Care Quality Commission – ‘a pinch of salt’

What has happened?

Dr Penny Dash, Chair of the North West London Integrated Care System, was asked to conduct a review of the Care Quality Commission (“CQC”) in regards to the operational functions of the independent body. The interim report was published on 26th July 2024 and can be found here.

What has this revealed?

The interim report (the final report is expected to be published in the Autumn) has revealed significant failings within the internal operations of the regulator and highlighted the need for serious reform.

Dr Dash’s interim report identified a number of inconsistencies which included, but were not limited to:

• Inspectors not being sufficiently qualified to conduct a review,
• Re-inspections not being done within a timely manner and a lack of consistency in assessments. For example, the report found that some social care providers have been awarded a ‘requires improvement’ rating and re-inspection does not occur with in a sufficient timeframe. This has resulted in those providers missing out on contracts with local authorities and hospital discharge teams refusing to discharge people to them.

Furthermore, the Single Assessment Framework (“SAF”) was introduced in November 2023 to replace the previous system of inspections and assessments. SAF was applied in order to develop an approach to measuring quality of care across all health and social care sectors. The rollout it said has not been successful and the interim report revealed a number of issues with this including:

1. There is no description of what ‘good’ or ‘outstanding’ care looks like so providers are unable adequately to put measures in place to improve.
2. There is a lack of focus on outcomes.
3. The guidance on the SAF for providers is difficult to follow thereby making it hard for providers to comply.
4. Data used to identify service users’ experiences may not be statistically significant as the majority of data is drawn from national surveys which may not be representative of the services as a whole. The data is supplemented by interviews with service users but some of these only represent 10 users of a service that may be caring for thousands of people a year.
5. SAF does not reference use of resources or sufficiently deal with the requirements for efficient delivery of care despite being stated in section 3 of the Health and Social Care Act 2008.
6. Limited reference to innovation in care models or ways of encouraging adoption of these.

What has been said in response?

Wes Streeting, the Health Secretary, has stated that the public should take any ratings on the CQC website with a ‘pinch of salt’ and that the CQC in its current form is ‘rotting’. The Health Secretary immediately ordered for this interim report to be published, instead of waiting for the full findings to be released in October, so that action can immediately be taken in rectifying the CQC’s failings.

What does this mean?

This is an interim report and more in-depth findings will be published in Autumn 2024 where the full extent of the operations will be examined. It remains to be seen what can be achieved by the CQC between now and final report being published in Autumn but it appears that it could get worse before it gets better.

Providers and service users will understandably be extremely concerned by the findings in the interim report and find themselves placed in a difficult position on how much trust can be placed on current ratings.

The inspection process and the feedback from those inspections can help many organisations understand what can be improved and how to achieve best practice. Lessons can be learned from individual reports across a whole sector. Consistency and quality in the CQC’s methodology is therefore fundamental and we often encounter situations in which timely CQC guidance could have avoided important failures.

When we represent at inquests, prevention of future death reports sometimes refer to issues the CQC could have picked up at an early stage. In our wider healthcare regulatory work, we often find ourselves providing the kind of advice we would expect the CQC to give when engaging with a provider. The report is therefore an important step in addressing a long-standing shortfall, but the extent to which additional resources can be applied to the process will depend very much on political priorities.

What about sponsor licences?

For many years, care homes in the UK have been able to secure a sponsor licence to sponsor care workers. In an effort to crack down on net migration, and due to the large number of care homes sponsoring staff to undertake the recognised shortage occupation role, the previous Conservative government made it a requirement that care providers in England must be undertaking activities regulated by the CQC in order to sponsor migrant workers. This change was implemented earlier this year in the hope that the government could reduce the number of care providers sponsoring Skilled Workers under the Health and Care Worker route, presumably because additional regulatory requirements should have made it more complex for care providers to secure CQC approval and thus be able to sponsor international workers. We now know this may not have been the case; the interim report released indicates that the additional step of holding CQC registration does not necessarily mean that care providers with CQC approval are more likely to be compliant with their sponsorship duties. Furthermore, due to the issues highlighted in the report, securing CQC regulation may not have been as difficult as what the Conservative government anticipated.

For now, CQC regulation remains a requirement for care providers wanting to sponsor care workers; it’ll be interesting to learn the outcome of the full report later this year, and whether the current government will still require CQC regulation for the organisations looking to sponsor care workers.