Dash review finds ‘significant failings’ in how the CQC operates

A major review of the Care Quality Commission (CQC) by Dr Penny Dash has found ‘significant failings’ in the way the regulatory body operates.

The review, which is based on conversations with more than 300 people across the health and care sectors, found that there has been a deterioration in the ability of the CQC to identify poor performance which has had a direct impact on quality of care.

It also highlighted significant issues related to safety across both health and social care. Over the next four months, Dr Dash will conduct a further review of the wider landscape for quality of care and patient safety, including the roles of the different national bodies involved.

CQC inspections and assessments have halved over the last four years

The Dash review into the CQC found multiple failings in the internal workings of the health and social care watchdog, highlighting 10 areas of concern:

1. Poor operational performance
2. Significant challenges with the provider portal and regulatory platform
3. Delays in producing reports
4. Loss of credibility within the health and care sectors
5. Concerns around the single assessment framework (SAF) and its application
6. Lack of clarity regarding how ratings are calculated and how the outcomes of previous inspections are used to calculate current ratings
7. Opportunities to improve CQC’s assessment of local authority Care Act duties
8. ICS assessments are in early stages of development with a number of concerns shared
9. CQC could do more to support improvements in quality across the health and care sector
10. Opportunities to improve the sponsorship relationship between CQC and the Department of Health and Social Care.

Indeed, the report found a ‘stark reduction’ in operational activity over recent years, with the number of inspections and assessments carried out in 2023 half that of 2019 (6,700 in 2023 compared to 15,800 in 2019). As a result, there is a significant backlog of inspections and assessments, with the oldest rating for a social care provider dating back to 2015.

Problems with the single assessment framework, the organisational structure of the CQC, and the provider portal and regulatory platform were also identified. Dr Dash also found that delays to producing reports are increasing stress on staff and causing a loss of crucial quality improvement time. In addition, some providers and CQC staff said the way ratings are calculated are ‘confusing’.

Other areas of concern which will be considered in future reports include one-word ratings, how the CQC is funded, how data is obtained and utilised, and whether a number of regulatory bodies could be streamlined to ensure effective and responsive regulation.

The social care sectors ‘needs and deserves a high-performing regulator’

To ensure a ‘rapid turnaround’ and ensure the CQC transforms itself into a high-performing regulator, Dr Dash has made seven key recommendations for the watchdog.

This includes rapidly improving operational performance, rebuilding expertise within the organisation and relationships with providers, reviewing the single assessment framework and providing greater clarity on how ratings are calculated. Dr Dash also recommends that local authority assessments are improved, ICS assessments are paused and sponsorship arrangements are strengthened in order to better support the CQC’s provision of public services.

“There is an urgent need for a rapid turnaround of CQC – a process that has already started with the appointment of an interim chief executive in June 2024 and the announcement of further changes following the publication of my interim report. I am pleased to see the openness and honesty with which the organisation has begun to address the changes required.

“The health and care sector accounts for around 12% of the economy and 21% of public expenditure, and is one of the most significant drivers of health, public satisfaction and economic growth. It needs – and deserves – a high-performing regulator,” said Dr Dash.

The Social Care Institute for Excellence (SCIE) has supported Dr Dash’s recommendations, saying it stands ready to help scale efforts and provide resources to improve care access 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,” said Kathryn Smith, Chief Executive of SCIE.

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 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.”

Lauren Nicolle

Lauren is a qualified journalist who writes primarily across the health and social care sectors. She is passionate about exposing the injustices faced by people with a learning disability, with a particular focus on equal access to healthcare.

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