Rebuilding trust in the CQC: regulation survey 2026

Summary

This report presents results from the NHS Alliance’s first governance and regulation survey, building on similar publications by NHS Providers.

It is the first in a three-part series, focusing on trust leaders’ experiences of the Care Quality Commission (CQC) over the past year. The second report will focus on ICB and trust leaders’ experiences of NHS England’s (NHSE) oversight and regulatory approach.

Conducted in August 2026, the findings and recommendations in this report are based on the 166 responses from 116 trusts (57% of all trusts). All regions and trust types are represented. Respondents included chief executives, chairs, company secretaries, medical directors and nursing directors.

Our analyses and interpretation are supplemented by free-text responses and insights gathered via a series of in-depth interviews and wider engagement with NHS leaders.

Content

Key points

• Two years into the CQC’s recovery, trust leaders are still encountering many of the issues described in 2024 by the Dash and Richards reviews and previous regulation survey.

• While most trust leaders believe the CQC still has much to do, there are signs of progress. Stabler local relationships, better informal engagement, faster reporting and improved report quality are reported by some, but are not yet the norm.

• For many trust leaders, the CQC still needs to improve on the basics of inspection. Almost two thirds said inspection quality had not changed or had got worse in the past year, with inspector expertise and factual inaccuracies persistent concerns. Inspection reporting also remains too slow in most cases, with some trusts still waiting more than a year for reports.

• The return to sector-specific regulatory frameworks is welcome, but deeper sector expertise must be balanced with joined-up regulation that reflects how care and risk often span organisational boundaries.

• Some trust leaders continue to report an adversarial and fault-finding inspection culture, with the CQC not yet consistently experienced as a regulator that supports improvement and learning.

• Just 21% of trust leaders believe the CQC is making the changes needed to improve its performance longer term. Leaders broadly support the direction of key policy changes but are not yet convinced these will translate into change on the ground.

• The CQC’s challenge is now to turn promising policy changes and pockets of progress into consistently better regulation.