In May 2024, a review of the Care Quality Commission (CQC) was carried out. About 170 health and care sector senior managers, caregivers and clinicians contributed to the review, as well as over 40 senior managers and national professional advisors at the CQC. During the review, considerable and consistent concern was expressed about how the CQC functions.
An interim report was published on 26th July 2024, with the full report expected some time in Autumn 2024. The report sets out a high-level summary of what’s been found so far and the changes that will be needed to ensure the CQC is fit for purpose.
What is the Care Quality Commission (CQC)?
The CQC is the independent regulator of healthcare and adult social care in England. Established in 2009 under the Health and Social Care Act 2008, it brought together the formerly separate Commission for Social Care Inspection (CSCI), the Mental Health Act Commission and the Healthcare Commission.
All providers of healthcare and adult social care regulated activities in England must register with the CQC and the Commission monitors, inspects and regulates these services to ensure they meet fundamental standards of quality and safety.
To protect those who use these services, the CQC assesses provider performance and rates them. To ensure transparency and to reassure service users, the assessments and ratings are available to the public.
In November 2023, the CQC replaced its previous system of inspections and assessments with what it called its Single Assessment Framework (SAF).
This was intended to simplify the assessment process and make it more insight-driven, increasing the frequency of inspections and reflecting how care is delivered by different sectors.
However, those intentions were not borne out by experience since its introduction, and there have been concerns that it was not operating as it had originally been intended; nor was it providing effective assessments.
What the review found
The findings fall into five key areas:
- Operational performance levels are perceived as poor.
- There have been significant challenges with the provider portal and regulatory platform.
- The CQC has experienced loss of sector expertise and wider restructuring, and this has caused considerable loss of credibility within the health and care sectors.
- Concerns have been expressed about the Single Action Framework
- The way the ratings system works is unclear. The use of the outcome of previous inspections (which often took place several years ago) to calculate a current rating, which has led to significant concern in the care sector.
rradar’s Rupert Nevin has taken a look at the interim report to find out what the care sector needs to be aware of. Rupert says:
“It is likely that in the short term, there will be an increased number of inspections, but this will not mean better or more consistent outcomes until the competency of inspectors and consistency of approach is addressed – and this could take years. There may therefore be some more ‘wobble’ whilst issues are ironed out.
“From a purely legal perspective, if ratings issued are not reliable, then this could potentially open up the possibility of appeals out of time for enforcement decisions that – with the benefit of hindsight – were wrong.
“The interim report is an insight into the approach of the new Government to regulation – clearly, they want better regulators.
“It’s also worth considering that this focus on regulators and regulation is likely to be transposed into the HSE, whose enforcement activity has dropped dramatically in recent years as this article shows:
https://www.constructionnews.co.uk/health-and-safety/revealed-sharp-drop-in-work-at-height-safety-investigations-02-07-2024/
“The terms of reference of the report include CQC investigations but do not directly consider the effectiveness of enforcement for care providers in breach of the Health and Social Care Act 2008. Yet any enforcement action in the next few months is likely to be scrutinised by lawyers in ever more detail – for how long can this be sustained?
“In my experience, CQC inspectors very often see lawyers (and sometimes regulated care providers) as the enemy when what we all want is a level playing field and clear and transparent decision making. The common denominators are defensiveness and lack of transparency inside the CQC (which may be the consequence of lack of sector knowledge). We often see lack of response by the CQC to self-reports and – all too often – criticism of the CQC at inquests.”
If you’re concerned about what this review might mean for your business, contact rradar’s Business Crime and Regulatory Team, who have extensive experience dealing with a wide variety of regulators, including the CQC. The team has also helped many businesses in the Care sector who have come under investigation following incidents reported to the CQC, and they have provided advice, guidance and – where necessary – legal representation in hearings, interviews under caution and court appearances.