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Last Updated: 18 July 2026 · CQC & Regulation · Leadership

The Care Quality Commission announced the appointment of Emily Miles as its new Chief Executive on 16 July 2026. She will join CQC in the autumn, taking over from interim Chief Executive Dr Arun Chopra, who will return to his substantive role as Chief Inspector of Mental Health.

As is often the case with a senior appointment at CQC, the announcement has attracted a mixed reaction. That is understandable. The Chief Executive of England's health and social care regulator holds a position of considerable influence, and appointments of this importance will rightly be scrutinised by people using services, providers, professionals and the wider public.

For providers, it may also feel like another significant change in a sector where change has often seemed to be the only constant.

However, although senior leaders, inspection models and regulatory language may change, the regulations underpinning health and social care services tend to remain much more stable. That distinction is important and should not be lost among the wider discussion about what this appointment could mean.

A significant appointment at a difficult time

Emily Miles joins CQC from her current role as Director General for Food, Farming and Biosecurity at the Department for Environment, Food and Rural Affairs. She previously served as Chief Executive of the Food Standards Agency, where she had responsibility for food safety and protecting the interests of consumers across England, Wales and Northern Ireland.

She is therefore not new to regulation or to leading a national public body.

CQC's Interim Chair, Kay Boycott, highlighted Emily Miles' experience of leading organisations through challenging periods, delivering significant change, developing a high-performance culture and rebuilding stakeholder trust. She described that experience as invaluable as CQC continues its turnaround.

The wording used by CQC is significant. It shows that the Board understands the scale of the challenge. This has not been presented as an appointment focused simply on maintaining existing arrangements. CQC appears to have deliberately looked for someone it believes has the skills needed to lead organisational change, improve performance and rebuild relationships.

That is an important first step, but it also creates substantial expectations.

A regulator still rebuilding trust

It is fair to describe recent years as a period of turbulence for both CQC and the providers it regulates.

The introduction of the Single Assessment Framework took place alongside major changes to CQC's technology, operational structure and ways of working. The independent review led by Dr Penny Dash subsequently identified significant failings within CQC, including poor operational performance, difficulties with its technology, delays and inconsistencies in reports, a loss of sector expertise and concerns about the way the assessment framework had been implemented.

Emily Miles is therefore not simply taking responsibility for an established regulatory system that needs minor adjustment. She is joining an organisation that is still working to rebuild confidence in how that system operates.

Providers need to believe that assessments are timely, consistent and based on an accurate understanding of their services. People receiving care and support need confidence that the regulator can identify poor care, respond to risk and recognise when services are delivering positive outcomes.

Rebuilding that trust will require more than another change in language, structure or technology. It will depend on what people and providers experience in practice.

Putting people's needs first

One part of Emily Miles' statement that stood out was her reference to a career rooted in putting people's needs first.

Putting people first should sit at the heart of health and social care regulation. However, it is important that this is understood through people's lived experiences, rather than only through systems, ratings and regulatory processes.

For a person receiving care, quality may be reflected in whether staff notice when something has changed, whether they feel safe, whether their preferences are respected and whether they are supported to live a meaningful life.

It may be reflected in whether staff know them well enough to recognise that they are quieter than usual, are eating less, appear uncomfortable or no longer seem interested in something they previously enjoyed.

These experiences are not always easy to understand through data alone.

Effective regulation therefore needs to connect organisational evidence with what is actually happening around people. Policies, audits and care plans matter, but they must be considered alongside conversations, observations, outcomes and the experiences of people receiving support.

That is also why person-centred care cannot be reduced to a section in a care plan. It has to be visible in the way people are supported, spoken to, understood and involved. The same principle applies to records. Person-centred care notes should help show what changed, what mattered to the person and how staff responded, rather than simply listing completed tasks.

The challenge for CQC will be ensuring its systems make those experiences more visible, rather than creating further distance between the regulator and the people it exists to protect.

Protecting people and supporting services to improve

Emily Miles also said she would do all she could to ensure CQC protects people and supports services to improve.

Protecting people has always been central to CQC's purpose. The more interesting part of this statement may be the commitment to supporting improvement.

CQC holds a large amount of information about health and social care. Through inspections, assessments, notifications, enforcement activity, Provider Information Returns and feedback from people, it can identify recurring risks and patterns across thousands of services.

Inspection reports repeatedly identify similar issues, including:

• weak governance and oversight;
• actions from audits not being completed;
• poor-quality or inaccurate care records;
• inconsistent medicines management;
• limited learning following incidents;
• people not consistently receiving person-centred support;
• leaders not identifying concerns until CQC finds them.

CQC is uniquely placed to bring this information together and help the sector understand not only what is going wrong, but what stronger practice looks like.

Some of this learning is already shared through publications such as the annual State of Care report. However, a significant amount of the detailed information held by CQC is not routinely translated into practical sector-wide learning.

There is a legitimate boundary to consider. CQC must remain an independent regulator. It cannot become a consultancy service for individual providers, and it must retain the ability to assess services objectively and take enforcement action where required.

But impartiality does not prevent a regulator from sharing learning.

One option would be for CQC to work more closely with organisations such as Skills for Care, the Social Care Institute for Excellence, The Outstanding Society and other credible sector bodies. CQC could share anonymised themes, trends and examples from the evidence it holds, while those organisations could help translate that information into practical guidance, learning resources and examples of stronger practice.

This could allow CQC to maintain a clear boundary between regulation and consultancy while making much better use of the knowledge it gathers.

Supporting improvement does not have to mean telling individual providers how to run their services. It could mean helping the sector understand:

• which failings appear repeatedly;
• what effective governance looks like in practice;
• how stronger services respond when something goes wrong;
• which approaches have helped services improve;
• what people experience when care is genuinely outstanding.

This could be particularly valuable in areas such as learning culture, where the same weaknesses repeatedly appear in inspection findings. Services are often able to show that an incident was recorded, but less able to demonstrate what changed afterwards, whether learning was shared or whether similar risks were reduced.

The same applies to safeguarding. CQC's national view could help services understand the gap between written systems and real practice, particularly where the safeguarding policy is not reflected in what staff actually do.

CQC is in a position to identify patterns that no individual provider or sector organisation could see alone. The question is whether that position will be used more effectively under its new leadership.

The challenge and opportunity presented by AI

Emily Miles will also face a challenge that no previous permanent CQC Chief Executive has encountered at the same scale: the rapid development of artificial intelligence.

AI presents genuine opportunities for regulation. It may help CQC analyse information more efficiently, identify patterns across large amounts of evidence and reduce some of the administrative work associated with assessment.

It may also help providers strengthen their own systems. Used carefully, AI could support analysis of audits, incidents, complaints and care records, helping services recognise themes that might otherwise be missed.

But adult social care is a human sector.

People generally join care because they want to support others, not necessarily because they possess advanced digital skills. Providers also vary greatly in size, resources, infrastructure and confidence with technology. A large national organisation may be able to introduce a new system very differently from a small care home, supported living service or domiciliary care provider.

Digital innovation must therefore be accompanied by accessibility, transparency and realistic implementation. New technology should make regulation clearer and more effective. It should not create additional barriers for providers or make it harder to understand how regulatory decisions have been reached.

The question is not simply whether CQC will use more AI. It is whether that technology will help CQC understand services more accurately, communicate more effectively and protect people more consistently.

Will inspection frequency be addressed?

Although the appointment announcement was understandably high level, one issue not addressed was the frequency of physical inspections.

Adult social care providers can point to many examples of services that have gone several years without an on-site inspection. In some cases, the service, leadership team and people being supported may have changed considerably since CQC last physically visited.

CQC does not need to inspect every service in the same way or at the same frequency. A proportionate and risk-based approach remains important.

However, there is a legitimate question about how long a regulated service should go without an inspector seeing the environment, speaking directly with people and observing practice.

Data can help CQC decide where to focus its attention, but it cannot always replace physical presence. Some aspects of care become visible only when someone enters a service, listens to conversations, notices the atmosphere and compares written evidence with what actually happens.

Providers cannot control when CQC will visit, but they can control how well they understand their own service. That includes maintaining oversight between inspections and using tools such as an Inspection Readiness Dashboard to identify gaps, monitor actions and keep evidence current.

Another assessment framework is already on its way

It is too early to predict exactly how Emily Miles will shape CQC, but she will not be starting with a blank sheet of paper.

CQC's proposed move away from the current 34 Quality Statements is already well advanced. It has developed separate draft assessment frameworks for adult social care, mental health care, primary and community services, and hospitals.

Under the proposals, the five key questions of safe, effective, caring, responsive and well-led will remain. The current Quality Statements will be replaced by sector-specific Key Lines of Enquiry, supported by rating characteristics describing what care at each rating level may look like.

The draft adult social care framework currently appears to reduce the number of assessment areas from 34 Quality Statements to approximately 24 KLOEs. However, the framework remains subject to testing, evaluation and possible amendment before final implementation.

This means the next change in assessment methodology is already in progress. Emily Miles will inherit a programme of reform rather than decide whether that programme should begin.

For registered managers, the proposed changes are likely to affect how services organise evidence, prepare teams and understand CQC's lines of enquiry. Our article on what the new CQC assessment frameworks may mean for registered managers considers these practical implications in more detail.

For providers, this may understandably feel like another significant change in a sector where change has felt like the only constant. In a relatively short period, services have moved from the previous KLOEs to 34 Quality Statements and are now preparing for a revised set of sector-specific KLOEs.

Why the regulations are the stable ground

Quality Statements and KLOEs are assessment tools. They help CQC organise its enquiries, gather evidence and reach judgements. They are not the legal requirements with which providers must comply.

A provider does not legally breach a Quality Statement or a Key Line of Enquiry.

Where CQC identifies a regulatory breach, the provider has failed to meet one or more legal requirements, within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People must still receive person-centred care. Consent must still be obtained lawfully. People must still be protected from abuse and avoidable harm. Providers must still deploy sufficient numbers of competent staff. Complaints must still be handled appropriately. Effective systems of governance must still be maintained.

For services trying to follow every CQC development, it can be tempting to rebuild auditing and assurance systems whenever the regulator changes its terminology. Some adjustment will be necessary, particularly where providers organise their evidence around the current framework.

The safer foundation is to understand the regulations, know how they apply to the service and be able to demonstrate that they are being met in practice. That includes understanding Regulation 17 and good governance. Whatever CQC calls its assessment framework, providers still need effective systems to assess, monitor and improve the quality and safety of care.

Senior CQC leaders will come and go. Inspection models and assessment frameworks will continue to evolve. The regulations that underpin safe, effective and person-centred care tend to provide a much more stable point of reference.

RAOF™ in practice when the language changes

If the assessment language is going to keep moving, leaders need a way of knowing what is happening in their service that does not depend on the language at all. RAOF™ is that habit. It is not an audit and not another framework to map your evidence against. It is four questions a leader can ask about any area of practice, in any inspection regime.

None of those four questions mentions a Quality Statement or a KLOE. That is the point. When the framework changes, the mapping changes, but the leadership habit does not. A manager who knows what is happening on the floor can answer questions posed in any regulatory language, because the underlying knowledge already exists.

Where RAOF™ finds drift, the action still needs to close properly rather than simply be written down. That is where closing the loop matters, and why Carevia tracks actions through to Tested and Embedded rather than stopping at Complete.

What should providers look for next?

Providers are likely to watch for progress in several areas once Emily Miles takes up the role:

• more consistent and timely assessments;
• clearer communication about the revised framework;
• a manageable transition from Quality Statements to KLOEs;
• technology that supports rather than obstructs regulation;
• greater transparency about how evidence informs judgements;
• more frequent and proportionate physical inspection;
• better use of CQC's national intelligence to support learning;
• renewed confidence among people, providers and CQC's workforce.

This appointment matters, but it is one part of a much wider period of regulatory change.

CQC believes it has appointed a leader with the regulatory insight and change-management experience needed to help turn the organisation around, improve performance and rebuild trust. Emily Miles has said that putting people first, protecting them from poor care and supporting services to improve will be central to her approach.

The next question is how those commitments will be reflected in what people and providers actually experience.

For providers, a reliable response is not to ignore changes within CQC, but neither is it to redesign the service around every new piece of regulatory language. The fundamentals remain the same: know the regulations, understand the service, listen to people, recognise risk and be able to demonstrate that governance systems are working in practice.

That also means ensuring that improvement is not dependent only on the registered manager. Developing knowledgeable staff, deputies and meaningful champions within adult social care services can help embed learning and strengthen oversight, provided those roles are supported and do not become tokenistic.

That is just as important today as it has ever been.

Frequently asked questions

This article discusses governance, regulation and leadership in adult social care. It is not legal advice and it is not clinical guidance. Regulatory expectations and draft frameworks change, so always refer to current CQC publications and use professional judgement in your own service.