Review into the operational effectiveness of the Care Quality Commission identifies failings

The interim findings of the independent review by Dr Penny Dash into the operational effectiveness of the Care Quality Commission (the “CQC”) was published on 26 July 2024. The review has found significant failings within the CQC and has identified the following five key areas which require improvement.

This update will be relevant to all those involved in the delivery of regulated healthcare services, including providers, shareholders and potential investors, as it provides an indication as to the potential evolution of health and social care regulation in England.

Five Key Areas for Improvement

The five key areas for improvement are as follows:

1. Poor operational performance: the interim report details a number of operational performance issues including, but not limited to a backlog in registrations for new providers, providers not being re-inspected for a number of years and 1 in 5 providers having never been rated.

2. Significant challenges with the provider portal and regulatory platform: poorly performing IT systems have been identified as “hampering” CQC’s ability to roll out the single assessment framework (“SAF”) and impacting providers’ time resources.

3. Loss of credibility: the interim report has identified a lack of expertise, particularly within healthcare (as opposed to social care) and some inspectors have reported that they have visited hospitals without previously visiting one. The interim report has found that this lack of expertise has resulted in providers not trusting the outcome of reviews.

A reduction in ongoing relationships between CQC staff and providers has also been identified. The interim report notes that the combination of these issues not only impacts the credibility of the CQC but has resulted in a lost opportunity to improve health and social care services.

4. Concerns around the SAF: the interim report identified six concerns with the SAF:

• there is no description of the different ratings resulting in providers struggling to understand what the inspectors are looking for and how to do better;
• there is a lack of focus on outcomes despite the importance of outcomes in care;
• the SAF is poorly explained and the review found that across the executive team, few were able to describe the SAF;
• the data used to understand service user experience is not sufficiently transparent and it is unclear how the CQC analyses this data, the response rate and representation across service users;
• there is a lack of an objective assessment of the efficient delivery of care; and
• there is limited reference to innovation in care models or ways of encouraging adoption of these models which is deemed to be a missed opportunity to help drive better quality and more efficient care.

5. Lack of clarity as to how ratings are calculated: the final issue identified by the interim review is that providers do not understand how ratings are calculated. The report also raises concerns about the practice of providers’ overall ratings being based on aggregating outcomes from inspections over several years.

The CQC’s interim Chief Executive has confirmed that the CQC accepts “in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgent needed.”

The Five Recommendations:

The interim report sets out five recommendations based on the findings identified so far:

1. Rapidly improve operational performance through recruiting additional staff (with prior experience) and setting operational performance targets in conjunction with the Department for Health and Social Care (the “DHSC”).

2. Fix the provider portal and regulatory platform. It is recommended that the CQC considers working with providers to obtain feedback on progress.

3. Rebuild expertise and relationships with providers and of note, it is recommended that the CQC should re-instate its leadership team structure so there are three chief inspectors.

4. Review the SAF with a wholesale review being undertaken to address the interim findings to ensure the framework is fit for purpose.

5. Clarify how ratings are calculated and make the results are more transparent.

As part of the report’s recommendations, it has also been suggested that the DSHC should enhance its oversight of the CQC and in particular, the DHSC should undertake more regular performance review conversations with the CQC to check progress against the recommendations made.

It is anticipated that the full report of the independent review by Dr Dash will be published in Autumn 2024.

If you would like to discuss any of the above please contact a member of our Healthcare team.

This article was written by Lisa Mulholland and Patrick Parkin.