A new report on the effectiveness of the Care Quality Commission (CQC) has found significant failings that leave it unable to consistently and effectively judge the quality of health and care services, including those in need of urgent improvement.
The independent review 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 the CQC’s IT system.
It also found that social care providers are waiting too long for their registration and rating to be updated, with implications for local capacity.
All providers of healthcare and adult social care regulated activities in England must register with the CQC, which monitors, inspects, and regulates these services to ensure they meet fundamental standards of quality and safety. The report however found that approximately one in five locations had never received a rating with some organisations not being reinspected for several years. The oldest rating for an NHS hospital dates from over 10 years ago and the oldest rating for a social care provider dating from 2015.
Dr Dash said: “The contents of my interim report underscore the urgent need for comprehensive reform within the Care Quality Commission. 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.”
Health and Social Care Secretary, Wes Streeting, said that the government 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 the CQC, ahead of a full report by Dr Dash which will be published in the autumn.
He 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 the 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 government 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:
Dr Dash was asked to carry out a review of the CQC in May 2024. Over the last two 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 the CQC.
The CQC said that it accepts in full the the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed. Many of which, it said, aligns with areas it has prioritised as part of its work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what it has got wrong.
Kate Terroni, interim chief executive, added: “We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve. Work is underway to improve how we’re using our new regulatory approach. We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement.
“We’re increasing the number of people working in registration so we can improve waiting times. We’re working to fix and improve our provider portal, and this time we’ll be listening to providers and to our colleagues about the improvements that are needed and how we can design solutions together. We’ll be working with people who use services and providers to develop a shared definition of what good care looks like. And we’re also developing a new approach to relationship management that enables a closer and more consistent contact point for providers.”
To strengthen its senior level healthcare expertise, it has appointed Professor Sir Mike Richards to conduct a targeted review of how the single assessment framework is currently working for NHS trusts and where it can make improvements.
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 the 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 the 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.
“The CQC must embark on a radical improvement program 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.”
