Regulation, Responsibility, and Reality --- How Do We Fix Care from the Ground Up?
Every year, the Care Quality Commission (CQC) publishes The State of Health and Adult Social Care in England.
The 2024/25 report again highlights what many already feel on the front line: the health and social care system is under unprecedented strain.
The Current Picture
The report shows:
- Fewer older people receiving council-funded care --- now just 1 in 27, compared with 1 in 12 two decades ago.
- Three times more vacancies in social care than in other sectors.
- Nearly two million people waited more than 12 hours in A&E last year.
- Half as many district nurses per older person as there were 14 years ago.
These pressures are deeply systemic. They affect hospitals, care homes, GPs, and community providers alike.
The Role of the Regulator and Government
The CQC is the independent regulator for health and social care in England, ensuring safety, quality, and improvement.
Yet it is not without oversight.
- It is a non-departmental public body (NDPB) sponsored by the Department of Health and Social Care (DHSC).
- The Secretary of State for Health and Social Care, Wes Streeting, is responsible for ensuring the CQC performs its duties effectively.
- The CQC is accountable to Parliament, where the Public Accounts Committee (chaired by Dame Meg Hillier MP) and the Health and Social Care Committee (chaired by Steve Brine MP) may scrutinise its performance.
- The National Audit Office (NAO) audits its accounts and assesses value for money.
- The Parliamentary and Health Service Ombudsman provides recourse if the regulator acts unfairly or unlawfully.
Importantly, most of the CQC's income is generated from the very providers it regulates --- through registration and inspection fees --- with only part funded by the DHSC.
This structure preserves independence, but it also means the regulator and providers are financially and operationally intertwined.
The Regulator's Own Challenges
While the CQC demands high standards of efficiency and responsiveness from providers, it faces its own operational difficulties:
- A malfunctioning provider portal, causing registration delays and poor communication.
- Wait times of 16--24 weeks to register new services or managers.
- Unbalanced expectations --- providers are expected to respond to data requests within two days, yet processing by the regulator can take months.
- A circular complaints system, where providers are directed to a general enquiries line that cannot resolve regulatory issues.
These challenges undermine confidence and consume time that could otherwise be spent on care.
Transparency and reliability must flow both ways: the same accountability the CQC expects of providers should also apply to its own systems.
The Providers' Reality
Providers continue to deliver essential care amid:
- Workforce shortages and burnout.
- Rising costs, tight local authority budgets, and real-terms funding cuts.
- Expanding regulatory and administrative demands.
The result is a growing divide between what regulation requires and what resources allow.
The Call for Collaborative Reform
At Clinivi, we recognise the integrity and importance of regulation --- and the dedication of the government and CQC in striving to protect patients and service users.
But the solution lies in partnership, not polarity.
We need to:
- Develop a shared accountability model between regulators, providers, and commissioners.
- Invest in functional technology --- especially digital systems that support both oversight and efficiency.
- Refocus inspection and reporting on improvement rather than repetition.
- Reduce bureaucratic duplication, freeing clinical teams to deliver care.
- Revisit funding frameworks, aligning them with staffing levels, demand, and inflation.
The Bottom Line
If the system is failing, it's not because one part isn't trying --- it's because the parts aren't working together.
Regulators, policymakers, and providers share the same purpose:
➡️ Safe, effective, compassionate care for every person who needs it.
Let's stop passing accountability and start building alignment ---
from the top down and the ground up.