An independent review of the Care Quality Commission has identified “considerable concerns” over the functioning of the organisation.
Dr Penelope Dash, who led the review and serves as chair of the NW London Integrated Care System, spoke to around 170 senior managers, caregivers and clinicians working in the health and care sector, along with over 40 senior managers and national professional advisors at the Care Quality Commission (CQC).
Dr Dash’s review identified five key areas of shortfall in the functioning of the regulator, consistent across interviewees, which were preventing it from operating as it needs to.
'The CQC is paramount'
Leandre Archer, head of industrial relations at the SoR, said: “The announcement by health secretary Wes Streeting that the CQC is not fit for purpose is very worrying for both patients, their families and health service staff. The population depends on our health services being safe and effectively regulated and this in turn provides confidence in the services that are provided.
“Our NHS needs to be repaired after years of under-funding, and it is apparent that the CQC had also been a victim of austerity measures by the previous government. The public need to have trust and confidence in our health systems and the CQC is paramount in ensuring this.”
Five core problems
Issues included:
1. Poor operational performance
Just 7,000 inspections and assessments were carried out in 2023 to 2024. This compares to more than 16,000 inspections conducted in 2019 to 2020. At the end of 2023 to 2024, 54 per cent of applications pending completion were older than 10 weeks. The backlog was a particular problem for small providers trying to set up a new service.
2. Significant challenges with the provider portal and regulatory platform
A roll-out of updated IT systems for assessment was introduced in 2021, but their deployment resulted in “significant problems” for users – inability to easily upload documents, issues if the named user is away or off sick, and hours-long waits for a password reset.
3. Considerable loss of credibility
As part of the restructuring of the CQC, sectoral knowledge was separated out from assessment and inspection teams, to move to a greater reliance on generalists. However, this means inspectors visiting hospitals may never have been in a hospital before, and some inspectors visiting care homes commented they had never seen anyone with dementia before.
Dr Dash explained the lack of sector expertise has resulted in providers mistrusting the outcomes of reviews, has compounded a reduction in ongoing relationships between CQC staff and healthcare providers, and has impacted the credibility of the CQC.
4. Concerns around the Single Assessment Framework (SAF)
The SAF was introduced in November 2023 to replace the previous system of inspection, and was intended to make the process simpler and more insight-driven, able to inspect more frequently, and better reflect how care is delivered by different sectors.
However, the review identified several concerns, including no description of what ‘good’ or ‘outstanding’ care looks like, resulting in a lack of assessment consistency; a lack of focus on outcomes and inequalities; poor communication of what the SAF is; a lack of transparency around data use and analysis; no reference to use of resources or efficient delivery of care; and limited reference to innovation.
5. Lack of clarity around ratings calculation
The overall ratings for a provider may be calculated by aggregating the outcomes from inspections over several years, the review found, which it described as not “credible or right”.
Providers do not understand how ratings are calculated and, as a result, believe it is a complicated algorithm, or a “magic box”, resulting in a sense it is “impossible” to change ratings.
As a result of these issues, the report made five recommendations:
- Rapidly improve operational performance.
- Fix the provider portal and regulatory platform.
- Rebuild expertise within the organisation and relationships with providers in order to resurrect credibility.
- Review the SAF to make it fit for purpose.
- Clarify how ratings are calculated and make the results more transparent particularly where multi-year inspections and ratings have been used.
'Fundamental standards of quality and safety'
Charlotte Beardmore, executive director of professional policy at the SoR, emphasised the report’s findings were “very concerning”, and that she is looking forward to discovering how the government will hold the CQC accountable.
She added: “It is essential that the public can be assured that services meet the fundamental standards of quality and safety which the CQC was established to monitor. We await the full report, which is due in the autumn, and understanding more about how the government will hold the CQC accountable for the services it provides.
“Positively, in terms of assuring quality of imaging services to patients, we are pleased to see the engagement from our members with the new Quality Mark Scheme.”
Quality Mark Scheme
The College of Radiographers and the Royal College of Radiologists relaunched the Quality Standard for Imaging earlier this month ( 1 July ), which sets professional standards for imaging services above the regulatory standard.
This scheme is designed to focus on quality improvement for imaging services for the benefit of both patients and members, and engages imaging services in continuous quality improvement through formal peer review.
The QSI is outcome based, with patient involvement core to its development. Services achieving the quality mark offer assurance to the public about the standard of an imaging service.
Further information is available here.
CQC is the independent regulator of healthcare and adult social care in England. All providers of healthcare and adult social care regulated activities in England must register with CQC, and are monitored, inspected, and regulated by it to ensure they meet fundamental standards of quality and safety.
(Images: Photo by John Lamb via GettyImages)