Health Watchdog Not Fit for Purpose, Says Minister

Then-shadow health secretary Wes Streeting speaks to the media outside BBC Broadcasting House in London,on April 28, 2024. Jonathan Brady/PA

Health and Social Care Secretary Wes Streeting has branded England’s health watchdog “not fit for purpose,” after a report revealed significant failings in the Care Quality Commission (CQC).

The interim report by Dr. Penny Dash published on Friday said the failings were impeding the CQC in its ability to spot poor performance at care homes, GP practices, and hospitals during the inspection process.

Some of Dr. Dash’s emerging findings include health and social care settings not being reinspected for several years, with one NHS hospital having not been rated since June 2014.

The oldest rating for a social care organisation was from October 2015.

All providers of health care and adult social care in England must register with the CQC, which regulates and inspects these settings to ensure standards are met.

However, of the locations CQC had the power to inspect, around one in five have never received a rating.

Mr. Streeting said in a statement he had 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 CQC is not fit for purpose.”

“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,” he added.

Operational Performance Not Recovered Since Lockdown

One failing the review found was in its operational performance, which it said “was impacted by the COVID-19 pandemic.”

The report noted that despite two and a half years having passed since the government started removing the last of the lockdown restrictions, “CQC’s operational performance is still not where it should be.”

Specifically, the number of assessments and inspections had decreased, from more than 16,000 in 2019 to 2020, to just 7,000 in 2023 to 2024.

While this is partly due to the rollout of a new assessment framework, the target for 2024 to 2025 is significantly higher at 16,000.

There is also a backlog of registrations for new providers, with more than half (54 percent) of applications pending completion being more than 10 weeks old. This particularly affected smaller providers who were trying to set up care homes or new health care services, resulting in lost revenue and having a knock-on effect on capacity.

Timeframes for re-inspections were also a problem. The review found that social care providers who had received a “requires improvement” rating were finding that re-inspections did not happen in a timely manner.

Interviewees said that this delay meant hospital discharge teams refused to release people to them and local authorities would not agree contracts with them, again affecting care capacity in the area.

Loss of Sector Expertise

Another major finding was the loss of sector expertise in the CQC, resulting in a considerable loss in credibility within the health and social care sectors.

Restructuring of the CQC saw a move away from specialists to generalists conducting inspections, and this was reflected in some inspectors appearing to not understand the context of the health care settings they were in.

“The review heard of inspectors visiting hospitals and saying they had never been in a hospital before, and inspectors visiting care homes and commenting they had never seen anyone with dementia before,” Dr. Dash wrote.

The report added that this lack of sector expertise resulted in health and care providers “not trusting the outcomes of reviews and not feeling they have the opportunity to learn from others, especially from highly regarded peers.”

‘Urgent Need’ for Reform

Dr. Dash said that the contents of her interim report “underscore the urgent need for comprehensive reform within CQC.”

She continued, “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.”

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

Responding to the interim report, Kate Terroni, the interim chief executive of the CQC, said the watchdog accepts in full the findings and recommendations, and that it was committed to increasing the number of inspections and strengthening its senior level health care expertise.

“We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve,” Ms. Terroni said.

The Department for Health and Social Care (DHSC) announced immediate steps to restore public confidence in the watchdog, including appointing Professor Sir Mike Richards, a senior cancer doctor, to review CQC assessments.

The government will also have increased oversight of the CQC, with the body updating the DHSC regularity on its progress in implementing Dr. Dash’s recommendations.

The full report will be published in the autumn.