It has been a tumultuous few months for CQC to say the very least. In May 2024 we saw the first public acknowledgement of concerns with CQC’s new Single Assessment Framework (“SAF”) through the commissioning of the Dash Review, in June we saw the announcement that CQC’s Chief Executive (Ian Trenholm) was stepping down and in July we saw an unprecedented public acknowledgement from CQC that it’s not fit for purpose. This was promptly followed by the publication of the interim report from the independent review into the operational effectiveness of the CQC, led by Dr Penelope Dash (‘the Dash Review’), on 26 July 2024.

A brief summary of the interim findings from the Dash Review is set out below and this article addresses where we are now, what this means for CQC registered providers and what we can expect in the future.

Main findings and recommendations noted in the Dash Review’s Interim Report

The interim report succinctly summarises the findings emerging from the review and has set out five recommendations for CQC to start working on right away.

Five emerging findings have been reported as follows:

  1. Poor operational performance (including a significant reduction in inspection activity, a lack of initial and follow-up inspections, delays to registrations and poor call centre performance).
  2. Significant challenges with the provider portal and regulatory platform which are hampering CQC’s ability to roll out the Single Assessment Framework (SAF) and cause considerable frustration and time loss for providers.
  3. Considerable loss of credibility within the health and care sectors due to loss of sector expertise and wider restructuring, resulting in lost opportunities for improvement.
  4. Concerns around the SAF (including no description of what ‘good’ care looks like, resulting in a lack of consistency in how care is assessed, a lack of focus on outcomes, a lack of transparency around the data used to understand the user voice and experience, no reference to use of resources or efficient delivery of care in the assessment framework and limited reference to innovation in care models or ways of encouraging adoption of these).
  5. Lack of clarity regarding how ratings are calculated and concerning use of the outcome of previous inspections (often several years ago) to calculate a current rating.

Five recommendations have been made in line with the findings. These are for CQC to:

  1. Rapidly improve operational performance;
  2. Fix the provider portal and regulatory platform;
  3. Rebuild expertise within the organisation and relationships with providers in order to resurrect credibility;
  4. Review the SAF to make it fit for purpose;
  5. Clarify how ratings are calculated and make the results more transparent, particularly where multi-year inspections and ratings have been used.

The interim report has additionally highlighted the necessity for the DHSC to enhance its oversight of CQC including more regular performance conversations to take place to reinforce progress against the recommendations set out above and expanded on in the interim report.

Where are we at now?

CQC has accepted there are genuine issues and has stated its commitment to working with providers and other relevant stakeholders to further develop and improve its processes.

Prior to the publication of the Dash Review’s interim report, Kate Terroni, the Interim Chief Executive of CQC, issued a statement on 15 July 2024 which noted three urgent and immediate areas of action as follows:

  1. Improve how CQC is using its regulatory approach by:
  • Increasing and improving the support and guidance for providers on CQC’s regulatory approach;
  • Increasing the number of assessments and inspections CQC is doing;
  • Improving registration waiting times following the recent increase in the number of people working in registration and working to get any outstanding registration applications processed as soon as possible.
  1. Fix and improve the provider portal by continuing to work with providers to identify improvements that can be made to the portal and design solutions together.
  2. Rethink CQC’s ways of working including testing a new approach to relationship management that enables a closer and more consistent contact point for providers.

The statement also included an apology that CQC got things wrong in the implementation of the SAF. It acknowledged the technical issues experienced with the provider portal and delays in the registration process. It also acknowledged that a number of issues CQC is now facing were anticipated and flagged by providers and CQC did not listen properly or take on board the concerns. It stated a commitment to urgently and rapidly improve how CQC is using its regulatory approach and to make the changes needed to steer CQC in the right direction.

A further statement was issued by CQC in response to the interim findings of the Dash Review on 26 July 2024 accepting the findings and recommendations in full and reiterating the points noted above. CQC has reflected on its failure to listen to providers and has stated a commitment to work together with people who use services, providers and partners to agree more actions and develop solutions.

What does this mean for CQC registered providers?

The key point to note is there has not been a pause in inspection activity as a result of recent announcements (albeit, as noted in the Dash Review’s interim report, CQC inspection activity has more than halved compared to figures from 2019-2020). CQC is continuing to inspect services under the SAF and continues to pursue enforcement action where it believes it is necessary. No changes have been announced in relation to the application of the SAF to inspections to date.

In the current landscape CQC may be more responsive to challenges raised in response to assessment findings through the FAC process. Therefore, if providers have concerns with any communicated inspection findings, they should utilise the FAC process to help ensure inspection reports are as accurate a reflection of the service as they can be.

What can we expect in the future?

There is still a lot of uncertainty around what changes will be made to CQC’s assessment process over the next few months and how wider changes to the organisation will impact this.

A lot of high-level statements have been made, including in Kate Terroni’s statement from 15 July 2024. As an example, during an online CQC Regulatory Approach Advisory Group meeting with providers on 29 July 2024, CQC said it was considering putting a pause on the scoring of evidence categories, while continuing to score Quality Statements.  No detail was provided as to how this might work in practice and generally speaking there has not been much tangible information about what’s happening on the ground. That said, we do know the following:

  • The Dash Review’s final report is expected to be published in Autumn 2024. The interim report has already listed 5 recommendations (noted above) and these are expected to be expanded on.
  • CQC continues to seek to engage the public in providing feedback on various aspects of its operations. The current live CQC survey is requesting feedback on whether Kate Terroni’s recent statement adequately reflects people’s feedback and concerns and whether the actions CQC is proposing feel like the right ones. The survey can be accessed here – https://citizenlabco.typeform.com/to/RWJlLVgt.
  • CQC has said it will be developing a new CQC handbook for all providers. It is working together with stakeholders to produce this and will be releasing more information soon on how people can get involved. So far CQC has been told the handbook should cover the following:
  • What providers can expect from an inspection
  • What customer services standards should be expected from CQC
  • How CQC can together with stakeholders reach a shared understanding of what ‘good’ looks like for different service types
  • Frequencies of assessment – further information on this was meant to be published in July but this has been delayed as a result of the Dash Review’s interim report. CQC is now saying it will publish an interim statement in August about how frequently it plans to assess each type of service. CQC will then publish more information on this in September.

Information will continue to be released by CQC over the coming weeks and months. Providers should sign up to CQC’s email circulars to ensure they get the most up to date news on developments and actively engage with CQC’s requests for feedback. The Health and Social Care Team at Gordons Partnership will continue to report on any significant changes that take place through the monthly newsletter and on LinkedIn.

 

About the Author

Samantha Burges

Senior Associate Solicitor