This research looks at the impact CQC has in system settings. This includes our assessments in Integrated Care System (ICS) and Local Authority (LA). The research looks at what is working well in our assessments and where we might need to improve.
We commissioned IFF Research to evaluate our ICS and LA assessments and carried out this research into our impact.
Why it matters
The Health and Social Care Act 2022 gave CQC a new role to assess health and adult social care services in each ICS and LA. We started to assess LAs in early 2024 and are currently developing our ICS approach. It is important that we evaluate new ways of working. This information helps us make sure our assessments are based on what we know works. We also want to understand our role in supporting improvement in ICS and LA settings.
The project had 2 aims:
- evaluate the approach to ICS assessment and LA assurance
- identify the ways our approach can lead to improvement in ICS and LA settings.
The evaluation looked at whether we use the right methods in the right way to lead to good outcomes.
The information from these aims will help us learn how we have impact. Previous research by Alliance Manchester Business School and the King’s Fund told us about the ways we influence providers to improve. This research aimed to see whether our approach in ICS and LA works in similar or different ways.
We will use the findings to inform our approach to LA and ICS assessments.
The approach used
IFF used a theory-based approach to understand how CQC’s ICS and LA assessments work.
The theory set out the different ways CQC might have impact after the assessments. This theory was then tested through case studies with ICS and LA pilot sites. It was also tested with 2 LAs who have had their formal assessment. IFF interviewed people from each case study. They also interviewed CQC staff and national stakeholders. This included people from Government, and the third sector. In total, 107 participants took part in the research. IFF used contribution analysis to understand CQC's role in improvement in ICSs and LAs.
The research also used Participatory Systems Mapping (PSM), supported by CECAN. This was done through a workshop with Birmingham & Solihull ICS. This helped to show the complexity of an ICS, and the many factors that influence improvement in care. The mapping also helped to consider how CQC might play a role in influencing these factors.
Findings
The ICSs and LAs IFF spoke to were positive about the benefit of CQC assessments.
They told us assessments would:
- check the quality of the services they provide
- help them understand what good practice looks like
- highlight aspects of delivery that are working well and what could be improved
- encourage more collaboration and joined-up working across systems.
IFF found that people also had some concerns about the new regulation of ICSs and LAs.
They told us:
- Local people might lose trust if assessments highlighted things that the system was not doing well.
- Assessments could be stressful for staff and add to workloads.
Staff from the cases studies thought inspectors had the right skills and knowledge to carry out system assessments. They particularly valued senior inspectors with experience in relevant settings. Staff felt that inspectors had some gaps in understanding how their organisations worked. Staff from ICSs thought the design of the assessments could be improved to better reflect the complexity of systems. Currently it was felt that the approach was similar to that of a provider assessment.
LA assessments experience
Completing the Information Return was valuable in helping LAs reflect on their performance. This helped highlight areas for improvement and gave ideas for how future data could be collected. But it was time consuming due to the amount of information LA staff had to bring together.
Overall, the on-site visit was a positive experience for LA staff. They thought inspectors asked the right questions and had relevant knowledge and experience. LAs wanted more clarity on what the sessions were about to help them arrange for the right people to join.
IFF asked about the assessment framework. But very few people in the LAs they spoke to felt they knew enough about it to comment. Those who did have a good awareness of the framework used it to prepare for assessments.
Assessment reports were useful in highlighting good performance and areas of improvement. Staff raised concerns over the accuracy of some reports. This was linked to how opinions from individual sources were corroborated. Some staff asked for more clarity in the reports on what to do to improve their assessment score.
ICS assessments experience
This research looked at our pilot ICS assessments. It asked questions to understand what the impact of our formal assessments could be. At the time of publishing in 2025, a pause on the development of ICS assessments has been announced.
The Information Return was helpful for some because it made the focus of the assessment clearer. Many felt that a lot of work was needed to complete the return and in a short amount of time. This was difficult because staff had to gather information from across the entire network. ICS staff would like clearer guidance on how to complete the return. They also requested the return uses language that better fits with the ICS context.
Most ICS participants felt the on-site visit sessions were well run. The sessions allowed them to share the right information with CQC about their ICS. Staff sometimes found it difficult to arrange sessions as they did not know who should attend.
There were mixed views about the assessment framework among ICSs. Some thought the framework was useful in setting out what assessments would focus on. It was also seen as helpful to understand what good looks like. But others suggested it needed updating to offer a more holistic view of the ICS.
There were mixed views on the structure and usefulness of assessment reports. There were concerns about inaccurate information being reported from some. Others found it difficult to know which part of the ICS was being referred to. Not all ICS participants had seen their reports at the time of the interviews.
How CQC has impact
CQC assessments in ICSs and LAs have the potential to influence change in a range of ways. The main ways CQC has influenced change are as follows.
Anticipatory mechanism
The assessment framework and pre-fieldwork stage of the assessment set out CQC’s quality expectations. This led to some ICSs and LAs introducing action plans or case audits in line with the themes set out by CQC in the assessment framework.
Guided mechanism
CQC guided LAs to take necessary action, rather than directing them. They guided by identifying areas for improvement and reporting on these areas.
Relational mechanism
LA staff found CQC staff to be approachable and they had positive experiences of on-site visits. These positive relationships may create change through informal, soft, influencing actions.
There is also strong potential for CQC to influence change by sharing information from LA and ICS assessments. This could then lead to other LAs and ICSs taking action within their own systems based on good practice shared by CQC. This would mean that CQC were having an impact through the informational mechanism.
Overall, the research found many positives in CQC’s regulatory approach for both ICS and LA assessment. Participants felt system regulation is valuable. They felt CQC’s approach has laid a solid foundation for future assessments. The report sets out some considerations for future improvements.
Read the report
Full report: Research to understand CQC's regulatory impact in systems
A summary of the report is also available to download: