Annual report and accounts 2023/2024

Published: 17 July 2025 Page last updated: 17 July 2025

Performance overview

This overview summarises our performance within the reporting period from 1 April 2023 to 31 March 2024.

Further detail is in the Performance analysis section.

Risks we faced

The greatest risk facing CQC in the reporting year was in relation to the development and planned rollout of our organisational transformation. This was designed with the intention to improve how we regulate health and care providers – to support them to improve quality, and ultimately, improve the experiences for people who use services. A dedicated programme team and external professional services, consultants, and delivery partners were brought in to deliver this transformation work.

We recognise the associated risks arising from a reduced capability and capacity to our operational performance, and the impact this has on our awareness of quality in health and care. Our organisational transformation work was seen as being the key enabler to future success in recovering our position.

From a people perspective, we also acknowledge the risks arising from difficulties in recruiting into key legal, specialist technology, and data and intelligence roles. The risks with our people were further compounded as colleagues had low levels of engagement with, and confidence in, the transformation across the organisation. The expectation was that our organisational transformation would help to improve our performance by providing a better framework, structure, and organisational culture to support our work.

For further detail please refer to our annual governance statement.

Performance against our strategic priorities

This includes considering our regulatory performance, achievements, progress towards delivering our objectives and targets, and our impact as a regulator, against our strategic priorities.

Strategic priority: People and communities

Disappointingly, we only completed 6,230 assessments and inspections of health and social care services during 2023/24, a reduction of 39.5% compared with 10,300 in 2022/23. This was driven by digital system issues and challenges with our new regulatory platform, alongside the introduction of a new assessment framework with new ways of working. This is a key aspect of our regulatory activity and an area we must improve going forward.

We supported people who use maternity services by completing our programme of focused inspections in 92 NHS acute hospitals (across 131 locations). Our programme report National review of maternity services in England 2022 to 2024 sets out our key findings.

In March 2024, we published our annual report on the use of the Mental Health Act 1983. We also published our interim approach to assessing how NHS mental health trusts promote race equity in access, experience, and outcomes, and produced guidance for mental health service providers on reducing the risk of patients taking their own lives or harming themselves using a ligature.

Since December 2023, we have been leading on the Independent Care (Education) and Treatment Reviews (IC(E)TRs)) for all autistic people and people with a learning disability who are in long-term segregation. We published our cross-sector policy position on reducing restrictive practice, which outlines how we expect leaders of services and systems, and those working in health and social care, to take immediate steps to identify and reduce restrictive practices where possible.

In June 2023, we launched our public engagement strategy 2023 to2026. This sets out our objectives for engaging with people who use services, their families, carers, and organisations that represent them or act on their behalf. Their feedback is essential to drive the insight and understanding we need to achieve our strategic ambitions. Our new Share for Better Care campaign also supports this and aims to increase the range and volume of care experiences that people choose to share with us. We were pleased to receive a very large number of submissions throughout the year.

We also investigated 220 complaints that met the criteria to be considered under our complaints procedure. Approximately half of the complaints we received during 2023/24 related to our performance when discharging our roles and responsibilities as an organisation – this includes the conduct of our staff. Some complaints related to how we handled and responded to information of concern about registered services, and others related to delays in our activity.

Strategic priority: Smarter regulation

We attempted to deliver the intended ambitions of our strategy to support smarter regulation. This included a new regulatory approach including a new single assessment framework, and new regulatory platform and provider portal technological solutions. While this did not go as intended, we were successful in commencing our new regulatory duties under the Health and Care Act 2022.

The Secretary of State for Health and Social Care asked us to undertake an important rapid review of Nottinghamshire Healthcare NHS Foundation Trust, under Section 48 of the Health and Social Care Act 2008. This followed the conviction of Valdo Calocane in January 2024 for the killings of Ian Coates, Grace O’Malley-Kumar, and Barnaby Webber. We published our vital findings in the Special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust report in March 2024.

We also attempted to update our registration process during the year to align with our regulatory and technological changes. This is a key part of our operation to maintain capacity and ensure people have access to health and social care services. While these changes were being implemented, we saw a 5% reduction in the number of registration applications processed, and we will work to improve our performance in this area.

Strategic priority: Safety through learning

Safety continues to be a key aspect of our regulation. Again, we have received a similar number of whistleblowing protected disclosure cases from health and social care workers ‘speaking up’ to us about their information of concern (15,919 in 2023/24 and 15,792 in 2022/23).

During 2023/24, we received and processed over 195,400 information of concern cases; of these, over 30,300 were safeguarding cases. During the year we aimed to adapt to a new regulatory approach and new ways of working. We made 78% of safeguarding referrals to the relevant local authority within 1 day of receiving the information (compared with 97% during 2022/23).

We have reviewed our organisational approach to how we handle and respond when we receive an information of concern case, and have made improvements to ensure we can act effectively on people’s experiences and prioritise safety.

To support services to attain stronger safety and learning cultures, we continued to encourage learning from safety incidents by adding to our repository of resources. These describe critical issues that have happened in services, what CQC and the provider have done about it, and the steps a service can take to avoid it happening in their services.

We also completed several national surveys to gather feedback from people about the care they receive from NHS services. This is to improve our understanding of both the risk and quality of care, which is a key component of our regulation for stronger safety cultures. See our published NHS survey results:

Strategic priority: Accelerating improvement

We recognise the importance of progress and innovation within the services and sectors we regulate to improve outcomes for people who use them.

We have made some valuable contributions throughout the year to support this as we focused on research and evidence to accelerate improvement, encouraging and championing innovation, and working effectively with other organisations to drive improvement.

We have commissioned a number of research activities and published useful findings to understand the experiences of innovators who have considered developing or adopting new ways of working including:

to accelerate improvement in medicines sustainability
to explore the improvement support available across the health and social care landscape
research on inequalities in dementia care.

This is in addition to publishing our important policy position on modern slavery, appreciating the value of workers recruited overseas and the key part they play in the UK’s health and social care workforce.

CQC continued delivering the Artificial Intelligence and Digital Regulations Service alongside our partners: the National Institute for Clinical Excellence, Medicines and Healthcare products Regulatory Agency and the Health Research Authority. The AI and Digital Regulations Service website brings together regulation and evaluation requirements for AI in health and social care from all partners.

Core ambitions

We produced some valuable work during the year to progress our 2 core ambitions and look forward to progressing further into 2024/25.

Against our core ambition of assessing local systems, we initiated formal assessments of the performance of local authorities in meeting their duties under Part 1 of the Care Act 2014 and published interim guidance on our approach to assessing ICSs to understand whether the needs of local populations are met. We carried out and evaluated pilot assessments to ensure our methodologies were adequately informed.

Our annual provider survey highlighted performance against our core ambition of tackling inequalities in health care. More than three-quarters of respondents agreed that our reports and publications effectively call out inequalities in health and social care. This was demonstrated with our focus on inequality and unfair care in our State of Care report 2022/23.

Our financial performance

Our total revenue expenditure (excluding non-cash items – see note 2.2 to the financial statements) was £260.2 million, with a further £23.9 million invested in capital expenditure.

We worked within both our operating revenue budget and capital budgets in 2023/24 and continued to provide stability and support to services in their financial planning. Our fee scheme continues to remain unchanged into 2024/25. This marks the fifth consecutive year despite marked levels of inflation experienced since 2019.

However, more is required to ensure greater value for money for the services we regulate and for taxpayers. We must work to ensure that we improve our productivity and timeliness as a regulator.

We continued to invest in our transformation work, aiming to deliver our intended strategic ambition in-year. Work to understand the financial impact of the benefits envisaged during its investment appraisal will persist into 2024/25.

We continue to see ongoing efficiencies in estate management – an area in which we can operate within our existing fee envelope. We’ve continued to make changes to ensure that our estate matches our requirements following our shift to a 95% home-based workforce. During the year, we have continued to serve notice and vacate 2 offices, reduce our occupancy where not utilised, and to provide accommodation for colleagues of other organisations. Our annual premises revenue expenditure in 2023/24 totalled £3.1 million compared with £10.9 million in 2018/19, a reduction of 72%.

Find out more in the section on our financial performance

Our corporate responsibility

Our corporate responsibility involves making a positive impact on society through delivery of our regulatory functions. Alongside our organisational strategic priorities and ambitions, some aspects require specific focus.

Sustainability

We have continued our commitment to improving our sustainability, having designed a Net Zero Plan. This outlines the specific actions and targets we wish to complete to improve our sustainability by the end of our 2025 reporting year and to achieve net zero by the end of our 2030 reporting year. This plan was designed collaboratively with CQC colleagues and support from the wider health and social care sector. The plan was signed off by our Executive team in October 2023. We have been working on achieving its targets, and hope to progress in this area in 2024/25.

People

As evidenced in our People report we have continued our work to achieve our strategic vision for our workforce, as detailed in our People Plan. This includes the development of a new equality, diversity, and inclusion strategy through to 2027.

Our internal communities and networks continue to play an important role within the organisation and in supporting our people.

The health and safety awareness of our people continues to develop and be effectively managed and co-ordinated. We have invested in our Counter Fraud offer to embed a strong culture and awareness of counter fraud, bribery, and corruption at all levels of CQC.

However, our People Survey highlighted that internally we must do better to make CQC a good place to work and ensure our people feel listened to and supported by senior leaders.

Security

Our Corporate governance report highlights the good work we have delivered throughout the year on security awareness and the importance of reporting information and cyber security incidents, as we, our suppliers, and providers continue to operate in a volatile environment.