Published August 2026. Last reviewed August 2026.
If you are choosing a residential rehab in England, the Care Quality Commission report is the most useful document you will read about it. It is the only assessment of that service written by someone with no commercial interest in whether you go there.
That document is about to change, quite substantially. The CQC has confirmed it is dismantling the single assessment framework it introduced in 2023 and replacing it with something closer to what came before. Anyone comparing services over the next year or two will be reading reports written under two different systems, and it helps to know which is which.
What the CQC has decided
The regulator ran a consultation called Better regulation, better care, which closed on 11 December 2025 and drew 1,703 responses. Its initial response, published on 25 March 2026, sets out five changes. Support was emphatic: around 95% of respondents agreed with the proposed changes to the assessment framework, and around 80% agreed with the changes to how services are assessed and rated.
Sector-specific frameworks are coming back. The single framework covering every kind of provider is being replaced by separate frameworks for each main sector. Four drafts have been published for consultation, covering adult social care, mental health care, primary care and community services, and secondary and specialist care.
Quality statements are going. The “we statements” that providers have been assessed against are being replaced by supporting key lines of enquiry, which is a return to the older language and structure.
Scoring is being removed. Under the current system, inspectors score evidence categories one to four, and those scores aggregate upward into ratings. That is being abolished. Rating judgements will instead be made holistically, using the professional judgement of inspection teams.
Rating characteristics are returning. Each framework will describe what care actually looks like at each of the four levels, so that outstanding, good, requires improvement and inadequate mean something more concrete.
Judgements will be made at key question level. The CQC will no longer make formal judgements below the level of its five key questions: safe, effective, caring, responsive and well-led.
The frameworks have been shaped by the independent reviews carried out by Dr Penny Dash, Professor Sir Mike Richards and the Care Provider Alliance. A full response to the consultation is due during 2026, and the draft frameworks are still being tested and piloted.
The open question for residential rehab
Look again at those four draft frameworks: adult social care, mental health care, primary care and community services, and secondary and specialist care.
Residential substance misuse treatment does not sit neatly in any of them. It is not adult social care, it is not a hospital, and while it sits closest to mental health care, it is regulated under its own activity, accommodation for persons who require treatment for substance misuse, and inspected by teams who specialise in it.
The CQC has said it will develop further guidance for specific services within each sector, and will work separately with sectors it does not rate. But as things stand, which framework will govern the assessment of a residential rehab has not been settled publicly. For a sector of a few hundred services treating some of the most vulnerable people in the health system, that is worth watching, and worth providers responding to while the consultation is open.
What this means when you read a report today
Residential substance misuse services are rated. That is worth stating plainly, because it is not true of every kind of independent healthcare, and the distinction matters. A rehab in England should have an overall rating and a rating against each of the five key questions.
But three things follow from the changes.
Current reports are artefacts of a method being retired. A report published in the last two years will refer to quality statements and will have been produced using scoring. A report published after the new frameworks land will not. The ratings will still use the same four words, but the reasoning behind them will have been reached differently.
Comparisons across that boundary need care. If one service was assessed in 2025 and another in 2027, you are not comparing like with like in method, even if the badges look identical.
The date matters more than the rating. Every CQC report carries an assessment date. A service rated good three years ago has told you about a service three years ago. The CQC has itself been moving toward more frequent, risk-based assessment, so the gap between assessments will vary by how much concern there is about a service.
What to look at instead of the badge
The rating is a summary. The report is the evidence, and it is usually only a few pages.
Read the safe and well-led sections first. Safe covers staffing, medicines and risk, which is where things go wrong in a detox setting. Well-led covers governance and culture, which is the best predictor of whether the other four will hold up over time.
Read the section on people’s experience. CQC inspectors speak to clients and families directly, and quote them. It is the closest thing available to an unfiltered account.
Check what the service is registered to do. A service registered for accommodation for persons who require treatment for substance misuse is not automatically registered to provide medically supervised detox. If someone needs a medical detox, that is a specific question to ask.
And check the date at the top.
Why we are writing this
The Recovery Trust publishes a directory of residential treatment providers. Our own standard requires members to be registered with and subject to inspection by the relevant statutory regulator, so when that regulator changes how it works, it changes what our own checks mean.
We do not deliver treatment, we do not take referrals, and we cannot tell you which service is right for you or your family. What we can do is explain how the system that inspects those services actually works, so that you can read the evidence yourself rather than take anyone’s word for it, including ours.
The changes look sensible. Sector-specific frameworks make more sense than one framework stretched across a dentist, a care home and a detox unit. Describing what good looks like is better than arithmetic. But a system in transition is a system where information is harder to compare, and the people doing the comparing are usually doing it in a hurry, at the worst point in their lives.
If you need help now
In an emergency, call 999. Samaritans are on 116 123, free and open at any hour. FRANK is on 0300 123 6600. NHS 111 can also help you find local support.
To check a service in England, search the CQC register at cqc.org.uk. In Wales, contact Care Inspectorate Wales. In Scotland, the Care Inspectorate. In Northern Ireland, RQIA.
Sources. Care Quality Commission, Our initial response to our public consultation: Better regulation, better care, 25 March 2026. Care Quality Commission, Give your views on draft sector-specific assessment frameworks. Care Quality Commission, Service inspections: independent substance misuse services.
This article explains how regulation works. It is not clinical advice and it is not an endorsement of any service. If any detail here has changed, please tell us and we will correct it.
