David Behan is the chief executive of the Care Quality Commission, the independent quality and safety regulator for health and social care services in England. Since 2012 he has overseen a radical redesign of the way health and social care services are regulated. This article summarises his presentation to the 2015 National Conference of the Australasian Society of Intellectual Disability (ASID) in which he described the influences on quality and safety and the role played by regulation, set out the influence of regulation on the improvement of health and social care services, and outlined the changes in the way health and social care services are regulated in England and their impact on the quality and safety of care. Prior to 2012, regulation was conducted by generic inspectors who assessed compliance with minimum standards. From 2012, regulation was carried out by specialist inspectors working alongside clinicians, specialists and experts-by-experience, whose purpose was to judge and rate the quality and safety of services. The focus was to challenge poor care, but also to identify care that was outstandingly good. Although spending on residential care for people with intellectual disabilities may have increased, the capability of the workforce skilled in this area has not risen to meet the needs of this growing population.