An independent review of the Care Quality Commission (CQC) has identified significant internal failings which is hampering its ability to identify poor performance at hospitals, care homes and GP practices.
The interim report, 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.
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 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.
This works forms part of the government’s wider efforts to identify the challenges facing the NHS and take action to address them head on as part of its mission to build a health service fit for the future.
The Health and Social Care Secretary Wes Streeting 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:
- The appointment by the CQC of Professor Sir Mike Richards 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
- Asking Dr Dash to review the effectiveness of all patient safety organisations.
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.
Some of Dr Dash’s emerging findings include:
- Of the locations the CQC has the power to inspect, it is estimated that around 1 in 5 have never received a rating
- Some organisations 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.
To start to rebuild its credibility Dr Dash has highlighted urgent actions the CQC can take, including overhauling the inspection and assessment system, rapidly improving operational performance and fixing faltering IT systems.