The new chief executive of the Care Quality Commission explains the steps he is taking to restore credibility in England’s health and social care regulator.
Sir Julian Hartley started as chief executive of the Care Quality Commission in December 2024. The former chief executive of NHS Providers and a career that includes a ten-year stint as chief executive of Leeds Teaching Hospitals NHS Trust, he has come into an organisation in much need of leadership.
Last year’s independent review into England’s health and social care regulator found an organisation with significant internal problems and one that had lost the faith of the general public. It is something he is trying to fix.
Here he talks to Healthcare Today about his plan to restore credibility in the organisation, learning from mistakes, and how to improve patient safety.
“The depth and scale of the challenges we are facing are perhaps even greater and more significant than I had initially anticipated.”
You were appointed in October and you started only in December. What’s been the largest surprise so far?
The depth and scale of the challenges we are facing are perhaps even greater and more significant than I had initially anticipated.
Before I began my role, I conducted some preliminary work by asking staff to identify their top three priorities. What has struck me most forcefully is the significant toll these changes have taken on our colleagues.
Despite these challenges, there is a silver lining. The CQC is fortunate to have a committed and passionate group of colleagues who are determined to overcome these obstacles and strive to be the best regulator possible.
How do you go about restoring credibility to the organisation?
The first step in addressing the challenges we face is to acknowledge the truth of what our staff and the organisation have endured. I have dedicated significant time to engaging with staff internally, as well as with the sectors we regulate externally, to gather their perspectives and insights on our work. This process has been a form of catharsis.
Following this, we have established a clear set of immediate priorities – four critical areas that demand urgent attention.
First, we must significantly increase the number of assessments we conduct. Second, we need to address the backlog of assessments that are currently stuck in the regulatory platform. Third, we must tackle the backlog of notifications and information of concern. Our standard is to act on these within ten days, but we currently have a backlog of approximately 5,000 cases, some of which date back months. Fourth, we need to improve our processes for registering new providers. At present, around 35% of applicants wait more than ten weeks for a response, which is unacceptable.
While these four areas are essential, they are not sufficient on their own. We must also focus on medium-term improvements to ensure lasting change. To this end, we have identified five key areas for development. We need to enhance our use of data and insight to improve effectiveness; we must repair the regulatory platform, which has been a source of significant problems; we need to refine the single assessment framework, which has faced criticism for being overly complex; and we are aiming to rebuild our clinical and sector expertise.
Finally, and perhaps most critically, we must address our organisational culture. Every member of staff should feel a sense of pride and purpose in being part of CQC, and they should feel supported and engaged by leadership.
Externally, we must also reset our relationships with those we regulate. We need to establish clear expectations about what providers can expect during inspections, foster more positive and collaborative relationships, and ensure that our assessments not only deliver judgments but also drive meaningful improvement.
“The most important lesson from our recent past is that the organisation did not listen well enough to its people.”
You’ve talked in the past about learning lessons from mistakes. How can you do it in a way that’s meaningful?
Over the past few weeks, we have embarked on an extensive and collaborative process to co-design a new approach for the CQC. This initiative involves all 3,000 members of our staff, as well as our stakeholders and partners across the sectors we regulate.
To ensure inclusivity, we have held a series of all-staff meetings where I have personally addressed the team, outlining our vision and inviting feedback.
Additionally, we have introduced an online resource which allows every member of staff to share their views and feedback anonymously.
Last week, we took this engagement a step further by hosting a number of major events across England. These large-scale, in-person gatherings brought together over 1,500 staff members and more than 500 providers, stakeholders, and partners. It provided a platform for frontline staff, middle managers, and leadership to come together, share insights, and contribute to the ongoing dialogue.
The leadership team used these events to discuss the challenges we face and the lessons we are learning, while also listening to the concerns and ideas of those in the room.
The most important lesson from our recent past is that the organisation did not listen well enough to its people. This is why our current efforts to engage staff, rebuild trust, and create a culture of openness and collaboration are so critical.
By the end of May, we aim to refine all of this feedback into a set of values that will guide our work.
How can you make sure that your inspections and your ratings actually improve the quality of care?
The first and foremost principle we are focusing on is transparency. Building trust with the sectors we regulate requires us to be upfront about what we are assessing and why.
We need to instil confidence in those we regulate by ensuring that the individuals conducting inspections have the necessary understanding and experience in the specific services they are assessing. The tone and approach we take as a regulator are also critical. How we present ourselves during inspections and the way we engage with those we regulate must reflect respect and a commitment to positive collaboration. We want to create an environment where those we regulate feel supported and valued, rather than apprehensive.
One way we plan to achieve this is by involving more of the people we regulate in our work. I believe it is important for senior leaders in the NHS, social care, and other sectors to participate in inspections and reviews. This peer-to-peer approach can help shift the dynamic from An Inspector Calls scenario to a more collaborative and constructive experience.
Finally, it is crucial that we demonstrate tangible improvements in our performance and operational delivery. But we must never lose sight of our ultimate goal which is to protect the people who use these services.
“With the development of the 10-Year Health Plan for the NHS, we have a unique moment to define our complementary but coordinated roles.”
Many of the issues that face the sector come down to a simple lack of funding. How can the CQC address that in a useful manner?
As a regulator, we must ensure that our approach takes into account the immense financial and resource pressures that providers are under.
Penny Dash’s report on the operational effectiveness of the CQC also highlighted this point, emphasising the need for a regulatory approach that balances quality with efficiency and resource use. By doing so, we can better support providers in delivering excellent care while navigating the financial challenges they face.
Given the need to collaborate with various regulators and government agencies, how can you ensure that oversight of the healthcare system remains coherent?
Providers often express frustration when they receive conflicting directions from different regulators. Since taking on this role, I have been encouraged by the genuine willingness and desire for collaboration among all the regulators I have engaged with.
With the development of the 10-Year Health Plan for the NHS, we have a unique moment to define our complementary but coordinated roles. This will enable us to tackle the major challenges we face collectively, while also seizing the opportunities to drive meaningful improvement across the health and care system.
