An independent review of the Care Quality Commission (CQC) has identified significant internal failings which is reported to be hampering its ability to identify poor performance at hospitals, care homes and GP practices.
The interim report, led by Dr Penny Dash, chair of the North West London Integrated Care Board, found inspection levels were still well below where they were pre-COVID, a lack of clinical expertise among inspectors, a lack of consistency in assessments and problems with CQC’s IT system.
Some organisations have not been re-inspected for several years, while data provided by CQC suggests that the oldest rating for a social care organisation is from October 2015 (nearly 9 years old) and the oldest rating for an NHS hospital (acute non-specialist) is from June 2014 (around 10 years old)
These failings mean the regulator is currently unable to consistently and effectively judge the quality of health and care services, including those in need of urgent improvement. The report also found that social care providers are waiting too long for their registration and rating to be updated, with implications for local capacity.
The government issued a statement that it will now take immediate steps to restore public confidence in the effectiveness of health and social care regulation, including by increasing the level of oversight of CQC, ahead of a full report by Dr. Dash which will be published in the autumn. This work will form part of the government’s wider efforts to identify the challenges facing the NHS and take action to address them head on as part of its mission to build a health service fit for the future.
Health and Social Care Secretary Wes Streeting said: “When I joined the department, it was already clear that the NHS was broken and the social care system in crisis. But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me CQC is not fit for purpose. We cannot wait to act on these findings, so I have ordered the publication of this interim report so action can begin immediately to improve regulation and ensure transparency for patients.
“I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care. I want to reassure them that I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed. This government will never turn a blind eye to failure.”
The Health and Social Care Secretary has announced four immediate steps the government and CQC will take to restore public confidence in the regulator and ensure patients can get an accurate picture of the quality of care available. These include:
- The appointment by CQC of Professor Sir Mike Richards to review CQC assessment frameworks. Sir Mike was a hospital physician for more than 20 years and became CQC’s first Chief Inspector of Hospitals in 2013, retiring from this role in 2017
- Improving transparency in terms of how CQC determines its ratings for health and social care providers
- Increased government oversight of CQC, with CQC regularly updating the department on progress, to ensure that the recommendations in Dr Dash’s final review are implemented
- Asking Dr. Dash to review the effectiveness of all patient safety organisations
Dr. Dash was asked to carry out a review of CQC in May 2024. Over the last 2 months she has spoken to around 200 senior managers, caregivers, and clinicians working across the health and care sector, along with over 50 senior managers and national professional advisors at CQC.
Some of Dr. Dash’s emerging findings include:
- Of the locations CQC has the power to inspect, it is estimated that around 1 in 5 have never received a rating
- Some organisations not being re-inspected for several years - with the oldest rating for an NHS hospital dating from over 10 years ago and the oldest rating for a social care provider dating from 2015
- A lack of experience among some inspectors - with the review hearing of inspectors visiting hospitals and saying they had never been in a hospital before and an inspector of a care home who’d never met a person with dementia
Commenting on her findings so far, Dr. Dash said: “The contents of my interim report underscore the urgent need for comprehensive reform within CQC. By addressing these failings together, we can enhance the regulator’s ability to inspect and rate the safety and quality of health and social care services across England.
“Our ultimate goal is to build a robust, effective regulator that can support a sustainable and high-performing NHS and social care system which the general public deserves.”
To start to rebuild its credibility, Dr. Dash has highlighted urgent actions CQC can take including overhauling the inspection and assessment system, rapidly improving operational performance and fixing faltering IT systems.
Professor Martin Green OBE, Chief Executive of Care England, said: “It is clear that Dr Dash has listened to the voices of care providers, resulting in a clear set of recommendations. This report acknowledges the severe and systemic problems that sit at the very heart of CQC and gives a specific set of steps that the regulator must take to improve performance and re-establish the sector’s long-eroded trust.
“This is going to be a long and difficult journey for CQC, but one that is entirely necessary. Care England stands ready to work with the regulator to help them deliver an effective and supportive regulatory system that will be the cornerstone of public protection and delivers fair judgements across health and social care.
“CQC must embark on a radical improvement programme that should not only include some tangible improvements in their performance, but also needs to move away from a culture of blame. We all want proportionate and effective regulation, and the challenge now is for CQC to take action and work with organisations across the sector to deliver it.”
