The major review of the CQC’s operational effectiveness, led by Dr Penny Dash, Chair of the North West London Integrated Care Board, has identified significant internal failings at the regulator, which are hampering its ability to identify poor performance at hospitals, care homes and GP practices.
The full report, published yesterday (October 15), confirms poor performance in relation to inspections, as well as a lack of capacity and capability to deliver improvements.
The report provides seven specific recommendations for improvement, which the Secretary of State for Health and Social Care, Wes Streeting, fully supports. This includes recommending that the CQC formally pauses the implementation of its assessments of Integrated Care Systems (ICSs) as it works to restore public confidence in health and care regulation. This will allow the CQC to focus on getting the basics right when assessing the organisations it regulates.
The report also recommends rapidly improving operational performance, including the portal and regulatory platform, and the use of data; rebuilding expertise within the organisation and relationships with providers; reviewing the single assessment framework (SAF) and how it is implemented to make it fit for purpose; clarifying how ratings are calculated and making the results more transparent; continuing to evolve and improve local authority assessments; and strengthening sponsorship arrangements with the DHSC to facilitate the CQC’s provision of accountable, efficient and effective services to the public.
The separate report from Professor Sir Mike Richards, former Chief Inspector of Hospitals at CQC (2013 – 2017), into the SAF and its implementation was also published yesterday. It recommends a “fundamental reset” and a return to the previous operational structure as soon as possible. Sir Mike Richards also recommends that whilst aspects of the SAF could be retained with modifications, other aspects should be suspended and scrapped. These elements include the evidence categories and scoring system. More work is needed to define what good looks like in different services. The use of data to inform judgements should also be given much higher priority than at present. The somewhat controversial topic of ‘one-word ratings’ was also raised, and the report recommends further consideration of this issue and particularly the level at which such ratings make sense to people using the services.
CQC response
Ian Dilks, Chair of CQC, says: “Both reviews have reaffirmed the support for a robust health and care regulator and recognised the dedication and experience of CQC staff. 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.”
The CQC has already taken its first steps to rebuild its approach to regulation, including announcing Sir Julian Hartley, former Chief Executive of NHS Providers, as its new Chief Executive. Both Dr Penny Dash and Sir Mike Richards have welcomed this appointment.
Next steps
The Health and Social Care Secretary has now asked Dr Dash to conduct two further reviews moving her focus from operational effectiveness to patient safety and quality. The first review will examine the roles and remits of six key organisations and make recommendations on whether patient safety could be bolstered through a different approach. These are:
• Care Quality Commission (CQC) including the maternity programme (MNSI)
• National Guardian’s Office (NGO)
• Healthwatch England (HWE) and the Local Healthwatch (LHW) network.
• Health Services Safety Investigation Body
• Patient Safety Commissioner
• NHS Resolution (quality and safety functions only).
A further review will focus on quality and its governance. This will guide the government’s next steps as it continues its drive for positive cultural change across health and social care.
All findings will also inform the government’s 10-Year Health Plan to transform the NHS and social care and make them fit for the future.
