Urgent Turnaround Of CQC Required As “Significant Failures” Revealed
A major review into the CQC has confirmed ‘significant failings’ in the way the watchdog operates, a report has revealed.
The Department of Health and Social Care (DHSC) has published the full report of Dr Penny Dash’s review into the Care Quality Commission (CQC)’s operational effectiveness. In addition the CQC published the report of Professor Sir Mike Richards’ independent review of CQC’s single assessment framework and its implementation.
In response to Penny Dash’s interim report and recommendations, in July this year, the Health and Social Care Secretary announced four immediate steps for the government and CQC to take to restore public confidence in the regulator. These included appointing Sir Mike Richards (former CQC chief inspector of hospitals) to review CQC’s assessment framework.
The Health and Social Care Secretary has now asked Dr Dash to conduct two further reviews:
- The first will examine the roles and remits of six key organisations (CQC, the National
Guardian’s Office, Healthwatch England and the Local Healthwatch network, the Health Services Safety Investigation Body, the Patient Safety Commissioner, and NHS Resolution), and will make recommendations on how patient safety could be strengthened via a different approach to national oversight.
- The second review will focus on quality and its governance and will support the government as it works to ensure positive cultural change across health and social care.
- The findings from these reviews will also inform the government’s 10-Year Health Plan.
This briefing includes an overview of Dr Dash’s and Sir Mike’s findings and recommendations, and NHS Providers’ view.
Key points
The two reviews reflect on different concerns over CQC’s leadership, processes and overall performance. They make complementary recommendations on how the regulator can restore its credibility, effectiveness, and its ability to ensure the safety and quality of care of services in England.
These recommendations include:
- A fundamental reset of the organisation, reverting to its previous model of three chief inspectors leading sector-based inspection teams, and considering the appointment of a fourth chief inspector to lead regulation of mental health and inspections under the Mental Health Act.
- Abandoning the concept of a ‘single assessment framework’ covering all sectors regulated by CQC, while retaining existing key questions and quality statements.
- Improving operational performance, including the quality and timeliness of reports.
- Rebuilding expertise within the organisation, and its relationships with providers.
- Fixing technical issues with the provider portal and addressing registration backlogs.
- Formally pausing ICS assessments.
- Working closely with providers to improve its approach to assessment and inspection.
- Revisiting the use of one-word ratings.
Dr Dash said: ‘This report reiterates the findings of my interim report while providing further detail and analysis of the CQC’s performance.
‘It builds on insights and perspectives from patients and users, and a wide range of health and social care providers as well as senior leaders from the NHS and local authorities.”
‘I am very grateful to the large number of staff within the CQC who have come forward to share their experiences of the last few years and to make recommendations for the future. They have shown exceptional patience and professionalism throughout this difficult period.’
Professor Martin Green OBE, Chief Executive of Care England, commented:
“Sir Mike Richards’ report confirms the deep-rooted challenges we have seen first-hand in recent years. The CQC’s restructuring and its Single Assessment Framework have, quite simply, not worked. These changes have placed unnecessary pressure on the sector, delayed critical inspections, and demoralised both CQC staff and care providers alike. Urgent action is needed to address these failings and rebuild trust.”
“The review underscores several key failures, including the overcomplicated nature of the Single Assessment Framework, delays in inspection reporting, and the damaging impact of the new regulatory platform. Care England welcomes the call for a reset of the CQC’s structure and operations, emphasising that the organisation must return to its core mission: ensuring safe, effective, and high-quality care.”
Key Concerns Raised by Care England Include:
- The reduction in the number of inspections and significant delays in publishing reports have undermined the CQC’s ability to regulate effectively, creating confusion and uncertainty for providers.
- The disconnection between operational delivery and clinical leadership, highlighted in the review, has contributed to a loss of expertise and accountability in the inspection process.
- With high levels of staff turnover and low morale, it is clear that the CQC’s restructuring has had a detrimental effect on its workforce, further exacerbating delays and inconsistencies in inspections.
Professor Green continued:
“The findings of this review are a wake-up call for the CQC. The fundamental reset proposed by Sir Mike Richards is essential if we are to see real improvements. The lack of clinical oversight, inadequate training for new staff, and the complexity of the assessment framework are all issues that need immediate resolution. These are not just operational challenges – they are impacting the care and safety of vulnerable people across health and social care settings, and care providers are being charged for services that aren’t being delivered.”
“Care England supports the recommendations set out in the report, particularly the reinstatement of sector-based inspection teams, the appointment of permanent Chief Inspectors, and a simplification of the assessment framework to better reflect the diversity of the services regulated by the CQC. However, the changes must be implemented swiftly to avoid further damage.”
Kathryn Smith, Chief Executive of the Social Care Institute for Excellence (SCIE), said:
“The review recognises the need for stronger policy in the areas of improvement and innovation. SCIE has long championed the need for evidence-based approaches to driving improvement in care delivery, focusing on ensuring that individuals receive high-quality care that is accessible to all.”
“It highlights that current efforts to innovate or improve care services are not operating at the scale needed to meet the challenges facing the sector. SCIE stands ready to help scale efforts and provide comprehensive resources to support providers, commissioners, and policymakers in improving care access and quality.”
“The review highlights significant issues related to safety issues. Safeguarding vulnerable individuals is at the heart of the social care sector and SCIE’s mission. We look forward to working with Dr Dash as part of her further two reviews on patient safety and quality.”
“The public needs confidence in the quality of social care services. SCIE commends the review for shedding light on these crucial issues and looks forward to collaborating with stakeholders across the sector to ensure that the necessary improvements are made. The sector needs a stronger, safer, and more innovative social care system.”
Eddy McDowall, Co-Chair of the Care Association Alliance:
“Two reports published today have laid bare the crisis which has overtaken the Care Quality Commission, whose job it is to ensure that health and care services in this country provide people with safe, effective, compassionate and high-quality care.”
“Professor Sir Mike Richards’ report is a review of the CQC’s single assessment framework, and its conclusions are damning. It finds that the transformation programme for the CQC in 2013 has failed to deliver the intended benefits and has brought about major adverse consequences.”
“Professor Richards says that as a result the CQC has been unable to fulfil its primary purpose; far fewer inspections have been carried out than in previous years; publication of inspection reports have been seriously delayed; and staff have become demoralised.”
“Dr Penny Dash’s full independent report into the performance of the Care Quality Commission is similarly critical and finds similar failings across the organisation.”
“The Care Association Alliance, which represents care associations across England, welcomes both reports and urges the government to take swift and decisive action to improve the performance of the CQC.”
“The key messages in these reports are extremely concerning and demonstrate that the CQC is currently failing in its important regulatory role.”