Health Watchdog Needs ‘Rapid Turnaround’ After Review Finds Significant Failings

A general view of staff on a NHS hospital ward at Ealing Hospital in London, England, on Jan. 18, 2023. PA Wire/PA Images

There is an “urgent need for a rapid turnaround” of the Care and Quality Commission (CQC) after a review found “significant failings” in the internal workings of the health and care regulator.

Dr. Penny Dash’s final review into the body published on Tuesday said the issues had “led to a substantial loss of credibility within the health and social care sectors” and a “deterioration in the ability of CQC to identify poor performance and support a drive to improved quality.”

The failings also had a “direct impact on the capacity and capability of both the social care and healthcare sectors to deliver much-needed improvements in care.”

Some of the issues Dash identified include poor operational performance, noting that there had been a “stark reduction” in the number of inspections between the pre- and post-COVID-19 pandemic periods, with 6,700 inspections carried out in 2023 compared to almost 15,800 in 2019. This fall in inspections resulted in delays in re-inspections, a growing backlog of new registrations of health and care providers, and an increasing age of ratings.

There are delays in producing reports and poor-quality reports, with all sectors telling Dash that they can wait several months to receive ratings and reviews after inspections. There is also a lack of clarity over how ratings are calculated.

A loss of sector expertise and restructuring had featured as issues contributing to the deteriorated quality of the regulator’s operations. The review said that the “current model of generalist inspectors and a lack of expertise at senior levels” is impacting the credibility of the watchdog.

“The review has concluded that poor operational performance is impacting CQC’s ability to ensure that health and social care services provide people with safe, effective and compassionate care, negatively impacting the opportunity to improve health and social care services, and, in some cases, for providers to deliver services at all,” the report found.

‘Root Out Poor Performance’

In July, Dash published her interim report which said there was an “urgent need for comprehensive reform within CQC.”

Dash said the full report published on Oct. 15 reflects the recent conversations she has had with staff and provides greater depth to her findings and recommendations.

Dash recommended a series of measures be taken to support improvements and restore credibility in the CQC, including a move to rapidly improve operational performance and quality of reporting, clarifying how ratings are calculated and being transparent about results, and rebuilding expertise.

Responding to the report, Secretary of State for Health and Social Care Wes Streeting said: “Patient safety is the bedrock of a healthy NHS and social care system. That’s why we are taking steps to reform the CQC, to root out poor performance and ensure patients can have confidence in its ratings once again.

“This government will never turn a blind eye to failure. An overly complex system of healthcare regulation and oversight is no good for patients or providers. We will overhaul the system to make it effective and efficient, to protect patient safety.”

Streeting has asked Dash to conduct two further health and social care reviews, the first focusing on patient safety and the second on quality and governance.

CQC Transformation Programme ‘Failed’

The Department for Health and Social Care (DHSC) also announced that Sir Julian Hartley, the former chief executive of NHS Providers, would be appointed as the CQC’s new CEO.

The CQC had previously asked Professor Sir Mike Richards, who the DHSC appointed to review CQC assessments, to conduct an internal review of the health watchdog, which was also published on Tuesday.

Richards’ review said that the CQC’s transformation programme in 2021 had delivered three significant changes: a major organisational restructure; the introduction of a single assessment framework across all sectors (including hospitals, mental health services, ambulances, and adult social care); and the development of a new IT system.

He said “all 3 have failed to deliver the benefits that were intended.” Some aspects of the transformation programme which were criticised included chief inspectors no longer being responsible for the inspections in their own sector and that the assessment framework is too complex and does not work with the range of diverse services that the different sectors provide.

Richards, a former chief inspector of hospitals at the CQC, called for a return for chief inspector-led teams and a less complex framework, as well as for the IT system to be rectified.

The CQC said it accepted the recommendations of both Dash’s and Richards’ reports “and is taking rapid action in response.”

Saffron Cordery, deputy chief executive of NHS Providers, a membership body for NHS trusts in England, said, “With two new reviews announced which will focus on patient safety and quality, trust leaders are ready and willing to work with the CQC and all other key organisations as they strive to provide high-quality services for patients and in their quest to keep improving and innovating.”