To provide context for this review of the single assessment framework and its implementation as part of CQC’s new approach, the following need to be considered:

11.1 Activity

• 10,356 inspections were undertaken in 2022/23 and 10,306 in 2021/22. This compares with more than 16,000 in 2019/20.
• Only around 7,000 assessments and inspections were carried out in 2023/24 and only around 100 inspections per month have been undertaken so far in 2024.

11.2 Staffing

• Overall headcount and full-time equivalents (FTE) within CQC fell by around 3% between March 2020 and March 2023, but had increased by March 2024 to 5% above March 2020 levels. Most of the recent increase relates to staff working for the Maternity and Newborn Safety Investigations (MNSI) programme becoming part of CQC and to staff related to local authority assessments.
• Taking operations and regulatory leadership figures together, there was virtually no change in FTE between March 2020 and March 2023. However, this masks a considerable fall in the numbers of inspection/operation assessors/inspectors and inspection/operation managers over the same period and a marked growth in regulatory officers and ‘other’ staff.
• The overall number of staff working in registration increased by around 15% between March 2020 and March 2023, largely due to an increase in ‘other’ staff. Registration inspector numbers had fallen by around 6% over the same period.

11.3 Income

• CQC receives the large majority (82% in 2023/24) of its funding through fees, with a much smaller proportion coming from Grant in Aid from the Department of Health and Social Care.
• Total fee income in 2023/24 was £223.3m. Adult social care provided 41% of fee income, with 32% coming from NHS trusts, 17% from GP practices, 5% from independent healthcare providers and 4% from dental practices.
• Provider fees have remained static since 2019/20. If they had risen in line with inflation, CQC would have received an additional £25.3m in 2023/24.
• Fee income from NHS trusts in 2019/20 represented 0.067% of their turnover.