The Care Quality Commission (CQC) is “not fit for purpose” and its safety ratings can not be trusted, Wes Streeting, Secretary of State for Health and Social Care has said. His remarks came after the publication of an interim review of the CQC currently being undertaken by Dr Penny Dash, chair of the North West London Integrated Care Board.
The review found:
“significant failings in the workings of the 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 improved quality”.
Numerous problems have been found at the organisation, including plummeting number of inspections being carried out, significant IT problems, issues with the new single assessment framework (SAF) system, and a breakdown in trust between the CQC and the health and care sector.
The CQC regulates around 15,000 care homes, 13,000 homecare agencies, 11,500 dentists, 8,600 GPs and 1,200 hospitals as well as community services and supported living facilities.
Just 7,000 inspections and assessments were carried out in 2023 to 2024, following the introduction of a new IT system; in contrast, in 2019 to 2020 more than 16,000 inspections were carried out.
There was a major problem with long waits for registration of new providers and re-inspections of providers who had previously received ‘requires improvement’ ratings. The knock-on effect is a reduction in care capacity as hospital discharge teams and local authorities will not use unregistered providers or those with poor ratings.
Almost a fifth of locations the CQC has the power to inspect, have never been rated. Some of these services registered with CQC over 5 years ago.
Then once providers have been inspected, they can wait for several months to receive reports and ratings. This, the report noted, “increases the burden on, and stress of, staff and results in lost time when quality improvements could have been made.”
Some organisations have not been inspected for many years, including a social care organisation last inspected in October 2015 (nearly 9 years old) and an NHS hospital (acute non-specialist) inspected in June 2014 (around 10 years old).
The CQC’s new system for assessments, the SAF, introduced in November 2023, was designed to make the assessment process simpler, with more frequent assessments, but it has met with numerous issues.
The roll-out of the SAF has been hampered by a poorly performing IT system, plus numerous other issues, including; a lack of information over what ‘good’ or ‘outstanding’ care actually is in reality, so there is an inconsistency to the ratings and organisations do not know what they are aiming for; the system being poorly described on the CQC website; and the use of data on the user voice and experience, although there is little or no transparency on how representative that data is, and how it is analysed for the purposes of informing inspections.
The report noted:
“Many providers referred to a lack of consistency in ratings awarded to providers. Those who work across multiple sites, for example, a large care home provider with multiple sites or a large group of GP practices, report ratings differing from one site to another, when they know (spending far more time with them) that the differences are not as being reported – and in all directions, for example, their poorer quality providers getting better ratings than their top providers and vice versa.”
The lack of experience of inspectors was also evident, with the report noting that the CQC took the decision to restructure and to move to a far greater reliance on generalists, which has led to situations such as an inspector of hospitals never having visited one and an inspector of a care home never having met a person with dementia.
As the report notes:
“The lack of sector expertise results in providers not trusting the outcomes of reviews and not feeling they have the opportunity to learn from others, especially from highly regarded peers.”
There is also a ‘noticeable lack of healthcare experience’ in the executive team, which is largely from a social care background.
Early in July 2024, the CQC apologised for the situation after care organisations complained of a “hostile” inspection regime and a major new computer system failed to work properly.
The full report will be available in Autumn, but a statement from the DHSC said the government will take “immediate steps to restore public confidence in the effectiveness of health and social care regulation” ahead of the full report.
The DHSC has already appointed Professor Sir Mike Richards (a former hospital physician and CQC’s chief inspector of hospitals 2013-2017) to review CQC assessment frameworks. And is working to improve transparency and increase government oversight of CQC.
The review and recommendations were welcomed by the chief executive of NHS Providers, Sir Julian Hartley, although he also said “winning back credibility for the CQC will take a lot of work.”
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
Comments are closed.