In 2020 the Care Quality Commission (CQC) set out ambitious plans to transform their approach to regulation, the technology used and ways of working. Fast forward four years and the vision has not come to fruition.
The roll out at the end of 2023 experienced many hitches including the move to the new digital system, the regulatory platform. This was launched at the same time as the new Single Assessment Framework (SAF).
Concerns were raised almost immediately from providers who had to submit information electronically on a new portal that experienced many problems. Another issue providers faced was the loss of inspectors allocated to their service. This meant providers no longer had access to, or a relationship with an inspector who knew their service well, and providers quickly started reporting problems when they were trying to raise issues or had queries.
By mid-2024 information was emerging that not all was well at CQC. It was announced in May 2024, that Dr Penny Dash had been asked to conduct a review into the operational effectiveness of the CQC. On 25th June 2024, the CEO Ian Trenholm announced he was resigning with almost immediate effect. His resignation statement included, “I am very proud of what we have done together over the last six years.” A few days after Ian Trenholm’s departure, the interim CEO Kate Terroni issued a problem statement stating, “Stakeholders and the Department of Health and Social Care are losing confidence in our ability to deliver our purpose.” It stated the way CQC was operating was not keeping people who used services safe and the “organisational structure, flow of decision making, roles, internal and external relationships had not promoted a productive and credible way of working.”
Just four weeks later, Dr Penny Dash’s interim report was published. The findings were damning, stating significant failings in the internal workings of CQC which 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 – and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care. It noted:
- significant challenges with the provider portal and regulatory platform.
- concerns around the single assessment framework (SAF).
- a lack of clarity regarding how ratings were calculated, and
- a concerning use of the outcome of previous inspections (often several years ago) to calculate a current rating.
Fast forward to October 2024 and the announcement that Sir Julian Hartley has been appointed as CQC’s new chief executive. Sir Julian joins from NHS Providers, where he has been chief executive since February 2023. In March 2024, NHS Providers, under Sir Julian’s leadership, launched a report looking into how the CQC could enhance its approach to regulation Good-quality-regulation-how-cqc-can-support-trusts-to-deliver-and-improve, NHS Providers . Recommendation 10 in this report states, ‘We recommend that: It is for CQC to act on feedback about its credibility and work with providers to regain their trust. It should consistently act with openness and transparency, meaningfully collaborate with those it regulates, and display a positive learning attitude.’ The report, in full, may provide some background to what Sir Julian will be focusing on in his early days.
On 15 October, two reviews were published outlining findings about the effectiveness of the CQC. The findings will bring no surprises for both providers and CQC staff. Single Assessment Review findings, CQC and Full report on review of operational effectiveness of the CQC, GOV UK. We hope these recommendations are implemented as urgently as possible. The focus on adult social care, we hope, will be aided by the reinstatement of a Chief inspector for social care. This is essential to balance the strong health background the new CEO brings. There is also a current survey by the Care Provider Alliance which is seeking feedback. We urge all providers to respond to any such requests so their experience is used to make improvements. See: Care Provider Alliance CQC Single Assessment Framework Feedback
Let’s hope 2025 will bring about a solution to have an efficient and high-quality regulator in place to quickly and safely assess the quality of all health and social care services. These services have been hammered for far too long, whilst continuing to try and deliver the best care and support. They had a gruelling time during the pandemic and full recovery from the impact of this is still ongoing including the national inquiry.
The troubled regulator has had a torrid few years. We hope that CQC both recognises and retains some ‘organisational memory’ of the harm caused by their ‘transformation’. There has always been a power imbalance between CQC and providers and under an unsafe, ineffective and ‘we can’t hear you’ regulator, the fear, anxiety and frustrations providers experience have increased exponentially. CQC must recognise their responsibility to regulate safely and sensibly, listen to their few remaining staff who actually understand inspection, and act to provide clear guidance, in plain English to ensure everybody can understand what they must do to maintain their compliance with the regulations. Good care hasn’t changed.
Like many we continue to wait for the regulator to become ‘fit for purpose’ and provide reassurance that risks are being acted upon. Until then, appreciation must be shown to all health and social care providers and the staff that turn up day after day to make a difference. Whether you are a regulator or a provider, our motivation is usually aligned, we all come to work to make a difference to the lives of the people we support. Come on CQC, you have a chance to get this right. Listen to providers and your own staff who truly understand effective regulation. Think about your comms and messaging, and please, please ‘recover’ swiftly, health and social care providers and people using services deserves better.