The Care Quality Commission (CQC) has welcomed two important reviews that will help to set the future direction for CQC: the final report of Dr. Penny Dash’s review and the first report of the independent review by Professor Sir Mike Richards.
In May 2024, Dr. Penny Dash was asked by the Department of Health and Social Care (DHSC) to conduct a review into the operational effectiveness of the Care Quality Commission (CQC). An interim report of her work, providing a high-level summary of her emerging findings, was published in July 2024.
A full report has now been published confirming significant failings in the internal workings of CQC, which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improve quality - and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much-needed improvements in care.
The report summarises the final findings of the review and outlines the necessary changes to start improving CQC. In the Review into the operational effectiveness of the Care Quality Commission Dr. Dash makes seven recommendations:
- Rapidly improve operational performance, fix the provider portal and regulatory platform, improve use of performance data within CQC, and improve the quality and timeliness of reports.
- Rebuild expertise within the organisation and relationships with providers in order to resurrect credibility.
- Review the single assessment framework (SAF) and how it is implemented to ensure it is fit for purpose, with clear descriptors, and a far greater focus on effectiveness, outcomes, innovative models of care delivery and use of resources.
- Clarify how ratings are calculated and make the results more transparent.
- Continue to evolve and improve local authority assessments.
- Formally pause ICS assessments.
- Strengthen sponsorship arrangements to facilitate CQC’s provision of accountable, efficient and effective services to the public.
A second review considering the wider landscape for quality of care, with an initial focus on safety, will be published in early 2025.
Following the publication of Dr. Dash’s interim report in July, the CQC Board also asked Professor Sir Mike Richards to conduct an internal review of the single assessment framework and its implementation. Sir Mike Richards was Chief Inspector of Hospitals at CQC from 2013 to 2017. That review has also now been published by the CQC and can be viewed at: https://www.cqc.org.uk/publications/review-cqcs-single-assessment-framework-and-its-implementation/2-key-recommendations
Among the recommendations, Sir Mike Richards called for "a fundamental reset of the organisation". This needs to be akin to the reset in 2012/13, following the problems related to the regulator that were revealed by the report of the public inquiry into Mid Staffordshire NHS Foundation Trust (the Robert Francis inquiry) and the BBC investigation of Winterbourne View.
The previous organisational structure should also be re-instated as soon as reasonably possible. Chief inspectors should lead sector-based inspection teams at all levels. These teams can be brought together to assess integration of care across a local area, while retaining focus on their own specialism. Ongoing relationships between inspection staff with relevant skills and experience and providers should be re-instated as soon as possible.
Professor Sir Mike Richards, said: “CQC urgently needs to return to a structure where inspections teams are led once again by chief inspectors relating to the different sectors that CQC regulates. In addition, the current assessment framework needs to be radically simplified and the major problems with the new IT system need to be rectified. I know that work is already underway to address these areas.
“I believe that CQC’s problems can be fixed relatively quickly under the leadership of Julian Hartley, the incoming Chief Executive. Providers have overwhelmingly reaffirmed that they want good regulation, and many CQC staff remain fully committed to delivering this. These changes will help the regulator to effectively deliver its crucial work of ensuring that people get high quality, safe care.”
Ian Dilks, Chair of CQC, said: “We welcome the final part of Dr. Penny Dash’s review – we accept the findings and we will address the recommendations with urgency. We are also extremely grateful to Sir Mike Richards for his helpful work and will be using his recommendations to help us respond to the serious failings identified by Dr. Penny Dash. His review also offers additional suggestions for improvement that we will be exploring as part of our wider recovery work.
“Both reviews have reaffirmed the support for a robust health and care regulator and recognised the dedication and experience of CQC staff. We are committed to rebuilding trust in CQC’s regulation and are taking action to make sure we have the right structure, processes, and technology in place to help us fulfil our vital role of helping people get good care and supporting providers to improve.”
The Health and Social Care Secretary has now asked Dr. Dash to conduct two further reviews moving her focus from operational effectiveness to patient safety and quality. The first review will examine the roles and remits of six key organisations and make recommendations on whether patient safety could be bolstered through a different approach. These are:
- Care Quality Commission (CQC) including the maternity programme (MNSI)
- National Guardian’s Office (NGO)
- Healthwatch England (HWE) and the Local Healthwatch (LHW) network.
- Health Services Safety Investigation Body
- Patient Safety Commissioner
- NHS Resolution (quality and safety functions only)
A further review will focus on quality and its governance. This will guide the government’s next steps as it continues its drive for positive cultural change across health and social care. All findings will also inform the government’s 10-Year Health Plan to transform the NHS and social care and make them fit for the future.
Wes Streeting, Secretary of State for Health and Social Care, said: "Patient safety is the bedrock of a healthy NHS and social care system. That’s why we are taking steps to reform the CQC, to root out poor performance and ensure patients can have confidence in its ratings once again.
"This government will never turn a blind eye to failure. An overly complex system of healthcare regulation and oversight is no good for patients or providers. We will overhaul the system to make it effective and efficient, to protect patient safety."
