Report

Evidence on what works in regulating health and social care

This report from UK think tank The King’s Fund discusses evidence from the scoping phase of an evaluation of the CQC’s regulatory model.

This report sets out findings from a scoping phase of an independent evaluation commissioned by the Care Quality Commission (CQC) to inform the redesign of its regulatory model following significant operational and structural challenges identified in recent reviews.

Drawing on a literature review, expert interviews and engagement with CQC staff, it examines what works in regulating health and social care and identifies five core areas for improvement: setting clear regulatory expectations, strengthening workforce expertise, adopting risk-based approaches, rebuilding relationships and trust, and implementing change effectively. The evidence highlights that regulation is most effective when aligned with a clear purpose, uses multiple methods beyond inspection, and communicates high, well-defined standards that are co-produced with providers to support improvement.

The report emphasises that the quality and capability of the regulatory workforce are central to effective regulation, requiring a combination of sector knowledge, regulatory expertise and relational skills, alongside investment in training and professional judgement.

It also finds that while risk-based regulation is widely promoted, it is difficult to implement in practice due to imperfect data and challenges in predicting risk, meaning it must be complemented by human judgement and ongoing learning. Strong relationships between regulators and providers are identified as critical, with trust, transparency and flexible engagement styles improving compliance and supporting quality improvement. Conversely, overly prescriptive or punitive approaches risk undermining these relationships and reducing openness.

Looking ahead, the report concludes that successful reform depends on sustained focus on regulatory purpose and impact, clear articulation of how regulatory actions lead to outcomes, and careful adaptation of existing evidence rather than wholesale redesign. It stresses the importance of piloting, evaluation and embedding a culture of continuous learning to ensure the regulatory model evolves effectively over time.

Ultimately, regulation is characterised as a social process shaped by people, behaviours and relationships, meaning that how regulation is delivered is as important as the formal systems and frameworks that underpin it.