The Care Quality Commission is in difficulty.

NHS East of England chief executive Sir Neil McKay has been called in to support the trust registration process, which began last week.

It is barely possible to exaggerate the complexity of the task the CQC leadership has taken on

This follows the departure of chair Barbara Young, the leaking of its report into Basildon and Thurrock University Hospitals Foundation Trust and the dispute over the reliability of CQC assessments compared with Dr Foster’s mortality rates.

The registration process has had a shaky start. A new system of this size is bound to have teething problems, but chief executives have described a chaotic process where the requirements are changing and local CQC staff are struggling to cope.

The CQC - and Sir Neil - are adamant his arrival is not a significant event. He is merely “helping out”.

The statement put out in his name says “it is simply an example of CQC seeking support and advice from those they regulate”. But if that was the case the regulator would have quietly secured the advice of a top flight trust chief executive. Instead it is one of the most high profile strategic health authority chiefs, known to be close to the NHS leadership, who has gone in. The folksy image of Sir Neil rolling up his sleeves and getting stuck in to the CQC’s washing up stretches credulity.

The political stakes are high. The government knows the registration process is in difficulty and presents a severe electoral risk. If it is not completed by the 1 April deadline the Conservatives will use this failure to attack Labour for mismanaging the health service. Public confidence in patient safety would be further undermined.

As well as damaging the party, the reputation of health secretary and potential Labour leadership candidate Andy Burnham could be harmed if the registration process unravels.

It has been made clear to HSJ that the way the CQC handles registration will affect the government’s view on its future.

It is barely possible to exaggerate the complexity of the task the CQC leadership has taken on. It has had to merge three regulators with strikingly different cultures; develop assessment regimes covering everything from the largest hospital to the smallest care home which must withstand withering fire from the tabloids; introduce a registration system for trusts; and extend the reach of primary care regulation.

Widely admired chief executive Cynthia Bower is delivering all this in the most adverse conditions. She had to manage a difficult relationship with her chair, and is implementing these systems in an increasingly toxic political atmosphere in which any public sector body can find itself at the centre of a brawl. In such circumstances, it is easy to see the wisdom of securing external support.

It is open to doubt whether registration alone will deliver improvements in patient care commensurate with the time and effort being expended on it. But if it does not make a significant difference that will be the fault of the legislation, not the CQC.

Now this registration system has been dropped on the NHS it is imperative for the reputation of its trusts that it works well - not because it will make a big practical difference, but because it is now emblematic of the drive for a safe, improving health service. If registration is chaotic, the public will believe the NHS itself is chaotic.

The health service also needs stability in regulation. After the Commission for Health Improvement, the Healthcare Commission and now the CQC, “fourth time lucky” is unlikely to be a credible policy for any government.

Public and politicians alike need to accept the limits of what regulation can achieve.

Management leadership, clinical engagement, competition, choice, listening to patients and having motivated staff are what makes the NHS safe and effective, not inspection.

CQC SOS: high stakes mean it is essential registration succeeds