The CQC Consultation: 'Better Regulation, Better Care'.

On 16 October 2025, the Care Quality Commission (CQC) opened the ‘Better regulation, better care’ Consultation (the Consultation).

The CQC is aiming to reform its regulatory approach to be more effective, timely, consistent and transparent. Therefore, the CQC is consulting on proposals to revise how it assesses and rates health and social care providers in England. These proposals build on recent independent reviews and feedback about how the CQC assessment framework can be improved.

The Consultation focuses on improving 4 key areas: 

1. Publishing delayed reports of assessments that the CQC have completed.
2. Increasing the number of assessments completed each month, so the CQC can provide up-to-date ratings and ensure people understand the quality of care in services within their area.
3. Clearing the registration backlog to enable new services to start delivering care and increasing capacity in the system.
4. Making sure the CQC have acted promptly on information of concern and statutory notifications from providers.

There are two parts to the Consultation as set out below.

Part 1: Improving the assessment framework

The assessment framework is used to assess and make judgements about the quality of the services of registered providers. The CQC then award ratings and scores which are published.

What are the proposed changes and why are they being made?

Independent reviews, operational experience and feedback highlighted that improvements need to be made to the assessment framework by:

• Describing the CQC’s expectations of quality for all rating levels.
  • The CQC propose to re-introduce rating characteristics which would assess quality and safety, be clearly structured and help to ensure consistency and transparency in the rating process.
  • To support the rating characteristics, the CQC propose to develop a framework of supporting questions similar to the previous key lines of enquiry (KLOEs). This would replace the current quality statements, provide a clear structure for assessment, and assist in understanding the key areas the CQC are likely to assess.
• Providing a clearer view of quality and safety for CQC-regulated sectors.
  • The CQC propose to re-introduce assessment frameworks that are specific to each sector, which more clearly reflect and articulate the context of those health and care sectors.
  • The CQC also intends to support the assessment frameworks by publishing more detailed supporting guidance that shows the key standards and sources of evidence that will be considered for the services in that sector.
• Making the frameworks simpler and clearer.
  • The CQC propose to simplify the language in the frameworks to make them easier to understand.
  • The aim is to ensure an appropriately balanced level of detail in the different areas of the framework.

Part 2: How the CQC make judgements and award ratings

Ratings were introduced by the CQC as part of the independent assessments of care quality. These ratings reflect whether services are outstanding, good, require improvement or are inadequate.

What are the proposed changes and why are they being made?

The CQC propose to improve their approach to making judgements and awarding ratings by:

• Simplifying the rating approach, strengthening the role of professional judgement and making reports clearer and easier to use to support improvement in care.
  • No longer awarding separate scores underneath the key question ratings.
  • The proposed new approach includes the following:
    • Gathering evidence through inspections and other activities;
    • Rounded assessments of evidence collected across the whole key question, with reference to rating characteristics;
    • Key question rating awarded based on professional judgement;
    • Overall ratings awarded based on aggregation from key question ratings and professional judgement.
• Supporting the inspection teams to deliver timely and expert inspections, publish reports that have an impact, drive improvement, and maintain strong and effective relationships with providers.
• Reviewing and clarifying the approach to following up assessments and updating rating judgements, including through developing clear principles around the frequency of assessing providers.
  • The CQC’s aim will be to ensure that when they update ratings for a service, their judgements are not affected by evidence or other ratings that are significantly out of date.
• Potential changes to the CQC’s approach to rating NHS trusts and independent hospitals, including potentially reintroducing an overall quality rating and whether to drop local-level ratings. The CQC is also exploring whether to remove location-level aggregated ratings.

What will not change

The 5 key questions will remain the same: Are services safe, effective, caring, responsive and well-led? 

The fundamental standards and regulations under the Health and Social Care Act 2008 will continue to form the legal baseline.

For services that cannot be rated (due to legal constraints), the CQC will maintain their ‘regulations met’ or ‘not all regulations met’ approach, which informs the overall key question judgement.

The principle of an overall rating for services (aggregating across the 5 key questions) will continue, with the influence of professional judgement.

Responding to the Consultation

The CQC invites responses to the Consultation by 17:00 on 11 December 2025 and the link to this is below.

Respond to CQC's Consultation here

For more information, the Consultation can be read in full here: Better regulation, better care: Consultation on improving how we assess and rate providers

If you have any queries in the meantime, please contact Charlotte Greatorex.