CQC has ‘lost its credibility’ and must rebuild trust, says Government-commissioned review

The CQC has ‘lost its credibility’ within the services and providers it inspects, a damning review has concluded.

The watchdog’s ‘significant failings’ have led to ‘a substantial loss of credibility’ and to ‘a deterioration’ in its ability to identify poor performance, according to a Government-commissioned review published in full today.

‘Poor-quality’ and delayed CQC reports have also limited the credibility and impact of assessments for providers, according to North West London ICS chair Dr Penny Dash who led the review.

Dr Dash found that the CQC’s current model of generalist inspectors and ‘a lack of expertise’ at senior levels is impacting the credibility of the watchdog.

It comes after the CQC published its own internal review this morning, which argued that a ‘fundamental reset of the organisation is needed’ and that the CQC ‘will never be able to deliver on its objectives’ if the current structure is maintained.

The CQC went through a restructuring last year, which moved staff from three directorates with a focus on specific sectors into teams operating at local level, ‘resulting in a loss of expertise’ which meant providers did not trust the outcomes of reviews, Dr Dash concluded.

She said: ‘This review has found significant failings in the internal workings of CQC, which have led to a substantial loss of credibility within the health and social care sectors, deterioration in the ability of CQC to identify poor performance and support a drive to improved quality, and a direct impact on the capacity and capability of both the social care and healthcare sectors to deliver much-needed improvements in care.’

Her review received more than 125 emails from CQC staff members and saw letters from trade unions to former health secretaries informing them of ‘significant issues’.

It added: ‘The review acknowledges that there will always be internal resistance to any change or transformation programme, but the scale and consistency of comments is striking.’

Dr Dash said she spoke to around 200 senior managers, caregivers and clinicians, and over 100 people within CQC, and that all sectors told her that they can wait for ‘several months’ to receive reports and ratings following assessment.

The review found that there has been ‘a stark reduction’ in activity with just 6,700 inspections and assessments carried out in 2023, compared with almost 15,800 in 2019, resulting in ‘considerable delays’ in re-inspecting providers after a ‘requires improvement’ or ‘inadequate’ rating. 

Its recommendations (see box), include ‘a wholescale review’ of the single assessment framework to address the concerns raised, a suggestion that was also made in the CQC’s internal review.

Dr Dash pointed out that ‘poorly performing IT systems’ are hampering CQC’s ability to roll out the single assessment framework, and ‘cause considerable frustration’ and time loss for providers and CQC staff.

She also recommended that the CQC should ‘clarify how ratings are calculated and make the results more transparent’ and argued that changes to the one-word ratings used in inspections ‘could be beneficial’ in allowing greater clarity.

It said: ‘The approach used to calculate ratings should be transparent and clearly explained on CQC’s website.

‘The review has learnt that overall ratings for a provider may be calculated by aggregating the outcomes from inspections over several years.

‘This cannot be credible or right. Furthermore, providers do not understand how ratings are calculated and, as a result, believe it is a complicated algorithm, or a “magic box”.’

The review concluded that the CQC will need to set out how, and by when, it will make the changes required. 

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

In agreement with the Department of Health and Social Care, the CQC has paused its assessments of ICSs for six months and said that this is ‘to free up capacity to carry out more assessments’ of providers and enable the regulator to modify its current assessment framework.

The watchdog said it 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’. Once this is signed off, CQC will share what people can expect, and when.

CQC chair Ian Dilks said: ‘We welcome the final part of Dr Penny Dash’s review – we accept the findings and we will address the recommendations with urgency.

‘Today also sees the publication of the review we commissioned from Professor Sir Mike Richards – we are extremely grateful to Sir Mike for his helpful work and will be using his recommendations to help us respond to the serious failings identified by Dr Penny Dash.

‘His review also offers additional suggestions for improvement that we will be exploring as part of our wider recovery work.

‘Both reviews have reaffirmed the support for a robust health and care regulator and recognised the dedication and experience of CQC staff.

‘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.’