the care provided in a local system is improving outcomes for people and reducing inequalities in their care. This means looking at how services are working together within an integrated system, as well as how systems are performing as a whole.

We’re committed to our ambition of regulating to advance equality and protect people’s Human Rights. Everyone in health and social care has a role to play in tackling the inequalities in health and care for some people. This strategy sets out our ambition for how we can help influence change.

People and communities

Listening and acting

People need to see how their voice can make a difference to the safety and quality of the services they use and how we reflect their experience in our work. We want to hear both positive and negative experiences when people access, use and move between services.

  • We’ll make it easier for people, their families and advocates to give feedback in the most convenient and suitable ways for them whenever they want. We’ll also enable those who act as trusted intermediaries to share feedback with us. Working with local communities, we’ll make the most of existing sources of feedback so people don’t have to repeat themselves.
  • We’ll identify more and better ways to gather experiences from a wider range of people and develop the skills and tools that we need to do this. We’ll reach out to people whose voices and experiences we don’t often hear: 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. This includes people with a learning disability, people with communication needs, people living in poverty, those whose voices are not often heard, those who are detained under the Mental Health Act, and people who are at risk of abuse or other human rights breaches.
  • A priority will be improving our capacity and capability to get the most out of feedback. We’ll change the way we record and analyse people’s feedback so it’s easier for us to quickly identify changes in the quality of care – both good and bad. We’ll be clear about the value and weight we give to quantitative and qualitative information when using it with other evidence.

People’s feedback is vitally important. It’s important to build trust with the public and motivate people to share their experiences.

  • When we publish information about quality, we’ll be clearer about how we’ve used what people have told us – both good and bad. We’ll explain what action we and others have taken as a result.
  • When people take the time to share their experiences with us we’ll provide a response in the way people need it and explain how their feedback has informed our view of quality.

People are often afraid to speak up. We want to help build a new culture among the public, health and care providers, and all our partners, that welcomes, values and acts on feedback.

  • We’ll improve the way we assess how services and local systems encourage and enable people to speak up, and how they act on this feedback. It will be unacceptable if they are not doing this – where they are not, we will make sure they take action to address it. We’ll also focus on this when we look at how local systems are listening to their communities. This is so they can improve access to services that meet people’s needs, in particular people who are most likely to have a poorer experience of care or who are less able to speak up.

People are empowered

We know care is better when it’s developed through the eyes of people who use services and delivered in partnership with them. We think the same of regulation. When we talk about the quality of care in our work we will have people at the centre.

  • To empower people to drive change, it’s important for them to know who we are and understand what we do. We’ll proactively raise public awareness of CQC and be clear about our role as a regulator. We’ll invest in the most effective ways to reach different groups of people.
  • We’ll work closely with people who use services and those that represent them to understand their needs, and to co-design and develop how we work and our services for the public. Any changes we make will start with understanding what people expect and need from care services and pathways, and from CQC. We’ll involve people in a more equitable, targeted and meaningful way and enable them to engage with us in ways that best suit them.
  • We’ll work with all our partners and people who use services to develop an agreed and shared view of quality that makes clear what standards people can expect from their health and care services. We’ll provide a clearer definition of what good and outstanding care looks like for everybody, based on people’s lived experience of care and what matters to them. Everybody will be able to easily access, understand, and use these definitions. We’ll use them as the basis for assessing services and the information that we collect as evidence. This shared view of quality will enable a joined-up approach that’s applied to individual services, corporate providers, and across system boundaries in health and social care.

Providing independent, trusted and high-quality information about the quality of care is a fundamental part of our work.

  • We’ll change how we provide information so that it’s more relevant, up to date, and meaningful for people who use services, and reflects their experiences. We’ll ensure people have easy access to information in the way they need it, and use clear and accessible language.
  • We’ll encourage people to use our information in ways that are relevant to them. Our up-to-date view of the quality of care in a service will help people and their families make informed decisions, where they can, about where to go for their care. It will also give people confidence that our information reflects the quality of care that they can expect.

Prioritising people and communities

  • We’ll look at how effectively a service works with others, and in partnership with local communities, to involve people in designing and improving services. This includes how services embed equality, diversity and inclusion, and corporate social responsibility in everything they do, such as improving local health and wellbeing, and environmental sustainability.

Working collaboratively as a local system is essential to improving the quality and safety of care. Health and care services and commissioners need to understand the diverse needs of their local populations and where there are inequalities in how people access and experience care, and in their outcomes.

  • When assessing individual health and care services, we’ll look at how they work together in an area, as one system, to deliver better and more coordinated care. We’ll focus on how well local systems perform against the important things that matter to people in that community – such as being able to move easily between services. We’ll work to build our understanding of the needs of a local population so we can hold services to account effectively.

Our work in this area will be through legislation in the Health and Social Care Bill and we’ll align with other regulators to encourage a shift towards more integrated services.

  • Our assessments of local systems will provide independent assurance to the public of how they are working together to deliver high-quality care. We’ll ensure our people have the right skills and capability to assess at both a service provider and a system level.
  • We’ll publish what we find about the performance of a system. If we see good practice, we’ll highlight this and share examples so that others can learn from it and adapt it to their own area. We’ll also make recommendations to improve where we find issues or concerns.

We will identify and call out unwarranted variation and inequalities in how people experience health and care services. But we also know that a person’s health and wellbeing is significantly affected by factors outside health and care.

  • We’ll assess how local systems understand the needs of their local populations, especially people who face the most barriers to accessing good care and those with the poorest outcomes, enabling them to proactively address inequalities.
  • We’ll work with other appropriate agencies, voluntary and community organisations, and other regulators to develop a shared understanding of the factors that contribute to inequalities in people’s access and experiences and how this affects their outcomes from using care services. Together, we’ll identify the levers that we can all use to tackle these inequalities.

Smarter regulation

Safety through learning

Accelerating improvement

Outcomes from this strategy

By delivering this strategy, we will achieve 12 outcomes:

People and communities outcomes

  1. Our activity is driven by people's experiences of care.
  2. We clearly define quality and safety in line with people’s changing needs and expectations. This definition is used consistently by all people, and at all levels of the health and social care system.
  3. Our ways of working meet people’s needs because they are developed in partnership with them.

Smarter regulation outcomes

  1. We are an effective, proportionate, targeted, and dynamic regulator.
  2. We provide an up-to-date and accurate picture of quality.
  3. It is easy for health and care services, the people who use them and stakeholders to exchange relevant information with us, and the information we provide is accessible, relevant, and useful.

Safety through learning outcomes

  1. There is improvement in safety cultures across health and care services and local systems that benefit people because of our contribution.
  2. People receive safer care when using and moving between health and social care services because of our contribution.

Accelerating improvement outcomes

  1. We have accelerated improvements in the quality of care.
  2. We have encouraged and enabled safe innovation that benefits people or results in more effective and efficient services.

Core ambitions: Assessing health and social care systems, and tackling inequalities in health and social care

  1. We have contributed to an improvement in people receiving joined-up care.
  2. We have influenced others to reduce inequalities in people’s access, experiences and outcomes when using health and social care services.