An independent review of the Care Quality Commission (CQC) has identified significant internal failings which are hampering its ability to identify poor performance at hospitals, care homes and GP practices.
Health and Social Care Secretary, Wes Streeting, says he is: “stunned by the extent of the failings of the institution that is supposed to identify and act on failings.” He adds: “It’s clear to me the CQC is not fit for purpose.”
The interim report published today was led by Dr Penny Dash, Chair of the North West London Integrated Care Board. It found inspection levels were still well below where they were pre-Covid, along with a lack of clinical expertise among inspectors, a lack of consistency in assessments and problems with the CQC’s IT system.
These failings mean the regulator is currently unable to consistently and effectively judge the quality of health and care services, including those in need of urgent improvement. The report also found that social care providers are waiting too long for their registration and rating to be updated, with implications for local capacity.
The Government has announced it will 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. This work forms part of wider efforts to identify the challenges facing the NHS and take action to address them head on as part of the Government’s mission to build a health service fit for the future.
Four immediate steps
• Professor Sir Mike Richards appointed to review CQC assessment frameworks; Sir Mike was a hospital physician for more than 20 years and became the CQC’s first Chief Inspector of Hospitals in 2013, retiring from this role in 2017
• Improving transparency in terms of how the CQC determines its ratings for health and social care providers
• Increased government oversight of the CQC, with the CQC regularly updating the department on progress, to ensure that the recommendations in Dr Dash’s final review are implemented
• Dr Dash asked to review the effectiveness of all patient safety organisations.
Emerging findings
Dr Dash was asked to carry out this 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.
Findings include:
• Of the locations the CQC has the power to inspect, it is estimated that around one in five have never received a rating
• Some organisations are not being reinspected for several years – with the oldest rating for an NHS hospital dating from over 10 years ago and the oldest rating for a social care provider dating from 2015
• A lack of experience among some inspectors – with the review hearing of inspectors visiting hospitals and saying they had never been in a hospital before and an inspector of a care home who’d never met a person with dementia.
Commenting on her findings so far, Dr Dash says: “The contents of my interim report underscore the urgent need for comprehensive reform within the CQC.
“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.”
Professor Martin Green OBE, Chief Executive of Care England describes the road ahead for the CQC as “a long and difficult journey,” but one that is “entirely necessary.” He adds that the improvement programme should include tangible improvements in its own performance as well as a move away from “a culture of blame.”
Two weeks ago, the CQC’s Interim Chief Executive Kate Terroni apologised for the regulator’s failure to deliver changes it had promised in the implementation of its new approach. Commenting on the findings of the interim report, she says: "We accept in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed. Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong. 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.”
Sir Julian Hartley, Chief Executive of NHS Providers says Trust leaders will welcome today’s announcement, adding that its own recent report, Good Quality Regulation, had already underlined the need for the CQC to focus more on support and improvement.
“We fully agree with these recommendations,” he says. “Winning back credibility for the CQC will take a lot of work.”
