If you work in UK health and social care, the regulator you are answering to in April 2026 is not the same one you were answering to two years ago. The Care Quality Commission has spent the past 18 months in active reconstruction. Two independent reviews exposed serious operational failings. A new Chief Executive has been appointed. The internal structure is being rebuilt around sector expertise. The Single Assessment Framework introduced in November 2023 is being replaced. And Dr Penny Dash, the woman who reviewed the CQC, is now Chair of NHS England, drafting the National Quality Strategy that will sit alongside the regulator’s work.
This guide is about what has actually changed and what is changing next. Not the headlines from October 2024 when the first Dash report landed, but the picture eighteen months on, when the reform programme is moving from analysis into implementation.
For providers, this is the regulator your inspections, ratings, registrations, and ultimately your bid evidence now sit under.
How we got here
The story begins with an independent review commissioned by the Department of Health and Social Care in May 2024. Dr Penny Dash, then Chair of North West London Integrated Care System, was asked to examine the operational effectiveness of the CQC. The first report, published in October 2024, identified “significant failings” within the regulator: a stark reduction in inspection activity, a substantial loss of credibility across the sector, 19 per cent of locations the CQC has the power to inspect having never been rated, significant problems with the provider portal and regulatory platform, and months-long delays in producing reports.
A parallel review by Professor Sir Mike Richards examined the Single Assessment Framework specifically. Sir Mike found that the SAF, introduced in November 2023, had created additional complexity rather than streamlined assessment. The CQC accepted the recommendations of both reports.
The new leadership and three Chief Inspectors
Sir Julian Hartley was appointed Chief Executive of the CQC in 2025, bringing senior leadership experience from the NHS provider sector. His brief is the implementation of the reform programme: rebuild operational performance, particularly inspection volume and report turnaround; reorganise around sector expertise; and reset the relationship with providers after a period in which provider trust had reached a low point.
Underneath the new Chief Executive, the structural change matters as much as the leadership change. The CQC has committed to appointing at least three Chief Inspectors leading on hospitals, primary care, and adult social care respectively. Consideration is being given to a fourth for mental health services.
Under the previous SAF model, inspectors moved across sectors with the same framework, relying on the structure of the assessment to compensate for variable sector knowledge. The new model places sector specialism at the top of the regulator and is intended to flow down through the organisation. For adult social care providers, this is the change with the largest practical effect. Inspectors with deep adult social care backgrounds, reporting to a Chief Inspector dedicated to the sector, will read evidence differently from generalists trained on a single framework that covered hospitals, primary care, and care homes interchangeably.
The Single Assessment Framework is being replaced
The Single Assessment Framework, introduced in November 2023, was the centrepiece of the previous CQC strategy. It replaced Key Lines of Enquiry with 34 Quality Statements designed to apply consistently across hospitals, primary care, and adult social care. Sir Mike Richards’ review concluded that this consistency was a problem, not a strength: the framework asked too much of generalist inspectors, lacked sector-specific clarity, and had been deployed before the supporting IT and processes were ready.
What is replacing it: four sector-specific frameworks covering adult social care, mental health, primary care and community services, and hospitals; 24 Key Lines of Enquiry replacing the 34 Quality Statements (ten map directly to existing Quality Statements; fourteen are new); Rating Characteristics returning, providing clearer descriptors of what each rating level looks like in practice; and more transparent scoring of evidence.
Public consultation on the new frameworks closes on 12 June 2026. Implementation is expected by the end of 2026.
For providers, the practical reading is that the regulatory vocabulary providers have been learning since November 2023 is being replaced. Quality Statements are not gone tomorrow, but the language of inspection is changing. Bids, policies, and method statements that reference the SAF will need to map across to the new framework. Providers maintaining structured CQC evidence libraries will be able to remap with limited rework.
What else has shifted: ICS assessments, IT, and NHS England
ICS assessments are paused
One of Dr Dash’s specific recommendations was that the CQC pause its assessments of integrated care systems for six months, to free up capacity for provider assessments. The CQC accepted this. Discussions with DHSC are ongoing about when ICS assessments will resume. Local authority assessments under CQC’s remit are continuing under the reformed approach, with more transparent scoring of evidence and a stronger focus on nationally agreed priorities. For care providers commissioned by local authorities, this matters because LA assessment outcomes increasingly inform commissioning decisions and contract performance reviews.
The IT problem is being fixed
The provider portal and regulatory platform were among the most concrete operational issues Dr Dash identified. The recovery plan includes upgrading the data platform, improving the provider portal, and inspections are on track for 9,000 by September 2026. Until the systems are fully fixed, providers should document everything submitted through the provider portal, build buffer time into registration applications, and treat the portal as the official record.
The relationship with NHS England has shifted
Dr Dash, who reviewed the CQC, is now Chair of NHS England, drafting the National Quality Strategy. The strategy is the first of its kind in over 15 years, organised around effectiveness and outcomes, safety, and patient experience. The National Quality Board, which Dr Dash co-chairs alongside the CQC Chair, exemplifies a more collaborative regulatory architecture, with one shared definition of “good” running across the regulator and the commissioner.
What this means for providers in 2026
Five practical implications. The framework consultation matters: provider input still counts, particularly on the sector-specific framework most relevant to your service, with submissions due by 12 June 2026. A strong response will identify specific Quality Statements that have served evaluators and providers well, name the operational consequences of any proposed changes, and suggest practical refinements; generic responses are far less likely to influence the final framework than concrete, evidenced ones. The vocabulary of inspection is changing: care plans, policies, method statements, and tender responses written in 2024 and 2025 used Quality Statement language, and from late 2026 KLOE language returns. Inspector expertise is being upgraded: generic responses that sounded plausible to a generalist inspector will read as superficial to a sector specialist. The regulator is becoming more responsive but is still under pressure: registration and assessment timelines have not yet returned to pre-2024 norms. Bid evidence needs to track the reform: tender responses written today should reference the SAF as the framework in force, acknowledge the transition, and demonstrate that the provider’s evidence base will translate cleanly into the new regulatory language.
Examples of how providers position themselves for regulatory change are documented in AssuredBID’s case studies.
FAQ
Who is the new CEO of the CQC?
Sir Julian Hartley was appointed Chief Executive of the CQC in 2025, bringing senior leadership experience from the NHS provider sector. His brief is the implementation of the reform programme set out in response to the two independent reviews.
What is replacing the Single Assessment Framework?
The SAF is being replaced by four sector-specific frameworks: adult social care, mental health, primary care and community services, and hospitals. The 34 Quality Statements are being replaced by 24 Key Lines of Enquiry, and Rating Characteristics are returning. Public consultation closes on 12 June 2026, with implementation expected by the end of 2026.
How many Chief Inspectors will the CQC have?
At least three, leading on hospitals, primary care, and adult social care respectively. A fourth for mental health is under consideration.
Are CQC ICS assessments still happening?
No, not at present. ICS assessments were paused in line with Dr Dash’s recommendation, to free up capacity for provider assessments. Discussions with DHSC are ongoing about when they will resume.
How should providers prepare for the reformed CQC?
Maintain a structured evidence library mapped to the current Quality Statements; engage with the framework consultation by 12 June 2026; update policies, Statements of Purpose, and tender responses to reference the regulatory transition; prepare staff for sector-specialist inspection; and audit provider portal records for accuracy.
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