Review into the operational effectiveness of the Care Quality Commission confirms significant failings

The final Dash Report and report by Professor Richards commissioned by the CQC sets out recommendations to improve the regulator’s performance and provides insight into the future of health and social regulation in England 

The full report of the independent review by Dr Penny Dash (the "Dash Report") into the operational effectiveness of the Care Quality Commission (the "CQC") was published on 15 October 2024. 

The report by Professor Richards commissioned by the CQC Board, which focused on the Single Assessment Framework (“SAF”), was also published on 15 October 2024 (the “Richards Report”). 

This update will be relevant to all those involved in the delivery of regulated healthcare services, including providers, shareholders and potential investors, as it provides an indication as to the potential evolution of health and social care regulation in England.

Final findings of the Dash Report:

In line with Dr Dash’s interim findings, the full Dash Report “has found significant failings in the internal workings of the CQC, which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality.”

The conclusions reached in the Dash Report build upon those identified in the interim report which we considered in our previous article. However, the Dash Report makes additional conclusions as follows:

1. Delays in producing reports and poor quality of reports: the review identified that all sectors can wait several months to receive reports and ratings from the CQC following inspection. The review also identified concerns about the quality of reports. The combination of delayed and poor-quality reports “hampers users’ ability to access information, and limits the credibility and impact of assessment for providers.”
2. Opportunities to improve CQC’s assessment of local authorities’ Care Act duties: the review identified broad support for the overall assessment framework, but feedback was received which indicated that the assessment and reporting process could be improved (for example, the report identified that there are concerns as to how comprehensively local authorities’ commissioning functions are assessed).
3. Integrated care system ("ICS") assessments: whilst ICS assessments are in the early stages of development a number of concerns have been raised.
4. CQC could do more to support improvement in quality across the health and care sector: while the CQC should not be an improvement body, the report identified that there are opportunities for the CQC to do more to support the health and care sector to improve by, for example, describing best practice.
5. Opportunities to improve the sponsorship relationship between CQC and the Department of Health and Social Care ("DHSC"): the report identified that the DHSC could do more to ensure that the CQC is sponsored effectively.

The Dash Report sets out the following recommendations:

1. Rapidly improve operational performance, fix the provider portal and regulatory platform, improve use of performance data within the CQC, and improve the quality and timeliness of reports.
2. Rebuild expertise within the organisation and relationships with providers to restore credibility.
3. Review the SAF and how it is implemented to ensure it is fit for purpose, with clear descriptors, and a far greater focus on effectiveness, outcomes, innovative models of care delivery and use of resources.
4. Clarify how ratings are calculated and make the results more transparent.
5. Continue to evolve and improve local authority assessments.
6. Formally pause ICS assessments.
7. Strengthen sponsorship arrangements to facilitate the CQC’s provision of accountable, efficient and effective services to the public.

Review of the CQC's single assessment framework and its implementation:

The Richards Report has identified that the key elements of the CQC’s transformation plan (these being: organisation re-structure, introduction of the SAF and introduction of the regulatory platform) have all failed to deliver their intended benefits. These failures have had “major adverse consequences” and the report identifies the following key concerns:

1. The CQC has been unable to fulfil its primary purpose of ensuring that health and care services provide safe, effective and compassionate high quality care, and encouraging services to improve. 
2. Clinical oversight of the inspection programmes has been lost as Chief Inspectors are no longer responsible for their own sector of expertise (this is echoed by the Dash Report which identified that the current model of generalist inspectors has impacted the CQC’s overall credibility).
3. The SAF is too complex.
4. The regulatory platform has had a serious adverse impact on the working lives of CQC staff and those using it in provider organisations.
5. The report identifies a number of staffing concerns including low morale and insufficient staffing levels to undertake the CQC’s duties within reasonable timescales.

A number of recommendations have been made including:

1. A “fundamental reset” of the CQC. The report recommends reverting back to the previous organisational structure as soon as reasonably possible with at least 3 Chief Inspectors being appointed.
2. The SAF requires simplifying to ensure it is fit for purpose for each sector and it is recommended that evidence categories and scoring at evidence category level are removed. 
3. Further work is urgently needed to determine how the current backlogs in registration can be reduced or eliminated. 

Next steps:

The CQC has accepted the high-level recommendations of both reports and has committed to taking a number of actions to address the failings identified. These actions include the appointment of at least 3 Chief Inspectors alongside further work to modify the SAF. 

It is clear from both reports that the CQC will need to undertake significant work to remedy the issues identified and the output of the CQC’s further work is awaited. 

Following the publication of these reports, the Health Secretary has also announced that Dr Dash has been commissioned to conduct two further reviews focusing on patient safety and quality. These findings will inform the Government’s 10-Year Health Plan to transform the NHS and social care.

If you would like to discuss any of the above please contact a member of our Healthcare team.

This article was written by Harriette Alcock, Lisa Mulholland and Patrick Parkin.