Independent review finds “significant failings” in effectiveness of Care Quality Commission

An independent review has identified “significant internal failings” at the Care Quality Commission (CQC), and has warned that the regulator is unable to “consistently and effectively” judge the quality of health and care services.

The Government said it 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.

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 regulator’s IT system. 

Of the locations the CQC has the power to inspect, it is estimated that around 1 in 5 have never received a rating.

The independent review heard of inspectors visiting hospitals and saying they had “never been in a hospital before”, and an inspector of a care home who had “never met a person with dementia”.

Commenting on her findings so far, Dr Dash said: “The contents of my interim report underscore the urgent need for comprehensive reform within the CQC.  

“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.”

The Health and Social Care Secretary has now announced four immediate steps the Government and CQC will take to “restore public confidence” in the regulator, including:

• 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.

Health and Social Care Secretary, Wes Streeting, said: “I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me the CQC is not fit for purpose.

“We cannot wait to act on these findings, so I have ordered the publication of this interim report so action can begin immediately to improve regulation and ensure transparency for patients.”

He added: “I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care. I want to reassure them that I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed. This government will never turn a blind eye to failure.”

Kate Terroni, CQC’s interim chief executive, said: “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.

“[…] Work is underway to improve how we’re using our new regulatory approach. We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement.

“We’re increasing the number of people working in registration so we can improve waiting times. We’re working to fix and improve our provider portal, and this time we’ll be listening to providers and to our colleagues about the improvements that are needed and how we can design solutions together. We’ll be working with people who use services and providers to develop a shared definition of what good care looks like. And we’re also developing a new approach to relationship management that enables a closer and more consistent contact point for providers.”

According to the Department of Health and Social Care, the CQC’s progress will be monitored over the summer and the full independent report will be published in the autumn.

Lottie Winson