A government review has identified failings within the Care Quality Commission (CQC) which are ‘hampering its ability to identify poor performance’.
The interim report found that the regulator’s inspection levels were well below pre-COVID levels. It also described a lack of clinical expertise among inspectors and inconsistent assessments. Finally, the report identified issues with CQC’s IT systems.
The report said these failings mean CQC is ‘unable to consistently and effectively judge the quality of health and care services, including those in need of urgent improvement’. The result of this is care providers waiting ‘too long’ for registration and reviews, which limits their capacity to take patients.
CQC interim chief executive Kate Terroni said that the regulator fully accepts the findings and recommendations of the review. She said: ‘Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers.’
‘CQC is not fit for purpose’
The government said it would take ‘immediate steps to restore public confidence’. One of these steps will be developing a full report to be published in autumn.
Health and social care secretary Wes Streeting announced the following measures to improve CQC:
- A review of CQC assessment frameworks
- Improved transparency around how CQC determines ratings
- Increased government oversight of CQC, with regular updates provided
- A review of the effectiveness of all patient safety organisations.
The health secretary said: ‘When I joined the department, it was already clear that the NHS was broken and the social care system in crisis. But 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.’
‘Never turn a blind eye to failure’
Kate Terroni commented on CQC’s approach to the assessment framework review. She said: ‘We have appointed Professor Sir Mike Richards to conduct a targeted review of how the single assessment framework is currently working for NHS trusts and where we can make improvements.
‘Sir Mike’s career as a senior clinician, and a distinguished leader of high-profile national reviews, as well as his direct experience of driving improvement through regulation, make him uniquely placed to conduct this work.’
The interim chief executive also stressed that work is already underway to make improvements. She continued: ‘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.’
Wes Streeting said the public should be reassured by the government’s intervention. He said: ‘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.’
‘Long-eroded trust’
The CQC review was commissioned in May 2024, led by North West London Integrated Care Board chair Dr Penny Dash.
Dr Dash said: ‘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 is chief executive of Care England. He said: ‘It is clear that Dr Dash has listened to the voices of care providers, resulting in a clear set of recommendations. This report acknowledges the severe and systemic problems that sit at the very heart of the CQC and gives a specific set of steps that the regulator must take to improve performance and re-establish the sector’s long-eroded trust.’
Professor Green added that this would be a ‘long and difficult journey’ but one that is ‘entirely necessary’. He said: ‘CQC must embark on a radical improvement program that should not only include some tangible improvements in their performance, but also needs to move away from a culture of blame. We all want proportionate and effective regulation, and the challenge now is for CQC to take action and work with organisations across the sector to deliver it.’
‘A hugely significant move’
Earlier in the month, CQC issued an apology for many of the same issues identified in the review. Kate Terroni said CQC was ‘not consistently keeping people who use services safe’. She added: ‘For some of you, we’ve lost your trust because of this. I’m sorry.’
CQC also said that earlier concerns about these issues were not properly addressed. Kate Terroni said: ‘We didn’t listen properly or take on board these concerns, and that’s why we’re where we are now.’
FMC content director Guy Hiscott described this as ‘a hugely significant move’. He said: ‘An apology from a regulator is no mean feat – so I applaud Ms Terroni for her honesty and openness.
‘If this is a measure of what we can expect from the CQC going forwards then it bodes well for the future.’
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