CQC framework dubbed ‘likely to fail’ by internal audit

Due to ‘fundamental weaknesses’ in its governance, risk management and control framework, the Care Quality Commission’s (CQC) internal auditors concluded the regulator’s systems were ‘inadequate and ineffective or likely to fail’.

The CQC has published its Annual Report and Accounts 2024/2025, noting that it covers a period of ‘significant organisational and leadership change’ within the organisation.

In July 2024, a government investigation of the CQC found ‘significant failings’ including low inspection levels, lack of clinical expertise among inspectors and severe IT problems. By October, CQC interim chief executive Kate Terroni had resigned, describing her term as ‘an intensely challenging experience’.

The newly-released report explores these failings in more depth. For example, arrangements in a number of key areas are deemed inadequate or ineffective, leading it to conclude that the CQC’s framework of governance, risk management and control was ‘unsatisfactory’.

What are the issues in the CQC framework?

The report states that as of February 2025, only 3,428 inspections had been completed out of a target of 16,000. Additionally, 32.4% of registrations in the system were more than 10 weeks old compared to a target of 22.3%. Just 4% of newly registered services had an assessment within 12 months of registering.

The CQC also acknowledged its executive board was ‘divided’ following turbulence in its staffing. The report notes ‘a breakdown in trust between the non-executive directors (NEDs) and some of the executives’ and ‘a lack of alignment between the executives themselves on some issues’.

As the report was compiled, four in 10 members of the regulator’s executive team were interim appointments. While a new structure for the executive team had been proposed, it was yet to be implemented as of August 2025.

The report acknowledged that this inconsistent governance would inevitably have an ‘organisational impact’. It concludes: ‘Significant improvements are required to the overall control environment at CQC to ensure that the organisation is able to achieve its strategic objectives and manage public money as effectively as possible.’

Recent progress ‘towards rebuilding CQC’

However, the CQC also stressed that ‘the reporting period covered is now quite old’. It said: ‘Our organisation has changed considerably during the 2025/26 period, so it is important that we reflect this as we report on an older accounting period.’

The regulator said recent changes were ‘more reflective of the progress we have made towards rebuilding CQC’. Last year, it identified four immediate actions and five foundational improvements needed to rebuild CQC.

‘Our purpose remains clear: to be the strong, effective regulator of health and social care that people and providers need and deserve. Moving into 2026/27, we will continue to engage with our stakeholders as we develop and refine our approach.

‘While we know there is much work still to do to rebuild trust and confidence, we have made progress against the immediate priorities and the foundational improvements – and we are determined to continue to improve our registration services, how we respond to concerns, and how we deliver an increasing number of assessments that support improvement.’

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