The recent independent reviews of the Care Quality Commission (CQC) have brought attention to significant challenges the regulator faces in overseeing health and social care services in England. In two separate reports, Dr Penny Dash, Chair of the North West London Integrated Care Board, and Professor Sir Mike Richards, former Chief Inspector of Hospitals, identified critical operational issues and called for extensive reforms.
Findings from the Dash Review
Dr Dash’s final report highlighted continuing concerns from her interim findings, particularly focusing on the decline in CQC’s ability to perform inspections effectively. One of the most alarming findings was the sharp drop in inspections, from 15,800 in 2019-2020 to just 6,700 in 2023-2024. This reduction and issues with CQC’s new single assessment framework (SAF), have strained the regulator’s ability to respond to failing services. Providers have struggled with the ‘provider portal,’ which has suffered from technical issues that hinder timely registration and re-inspections, critical functions for maintaining quality.
These operational delays are not just inconveniences—they significantly impact businesses and care services. Providers with outdated ratings have faced challenges securing contracts, with some hospital discharge teams refusing to send patients back to certain care homes. Dash’s review also criticised the SAF, noting that its narrow focus on safety does not adequately capture the full range of service quality. The framework’s failure to address key aspects such as care effectiveness and outcomes has left providers struggling to meet the diverse needs of their services.
Richards’ Review of the SAF and CQC Structure
Professor Richards’ review specifically examined the effectiveness of the SAF in relation to healthcare services. The SAF was a central plank of CQC’s 2021 transformation strategy. The strategy aimed to streamline the regulatory process through a major restructure, introducing the SAF and creating a new IT platform. However, Richards found that these changes have not delivered the expected improvements. The number of inspections has fallen, reports have been delayed, and many providers have expressed dissatisfaction with the quality of inspections.
Richards also highlighted CQC’s reorganisation, which separated policy-making from front-line staff and removed chief inspectors from leading inspections in their respective sectors. This structural shift has weakened relationships between inspectors and providers, making collaboration more difficult and diminishing the effectiveness of the regulatory process.
Key Recommendations
Both reviews made several recommendations for addressing these systemic issues:
- Reinstating Sector-Based Leadership: Both reports suggested appointing sector-specific chief inspectors to lead hospital, primary care, and social care inspections, with a possible fourth role for mental health services.
- Revamping the SAF: Richards recommended abandoning the SAF’s current framework, advocating for a focus on the five key areas of safety, effectiveness, care, responsiveness, and leadership. Dash emphasised that the framework should better address outcomes, effectiveness, and resource management.
- Improving Rating Transparency: Both reviews called for greater clarity on how ratings are calculated, suggesting that the one-word rating system could be restructured to offer more transparency. This would improve trust among providers, service users, and commissioners.
- Upgrading IT Infrastructure: Immediate improvements to the regulatory platform and provider portal are essential to address the current system’s limitations and ensure timely assessments and report publishing.
- Enhancing Reporting and Communication: Both reports stressed the importance of clear, timely reports and immediate feedback to help providers improve care.
- Rebuilding Expertise and Relationships: Restoring CQC’s relationship with providers and ensuring staff have the clinical expertise needed to lead inspections was seen as crucial to improving the regulatory process.
CQC’s Response
In response, CQC has pledged to implement many of the recommendations. It has appointed Sir Julian Hartley as its new CEO, and is restructuring around sector-specific expertise, with plans to appoint chief inspectors for hospitals, primary care, and adult social care, with a fourth potential role for mental health. The SAF will be simplified, retaining key questions but refining quality statements to make it more relevant across sectors. Furthermore, CQC has committed to improving its IT systems and exploring alternative assessment methods to address current delays.
Looking Forward
The speed at which CQC can restore trust with stakeholders remains to be seen. However, the government has shown strong support for the reforms, with Health Secretary Wes Streeting commissioning further reviews focused on patient safety and quality. These findings will likely influence the government’s upcoming 10-Year Health Plan for the NHS and social care.
While CQC faces significant challenges, this moment represents a golden opportunity for reform.
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Our AlteaTalks podcast episode #13 explores the trials and tribulations faced by the CQC and what the future may hold for the regulator.
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