CQC promises assessments will become ‘simpler’ as two damning reports are released

The CQC has promised it will revise its current assessment framework ‘to make it simpler’ and more ‘relevant to each sector’, including primary care, in the face of two reviews published this week that identified serious organisational failings.

The watchdog has said it will retain the five key questions (safe, effective, caring, responsive and well-led) across all sectors, but amend the newly introduced 34 quality statements ‘to ensure clarity and remove duplication’. It will also stop scoring individual evidence categories, it has announced.

In addition, it has committed to appointing at least three chief inspectors to lead on regulation and improvement in the sectors of primary care, hospitals, and adult social care services. 

Earlier this week, two reviews – an internal one led by former chief inspector of hospitals at the CQC Professor Sir Mike Richards and a Government-commissioned review led by North West London ICS chair Dr Penny Dash – reported their findings.

Both highlighted major shortcomings, with Dr Dash concluding that the CQC has ‘lost its credibility’ and the internal review saying that a ‘fundamental reset of the organisation is needed,’ if it wanted to ‘deliver on its objectives’.

Sir Mike Richards said his overall findings ‘were entirely in line with Dr Penny Dash’s and that the reports complemented one another.

In particular, review found that:

• The CQC’s operational performance was poor, with far fewer inspections carried out than in earlier years
• The new single assessment framework is not ‘proving to be beneficial for primary care inspections’
• The new regulatory platform and provider portal are functioning poorly
• There is a serious backlog in processing registrations
• Reports are taking months to be published
• Some providers haven’t been reinspected for several years.

His review also recommended that the use of one-word ratings for GP practices should be further evaluated. Last month, the Government said that it is ‘not currently considering’ scrapping single-word CQC ratings for GP practices, despite the Institute of General Practice Management (IGPM) lobbying for change.

Meanwhile, Dr Dash’s report identified a similar catalogue of problems with the CQC. She also highlighted issues with the single assessment framework and pointed to a ‘lack of clarity on how ratings are calculated’ and a ‘concerning use’ of the outcome of previous much older inspections to calculate ‘a current rating.’

The review said that ‘ratings matter’ and are a significant factor in staff recruitment and retention.

Significantly, she also concluded there had been ‘a loss of expertise’ as a result of last year’s internal restructure, that saw staff from three directorates with a focus on specific sectors moved into integrated teams working at local level.

Her report said: ‘The review has found that the current model of generalist inspectors and a lack of expertise at senior levels of CQC, combined with a loss of relationships across CQC and providers, is impacting the credibility of CQC, resulting in a lost opportunity to improve health and social care services.’

The CQC said it has accepted the high-level recommendations of both reports and ‘is taking rapid action in response’.

As well as the changes outlined above, it said it will fix its regulatory platform and provider portal in the immediate term and review what improvements can be made to better the experience for providers registering with the CQC (see also box below).

In the next phase of its recovery, it said the CQC will work with ‘providers, colleagues, people who use services, local government, and wider stakeholders to develop a plan on how it will implement these changes and make sure it is realistic about what can be delivered by when.

It added: ‘Once this is signed off, CQC will share what people can expect, and when.’

Ian Dilks, chair of CQC, said both reviews have ‘reaffirmed the support for a robust health and care regulator and recognised the dedication and experience of CQC staff’.

He added: ‘We are committed to rebuilding trust in CQC’s regulation and are taking action to make sure we have the right structure, processes, and technology in place to help us fulfil our vital role of helping people get good care and supporting providers to improve.’

Professor Sir Mike Richards said that despite the failings he believed the CQC’s problems can be fixed ‘relatively quickly under the leadership of Julian Hartley, the incoming chief executive’.

‘These changes will help the regulator to effectively deliver its crucial work of ensuring that people get high quality, safe care,’ he also said.