Impact of the Care Quality Commission on provider performance: Room for improvement?

The Care Quality Commission (CQC) introduced a new approach to inspecting and rating health and social care providers in 2013. Alliance Manchester Business School and The King’s Fund have undertaken the first major evaluation of this approach. We have developed a new framework for understanding the impact of regulation that describes eight ways in which regulation can affect provider performance. It shows that impact can occur before, during and after inspection and through interactions between regulators, providers and other key stakeholders. Between 2015 and 2018 we examined how CQC’s inspection and rating model was working in four sectors (acute care, mental health care, general practice and adult social care) in six areas of England. We found examples of all eight types of impact in our framework, although some were more prevalent than others and there were differences between sectors. We also tried to measure the impact of CQC inspections and ratings quantitatively and identified only small and mixed effects. The CQC completed its first cycle of inspection and rating in 2017 and is now implementing a revised approach. We highlight issues for CQC, other stakeholders and providers to consider as they continue to develop the regulatory model.