Putting people at the centre of system regulation: learning to lead in changing times

Portrait image of Chris Day, Director of Engagement at CQC

Why it matters

We know from our work on systems that good local systems collaboration starts with a vision that can build trust. Trust from people who use services that those providing them really understand their needs, and trust of the people delivering that there is a sustainable plan that brings together the people providing services. The plans must be a delicate balance of what needs to happen today, and what an integrated care system (ICS) is trying to achieve for its population in the long term. Regulation must be equally balanced.

The opportunity and the challenge

ICSs are intended to promote equal partnership between the NHS and those providing social care. The history of previous attempts at integration suggests there is a risk that the NHS will dominate with social care seen as a secondary partner.

Making it work on the ground

For people working in health and social care, the task has rarely been more challenging, complex and uncertain. Trust and collaboration between health and social care organisations have never been more important.

Changing behaviours

We all need to move away from understanding quality in an individual provider only. Instead, we need to have a shared understanding of what good looks like in meeting people’s health and social care needs across a whole system.


Integrated approaches to care also require a workforce that understands what people need across health and social care. Local and national workforce planning needs to create the skills and career paths that allow people to work flexibly across the system as services evolve over time to meet the population’s changing needs. We want to play a role in supporting better workforce planning, identifying outstanding practice in this area, and sharing this to support others. This is already involving new partnerships, linking not just traditional health and care organisations but also partnerships with the third sector. Above all, the workforce planning should reflect the local needs and the local population.

Our role

For CQC, we’ll be using our new responsibilities under the Health and Care Act 2022 to provide independent assurance to the public of the quality of care in their area. We’ll do this by assessing ICSs and looking at whether local authorities are delivering their duties under the Care Act 2014 — in addition to regulating the quality of care from individual providers.

  • data
  • co-production
  • ratings
  • measuring leadership
  • proportionate regulation.

Next steps

Although the Act of parliament separates the regulation of ICSs and local authorities, we will use a single approach building on our new single assessment framework.



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Care Quality Commission

Care Quality Commission

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.