Photograph of a report on a table, the report is labeled, "NHS"

The Care Quality Commission (CQC) in England: Annual Review of Progress

By John Tingle

The Care Quality Commission (CQC) occupies a pivotal role in the National Health Service (NHS) and social care sector in securing health quality and patient safety. Its inspection activities through its reports and publications form the backbone of quality and safety in these sectors. As the independent regulator of health and social care in England it faces a mammoth task. The CQC has recently published its annual report and accounts, which provide useful insights into its work. The report provides a window on how England regulates health, social care quality, and patient safety. There is detailed reflection in the report about how the organisation can better perform its functions and the challenges and opportunities currently facing it.

CQC activities

The full scale of CQC activities are detailed in the report. In 2018/2019 the CQC carried out more than 17,000 inspections across all sectors. These inspections included first inspections-inspections and focused inspections. There were 3,903 inspections of primary medical services. In adult social care 12,227 inspections were carried out. The report states that in the hospital sector the CQC carried out overall 861 inspections with 222 being in relation to the NHS and 639 independent health inspections. In relation to NHS core services such as maternity, urgent, and emergency care there were 1,088 inspections. The CQC also carried out other activities.

CQC impact

The CQC state that 71% of providers from their 2019 provider study felt that the CQC had encouraged them to improve in the last 12 months. This is a very important positive outcome and impact of CQC activity. The report also mentions the CQC 2018 stakeholder survey where 84% said they have used CQC inspection reports and 85% said they have used CQC ratings. In terms of national reports these have a good awareness rating with 66% of providers saying they were aware of the State of Care, CQC annual report and 31% of those providers who found it useful, took action after reading it. The State of Care report is the CQC annual assessment of health and social care in England.

Legal sanctions

The CQC maintain a range of legal sanctions that they can impose for breach of regulations. There are civil and criminal enforcement provisions and a CQC enforcement policy.

The CQC issued 2,206 enforcement actions in 2018/19.These comprised on 1,089 warning notices, 906 civil actions, and 211 criminal actions (which includes fixed penalty notices, prosecutions, and simple cautions). A comparison is made with 2017/18 where there were 2,283 total actions (1,343 warning notices, 781 civil actions, and 159 criminal actions).The CQC have increased the use of their civil and criminal powers.

Promoting a system wide shared view of quality

It is stated in the report that tangible progress has been made by the CQC in promoting a single shared view of quality. A CQC priority is to work with others to agree a consistent approach to defining and measuring quality: “collecting information from providers and delivering a single vision of high-quality care” (p8).


This is a positive report which shows the good work of the CQC which has been on a steady road to improvement. There is room for further improvement and changes into how the CQC works and the report does recognise this. Overall, it’s fair to say that the CQC is making good and steady progress in its work.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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