The Care Quality Commission (CQC) has welcomed 2 important reviews that will help to set the future direction for CQC: the final report of Dr Penny Dash’s review and the first report of the independent review by Professor Sir Mike Richards.
The regulator has accepted the high-level recommendations of both reports, which identify serious organisational failings, and is taking rapid action in response. CQC has committed to:
- Align the organisation around sector expertise by appointing at least 3 chief inspectors to lead on regulation and improvement of hospitals, primary care, and adult social care services. Consideration will also be given to whether a fourth chief inspector is needed to lead on regulation and improvement of mental health services. CQC will support staff to strengthen their own sector knowledge and expertise and will work with its new Chief Executive, Sir Julian Hartley, key stakeholders, and colleagues to review whether any further changes are needed.
- Modify the current assessment framework to make it simpler and ensure it is relevant to each sector. This will enable CQC to carry out and report on inspections more quickly. It will retain the 5 key questions (safe, effective, caring, responsive and well-led) across all sectors, but will amend the 34 quality statements to ensure clarity and remove duplication. CQC will stop scoring individual evidence categories.
- Ensure they have the right systems and tools in place to support its regulatory activity. CQC is working to stabilise and fix its regulatory platform and provider portal in the immediate term. While it does this, CQC is exploring options for delivering assessment activity away from the current systems, so that it can rapidly assess, rate, and publish reports for the public. They will ensure these assessments are securely recorded.
- Improve the experience for providers registering with CQC. They are urgently reviewing what specific changes are needed to the provider portal to do this.
The report from Dr Penny Dash also talks about the need to change assessments of local authorities and integrated care systems, which the regulator welcomes. CQC has agreed:
- Local authority assessments will continue with ongoing improvements and continued engagement with the health and care sector. In line with changes to the assessment framework, CQC will make scoring of evidence more transparent, and will strengthen its focus on nationally agreed priorities.
- In agreement with the Department of Health and Social Care (DHSC) CQC has paused its assessments of integrated care systems for 6 months. This is to free up capacity to carry out more assessments of providers and enable the regulator to modify its current assessment framework.
- We will work with bodies that represent providers to improve our processes and strengthen arrangements for peer involvement of expert reviewers and advisors.
In the next phase of its recovery, CQC will work with:
- Providers, colleagues, people who use services, local government, and wider stakeholders to develop a plan on how it will implement these changes and make sure it is realistic about what can be delivered by when. Once this is signed off, CQC will share what people can expect, and when.
- Professor Vic Rayner and the Care Provider Alliance to support CQC in gathering further feedback from adult social care providers on the use of the assessment framework. This will build on the findings of the review from Professor Sir Mike Richards.
- Professor Sir Mike Richards, and the Care Provider Alliance, chaired by Professor Vic Rayner are working together to support CQC in determining what good regulatory assessment looks like, what to expect from an inspection and what the new reports for inspection will look like. Alongside the Dash report, CQC also expects DHSC to publish the terms of reference for part 2 of the Dash review. CQC understands this will focus on the broader landscape of health and care arm’s length bodies. The regulator welcomes the opportunity to explore how it can better work with partners.
Ian Dilks, Chair of CQC, said:
“We welcome the final part of Dr Penny Dash’s review – we accept the findings and we will address the recommendations with urgency. Today also sees the publication of the review we commissioned from Professor Sir Mike Richards – we are extremely grateful to Sir Mike for his helpful work and will be using his recommendations to help us respond to the serious failings identified by Dr Penny Dash. His review also offers additional suggestions for improvement that we will be exploring as part of our wider recovery work.
“Both reviews have reaffirmed the support for a robust health and care regulator and recognised the dedication and experience of CQC staff. We are committed to rebuilding trust in CQC’s regulation and are taking action to make sure we have the right structure, processes, and technology in place to help us fulfil our vital role of helping people get good care and supporting providers to improve.”
Professor Sir Mike Richards, said:
“I have been working closely with providers of health and social care and with CQC staff to find solutions to the very real problems identified by Dr Penny Dash. CQC’s transformation programme has not delivered what was intended.
“CQC urgently needs to return to a structure where inspections teams are led once again by chief inspectors relating to the different sectors that CQC regulates. In addition, the current assessment framework needs to be radically simplified and the major problems with the new IT system need to be rectified. I know that work is already underway to address these areas.
“I believe that CQC’s problems can be fixed relatively quickly under the leadership of Julian Hartley, the incoming Chief Executive. Providers have overwhelmingly reaffirmed that they want good regulation, and many CQC staff remain fully committed to delivering this. These changes will help the regulator to effectively deliver its crucial work of ensuring that people get high quality, safe care.”