Today’s report found that the CQC has completed its inspection and rating programme comprising more than 28,000 provider locations, which gives a benchmark of the quality of health and social care services. It has also significantly reduced staff vacancies and is increasing its focus on cost savings. In addition, the report says that CQC has improved how it measures its performance, and takes action to correct poor performance.

Inspection staff, however, highlighted concerns to the NAO about how well the broader information systems currently supported them. The NAO also found that CQC does not meet its timeliness targets for some of its regulation activities, such as registration and publication of inspection reports.

According to the NAO, while most providers and inspectors think that the CQC's judgements are fair, stakeholders have concerns about consistency. The CQC is seeking to address consistency issues through its quality assurance processes and training.

The CQC is taking more enforcement action when care falls below fundamental standards, and there is evidence that it influences providers to improve quality, with most of the providers rated either Inadequate or Requires Improvement having improved their rating on re-inspection.

The number of completed enforcement actions increased over 2015-16 and 2016-17, while the number of providers entering special measures remained steady. The CQC links the increase with a focus on improving its inspectors’ skills and knowledge about enforcement. Poor recording, however, means CQC cannot be assured that enforcement action is always completed.

The CQC has made progress in implementing its new strategy during 2016-17 although the NAO report says it missed early milestones on rolling out use of resources assessments and designing its approach to the next phase of inspection. It is preparing for new ways that care might be delivered and is already responding to changes such as online primary medical services.

According to the NAO, the CQC's ambition to base more of its regulatory activities on intelligence and risk-based information introduces significant challenges. These must be carefully managed, and supported by digital systems and capabilities if it is to minimise the risk of missing poor care. In addition, the Department of Health and CQC must also be realistic about its capacity to take on new responsibilities in this period of change.

Amyas Morse, Head of the National Audit Office said, 'The Commission has improved as an organisation. Value for money is getting better and the Commission can secure further improvement if it continues its current direction of travel. Its main challenge now is to develop its digital systems and capabilities to support its move to a more intelligence driven and risk based approach to regulation.'

Responding to the report, Sir David Behan, Chief Executive of the Care Quality Commission said, 'As the independent quality regulator, CQC plays an important role in making sure people receive safe high quality care. I welcome the NAO's independent review of how well we carry out those responsibilities.

'This report recognises the good progress we have made whilst at the same time confirming those areas where we need to continue to improve.

'I want to pay tribute to the CQC staff and Board for the commitment and energy they invest every day. It is their hard work and progress which is recognised by the NAO in its report.'