October 2026: two U-turns, a leadership warning and a framework still waiting in the wings
October was the month the government changed its mind.
Twice.
Plans to fold HSSIB into CQC and to abolish Healthwatch have both been dropped. Meanwhile, CQC's annual State of Care report named leadership as the weakest link in adult social care, and the new assessment framework moved a step closer without a launch date.
Here's what happened, what it means for independent providers, and what to watch in November.
What just happened
HSSIB stays independent. When the Health Bill was first published, it would have abolished the Health Services Safety Investigations Body and moved its work into CQC. Ahead of Lords committee stage, health minister Baroness Merron wrote to Peers to say the government no longer plans to go ahead with that merger. We covered the merger plan in September, so consider this our update: the two bodies look set to stay separate. The change still needs to be made formally through amendments to the Bill.
Healthwatch is saved too. The Bill also proposed abolishing Healthwatch England and local Healthwatch organisations. On 28 October, as Lords committee stage began, the government confirmed it would not go ahead with abolition. The Health Foundation called it the right decision, one that will "avoid yet more unnecessary disruption in the NHS".
The rest of the Health Bill keeps moving. The Bill had its Lords second reading on 13 October. Committee stage opened on 28 October, starting with the clauses on abolishing NHS England. The wider package, including new powers for the Secretary of State over NHS bodies, is still on track.
State of Care 2025/26 put leadership in the spotlight. CQC published its annual report on 23 October. In adult social care, leadership was the area most in need of improvement. Where inspectors looked at the governance, management and sustainability quality statement, they found shortfalls in 55% of assessments. They pointed to two recurring problems: leaders without the time or support to keep oversight, and leaders not acting on what staff tell them. On the health side, more than 80,000 children and young people have waited over a year for a community health appointment.
The new CQC framework: pilots done, no date yet. CQC's pilots of its new sector-specific frameworks ran from June to October, with the final evaluation due in November. CQC held an engagement event on the adult social care framework on 21 October. There's still no go-live date, so the current Single Assessment Framework and its 34 quality statements remain the rules you're assessed against.
What it means for the independent sector
Regulation and learning stay in separate hands. With HSSIB staying independent, the body that regulates and enforces (CQC) remains separate from the body that investigates to learn (HSSIB). That separation matters to anyone who has worked hard to build a just, open reporting culture under PSIRF. People talk more freely to an investigator whose job is learning, not judgement. Your incident response framework doesn't need to change, but it's worth noting in board papers that the landscape you planned around is staying put.
Patient voice still has a local home. Keeping Healthwatch means local patient feedback routes stay in place. If you haven't already, find out who your local Healthwatch is and how patients in your area use it. Feedback that arrives there is still feedback about you.
The leadership message applies to everyone. The State of Care figures on leadership come from adult social care, but the pattern is familiar across independent healthcare. Overstretched leaders lose sight of what's happening on the floor. Staff concerns go unheard. Boards and registered managers should ask themselves two questions this month: do our leaders have the time to keep proper oversight, and when staff raise something, what happens next?
Keep preparing for the framework you're assessed against now. Until CQC confirms a go-live date, you're still assessed under the current Single Assessment Framework. Preparation isn't wasted either way. Good governance, clear evidence and an open culture will matter under whichever framework comes next. Our free CQC self-assessment is a quick way to check where you stand.
Practising privileges: watch this space. IHPN's refreshed Medical Practitioners Assurance Framework, led by Professor Sir Stephen Powis, is due this autumn and hasn't been published yet. CQC uses the framework's principles when it judges whether independent services are well-led. If your practising privileges policy is due for review, it may be worth waiting a few weeks so you can align it with the new version.
On the horizon
• Health Bill committee sittings are scheduled for 3, 9, 11, 17, 23 and 25 November (dates may move). Look out for the government amendments that formally remove the HSSIB merger and Healthwatch abolition from the Bill.
• CQC's pilot evaluation is due in November. A go-live date for the new frameworks could follow, and we'll update our self-assessment tool as soon as it does.
• The refreshed Medical Practitioners Assurance Framework from IHPN is expected before the end of the autumn.
• CQC's dementia care guidance has a formal consultation planned for early 2027.
• Winter pressure is building. DHSC is asking providers to promote flu, COVID-19, RSV and pneumococcal vaccinations to staff and patients.
The theme of the month? Stability where it counts. Two bodies that independent providers rely on, one for safety learning and one for patient voice, are staying put. The direction of travel at CQC is clearer, even if the timetable isn't. And the clearest message of all came from State of Care: leadership with the time and willingness to listen is still the foundation everything else rests on.
We'll be back at the end of November with the next round-up. If you'd like our full monthly regulatory briefing, it's included in our Harbour and Deep Water subscriptions.
