Emily Miles Appointed as New Chief Executive of CQC
What Emily Miles’ appointment means for CQC and, more to the point, for you
Katherine Williams, Head of Regulation and Care Compliance at Fulcrum Care, shares her expert perspective on the appointment of Emily Miles as CQC’s new Chief Executive and what it could mean for adult social care providers.
If you have worked in this sector for any length of time, you will have developed a particular facial expression for the announcement of a new CQC Chief Executive. It sits somewhere between polite interest and the look you give a relative who has just told you they are going into cryptocurrency.
On 16 July, CQC announced that Emily Miles will take over as Chief Executive, arriving in October. She replaces Dr Arun Chopra, who has been holding the post on an interim basis and who now returns to his day job as Chief Inspector of Mental Health, presumably with the quiet relief of a man handing back a set of car keys.
Depending on how you count, Miles is the fourth person to lead CQC in roughly two years. Ian Trenholm went. Kate Terroni held the fort. Sir Julian Hartley arrived, and departed last October after less than a year, as an inquiry was launched into repeated maternity failures at Leeds Teaching Hospitals, where he had previously been chief executive. Then Dr Chopra. Now Miles.
An organisation that has spent two years telling providers to demonstrate stable, consistent, well-led leadership has cycled through interim arrangements twice in the same period. I mention this not to be unkind, but because somebody has to write it down.
The CV, and why it is more relevant than it sounds
Miles is not a nurse. She is not a doctor. She has not run an NHS trust. Anyone hoping for a clinician at the helm will need to make their peace with that fairly quickly.
What she is, is a career regulator and a career civil servant. She joins from Defra, where she has been Director General for Food, Farming and Biosecurity since 2024. Before that she spent five years as Chief Executive of the Food Standards Agency, from 2019 to 2024 which is to say, she ran a UK-wide regulator through Brexit, a pandemic and a run of food safety controversies, and it did not fall over. Before Defra she worked largely on home affairs: the Home Office, the Cabinet Office, and a spell as a policy adviser in Downing Street.
I have already seen the jokes about going from food hygiene to fundamental standards. I would gently suggest that people making them have not looked very hard at what the FSA actually does.
Consider what she is bringing with her:
She has run a public rating scheme. The Food Hygiene Rating Scheme is a blunt, plain-English score, displayed at the door, that consumers actually understand and businesses genuinely understand, familiar? Miles has spent years living with the central tension of any rating regulator: the rating has to be simple enough to be useful and nuanced enough to be fair, and it can never be both at once. CQC has been arguing with itself about exactly this since the day it invented “Requires Improvement”.
She has run risk-based, delegated regulation. The FSA’s Achieving Business Compliance programme was built on the premise that a regulator cannot and should not inspect everything, and should instead target the highest risk, use data and intelligence, and lean on businesses’ own evidence of compliance. Whatever you think of that philosophy, it is a coherent one, and she has spent years implementing it.
She has cleared backlogs before. Her CV includes clearing the historic asylum caseload at the UK Border Agency and running the local authority food inspection recovery after COVID. She has also closed one national body and stood up another, having overseen the wind-down of the National Policing Improvement Agency and the establishment of the College of Policing. That last line is worth reading twice, given that the Department is currently thinking out loud about the shape of health regulation generally.
She is used to being watched. FSA board meetings are livestreamed, papers are published in advance, and the public are invited to ask questions. That is a more exposed way of running a regulator than CQC has been accustomed to.
What she is walking into
October is not a gentle month to start.
The Single Assessment Framework is being dismantled and replaced with four sector-specific frameworks: adult social care, mental health, primary care and community services, and hospitals. For adult social care, the 34 quality statements become 24 Key Lines of Enquiry, the scoring model goes, and rating characteristics come back. Consultation closed on 12 June. Pilots have been running over the summer. Rollout is due before the end of the year.
So, she arrives roughly halfway through the most significant methodological change since 2024, with the ink still wet on the pilot findings. There are two realistic outcomes. Either she signs it off and ships it, or she looks at the pilot data with fresh eyes and inserts a pause. Plan for the first. Do not be astonished by the second. Incoming chief executives have a well-documented fondness for the phrase “before we proceed, I’d like to understand”.
She also inherits the registration regime that changed on 9 February, under which incomplete or inaccurate applications are returned or rejected on receipt rather than chased. She inherits an assessment target of 9,000 published by the end of September and a report backlog that has gone from around 500 to almost nothing. And she inherits a governance overhaul: Kay Boycott as interim Chair, with Baroness Julia Neuberger as the Government’s preferred candidate for the permanent post, subject to a pre-appointment hearing before the Health and Social Care Select Committee.
What I think actually changes for providers
This is inference rather than inside knowledge, so weigh it accordingly.
More weight on data you have already given them. A regulator with an FSA background is a regulator comfortable with continuous, remote, intelligence-led monitoring. Your statutory notifications, your workforce returns, your complaints profile, your safety data expect these to carry more of the burden of judgement, not less. The desktop is already assessing you. It will assess you harder.
Registration will not get softer. If anything, the “arrive complete or don’t arrive” doctrine fits her regulatory philosophy precisely. The cost of assurance moves to the applicant. Those of us who prepare applications for a living have already adjusted; anyone still submitting hopefully and waiting for a phone call has not.
More transparency, possibly more than is comfortable. For everyone, including CQC.
A harder line on proportionality
Risk-based regulation sounds delightful when you are a good provider. It means fewer visits at the safe end and considerably more attention at the other end. If you have a service you are quietly worried about, that is the one to fix this quarter.
And a genuine unknown
Food businesses are not care homes. A dirty kitchen can be closed on a Tuesday and reopened on a Friday. A failing nursing home contains 42 people who have nowhere else to go, and the regulator’s options are correspondingly limited. Whether that reality lands quickly is the single biggest question about this appointment, and no press release will answer it.
What does not change
Here is the thing that fifteen leadership announcements have never quite grasped.
No provider has ever experienced a Chief Executive. They experience an inspector – a person who arrives at nine in the morning, asks to see the training matrix, and forms a view.
Frameworks change, chief inspectors are reorganised, strategies are refreshed, and the actual regulatory event remains one human being making a judgement about another human being’s service, usually while holding a lukewarm cup of tea and a biscuit they did not ask for.
Emily Miles could be very good at this job. Her CV suggests someone who understands regulatory machinery, which is more than can be said for some previous appointments. But the distance between a well-designed framework in Newcastle or London and a consistent judgement in a converted Victorian house in Kent has always been the whole problem, and it will not be solved by an announcement in July.
What to do between now and October
Finish mapping your evidence against the draft KLOEs, stop maintaining anything that only maps to the 34 quality statements, make sure your notifications are timely and complete because they are increasingly your visible face, and read the final frameworks the week they are published rather than the week before your assessment.