New Developments

Before 31 March 2009, regulation of health and adult social care in England was the joint responsibility of the Healthcare Commission and the Commission for Social Care Inspection, with the Mental Health Commission monitoring the operation of the Mental Health Act 1983.

With the passing of the Health and Social Care Act 2008 there emerged an organisation to replace these three bodies and to regulate health and adult social care in an integrated form - the Care Quality Commission. The Commission began its operation in shadow form on 1 October 2008 and began operating on 1 April 2009.


The Act sets out the new Commission's functions in assuring safety and quality, assessing the performance of commissioners and providers, monitoring the operation of the Mental Health Act and ensuring that regulation and inspection activity across health and adult social care is coordinated and managed effectively.

The new system will enable a coordinated regulation for health and social care, driving better outcomes for the people who use services. There are already many good individual examples of integrated health and social care delivery so the creation of a single regulatory system will complement this.

NHS providers are, for the first time, included with other Health and Social Care providers, and will be required to register with the new regulator in order to provide services. The registration requirements that all providers must meet will be consistent across both health and adult social care and will be the subject of a forthcoming consultation. Regulation will be focused on the levels of safety and quality that those who use services care most about. This will help ensure that patients, users and vulnerable groups are protected.

For staff working in provider organisations the new regulatory system will provide a much clearer framework of exactly which requirements they must meet in order to provide services. The risk-based approach means that regulation activity will be targeted where action is required.

The Act provides the Commission with a wider range of enforcement powers along with flexibility on how and when to use them. This will allow the regulator greater powers to achieve compliance with registration requirements, such as requirements relating to infection control, a particular concern for anyone entering a hospital or other care facility. The Commission will be able to enforce specific conditions to respond to specific risks - such as requiring a ward or service to be closed until safety requirements are met, as well as being able to suspend or de-register services where absolutely necessary.
Bringing the functions of the Mental Health Act Commission into the remit of the Care Quality Commission will strengthen the monitoring of the Mental Health Act, and offer improved oversight of the treatment of patients subject to compulsory detention.

All health and adult social care providers that come within the future scope of registration will be required to register with the Care Quality Commission. In order to be granted registration, care providers must demonstrate that they can meet the registration requirements. To maintain their registration they need to establish a system that demonstrates an ongoing ability to meet the requirements.

A registration system for social care and independent health providers already exists under the Care Standards Act 2000 but there was no such system for the NHS. The new registration system will incorporate providers from all sectors into a single system, with Standards for Better Health being replaced in the NHS by the new registration criteria. The Department of Health offered a consultation on which health and adult social care services should require registration with the Care Quality Commission and what the requirements for registration should be.

In developing the new registration system and its requirements both the Government and the Care Quality Commission will build upon the experience of the current commissions and service providers in operating under the existing system and against the current standards.

This is how the Care Quality Commission describes itself:

"The Care Quality Commission is the independent regulator of health and adult social care services in England. We also protect the interests of people whose rights are restricted under the Mental Health Act. Whether services are provided by the NHS, local authorities, private companies or voluntary organizations, we make sure that people get better care. We do this by:

  • Driving improvements across health and social care
  • Putting people first and championing their rights
  • Acting swiftly to remedy bad practice
  • Gathering and using knowledge and expertise, and working with others."


The new registration system for health and social care will make sure that people can expect services to meet essential standards of quality and safety that respect their dignity and protect their rights. The new system is focused on outcomes and processes, and places the views and experiences of people who use services at its centre.

The Care Quality Commission is rightly hoping to provide a more robust system of regulation, which IRS welcomes, and to which high standards we aspire. While as individuals our professional bodies govern the standards that as professionals we should achieve in our day-to-day practice, we are happy to work within a wider regulatory framework to ensure that people who use our services are protected and receive the care, treatment and support they need.

Declan McNichol

Bill Young

Angela Gordon

Birgit Rathje-Vale

Helen Smart