Annual report and accounts 2022/23

This section provides a summary of our performance against our strategic priorities and core ambitions, how we have performed and significant highlights for 2022/23. The performance overview is intended to enable readers to understand the organisation, its purpose, the outcomes and objectives, and the impact and management of key risks.

People and communities

• We have continued to strive for people’s voice and experience to be a key part of our regulation by gathering information about people’s experiences across all types of health and care services. This is to ensure our activity is driven by people’s experiences.
• We received 96,300 contacts with feedback on care throughout the year, compared to 64,000 the previous year.
• We delivered a programme of work to transform the way we regulate services for autistic people and people with a learning disability. As part of the programme, we inspected 947 services.
• After the pandemic, we continued to use a varied approach to regulating services. We carried out over 10,000 on-site inspections, some of which were in response to risk (both new and emerging risks, and inherent risks), but also to support thematic work such as maternity or mental health services.
• We complemented our site visit inspections through direct monitoring activity of over 15,000 services to gather further evidence, including a telephone call with a provider.
• We use evidence from our inspections to help inform and share information with providers and the public. In November 2022 we published ‘Who I am matters: experiences of being in hospital for people with a learning disability and autistic people’. The publication focused on access to care, communication, experiences of people with other equality characteristics, and the quality of their care.
• Specialist professional advisors are key to our regulatory activity and offer knowledge and expertise to our inspections. The number of inspections involving a specialist advisor increased by 36% compared with last year.
• Throughout the year, we trialled a new webchat service for the public where people can start a live chat with a member of our Customer Services team. We also improved the accessibility of our website and partnered with Disability Rights UK to encourage people who are deaf and hard of hearing to contact us about their experiences.

Smarter regulation

• We used our independent voice to publish several reports summarising what we know from our assessments – we use the findings of these reports to drive improvement in care for the public.
• We have spent time across the year, through careful co-production and consultation, building our new approach to assessment, which we will start to implement at the end of 2023.
• Following a joint consultation with Ofsted, we implemented a new assessment framework to inspect services for children and young people with special educational needs and disabilities (SEND). The new framework is designed to allow inspectors to better understand what it is like to be a child or young person with SEND in a local area.
• We inspected safehouse and outreach support services, in a programme commissioned by the Home Office. These services are used by people who are survivors of human trafficking and modern slavery.
• During 2022/23, we undertook a range of activity to prepare for our new responsibilities from April 2023 in assessing care in a local area. This included partnership working and test and learn projects.

Safety through learning

• We received and processed 15,792 enquiries from workers who were speaking up and took appropriate regulatory action to ensure people receive safe, effective, compassionate, and high-quality care.
• We improved our approach to understanding and assessing a safety culture following a research project that explored current understanding of safety cultures and the conditions required to develop good safety cultures.
• We published 3 safety bulletins to enable registered persons to learn and make improvements. These included issues of capacity and consent, promoting sexual safety and unsafe management of sepsis.
• We referred 97% of patient safeguarding risks to the relevant organisation within one day of receiving the information, a 2% increase from the previous year.
• In March 2023, we published 2 reports designed to improve how we listen to, learn from and act on concerns raised in the sector. We want to encourage people to share their thoughts and ideas and raise concerns knowing these will be welcomed and heard. Our publications and recommendations strive for further improvements in this area.

Accelerating improvement

• In our 2022 annual provider survey, 77% of providers agreed or strongly agreed that they had the right support from CQC that is needed for them to improve.
• We published our CQC research programme with the 5 priority areas to focus our research on in June 2022. This included increasing the level of research.
• In December 2022, we launched a research project reviewing improving cultures in health and adult social care settings and, in March 2023, we initiated further research in improvement support offers across the sector.
• In March 2023, we published a follow-up piece to ‘Smiling Matters’, our previous work on access to oral health care in care homes, published in 2019.
• We collaborated with health and care leaders to co-produce resources to support improvement and encourage innovation. In October 2022, we published PEOPLE FIRST: a response from health and care leaders to the urgent and emergency care system crisis. 

Core ambition: assessing health and social care systems

• In October 2022 we published our annual State of Care report – our assessment of health care and social care in England. This highlighted the need to focus on systems, with local areas taking a whole system view that recognises the relationship between health and social care.
• In 2022 we carried out initial ‘test and learn’ activity to test our assessment approaches for integrated care systems and local authorities, and used the findings to inform our assessment methods.
• From 1 April 2023, we started to review data and documentary evidence from all integrated care systems. This was to build a national view of performance, initially focusing on themes of equity in access to care.

Core ambition: tackling inequalities in health and social care

• During the year, we continued to integrate our equality objectives into our research, data and engagement strategies.
• We are continuing to collaborate with other national bodies to develop our approach to health inequalities, to ensure alignment and best use of our respective powers. This includes NHS England, the National Institute for Health and Care Excellence, Office for Health Improvement and Disparities, and the Equality of Human Rights Commission. 

Our key risks:

Throughout the year, we have revised our corporate risk register to include new risk categories, our risk definitions and the appetite and tolerance we set for them. We have managed some key risks across the year as follows:

• Challenges in recruiting specialist technology, intelligence and legal roles has been a risk that has needed additional action to mitigate. We have explored a variety of recruitment options and closely reviewed capacity in these key areas to understand the risk to business delivery.
• While we are completing our technology and business change, there is a risk that our legacy systems do not meet the business need.
• Our people survey and other sources have identified risks in relation to engaging our colleagues in our culture change and ways of working.
• We have set an ambitious organisational transformation, and we need to closely monitor the risk of delivering both the transformation programme and the aspirations of our strategy, such as driving improvement in the sector. Within the year, we revised our transformation programme plan and shared all updates and changes with colleagues across the business to ensure that they understand the key aims of the programme.
• There is a risk that, as we change our regulatory methodology and technology, it will have an impact on our operational colleagues – specifically on their productivity and ability to deliver their regulatory activity. Through governance forums, we have agreed clear operational priorities to assure ourselves that we are using our resources in the most valuable way.

In all these areas, we have worked to build assurance and effective mitigation. This work continues going forward.