Inspection review

The Government has launched a review of the Care Quality Commission and has appointed North West London Integrated Care Board chair Penny Dash to lead it, according to a Health Service Journal article which first reported the story.

The full terms of reference for the review are not yet available although the Health Service Journal report says the review will examine how well the regulator’s new Single Assessment Framework (SAF) is working as well as:

  • Whether the CQC's ratings are properly rewarding and incentivising the improvement of care
  • Whether it is properly taking into account patient voices
  • Whether the CQC has the leadership and staffing it needs to review local authority adult social care functions

Purpose and scope of the review

The terms of the full scale review has been launched under the Cabinet Office Public Bodies Review Programme (PBRP) with the findings of the review expected before autumn. The review forms part of the Cabinet Office’s review programme launched in April 2022, which aims to periodically review the governance, accountability, efficacy and efficiency of existing arm’s length bodies (ALBs), including in response to significant changes in approach. Reviews are intended to be “constructive and challenging”, identifying areas in need of improvement and providing tangible recommendations for addressing them. For the first time, review teams are required to examine the wider “delivery system” within which ALBs operate, not just the body in isolation.

It is unclear what has triggered the review as the regulator was not included in the list of bodies scheduled for review in 2024/25.

The CQC was established in April 2009 under the Health and Social Care Act 2008. Since its inception it has operated as the sole regulator of health and adult social care in England and Wales. While the CQC as regulator has endured, the regime under which it regulates services has evolved over time and in 2021 it launched its new regulatory approach as part of its new strategy to rely less on set-piece inspections and instead becoming more risk-based and data driven.

Concerns about CQC registration delays and assessments

We expect this review will be welcomed by providers across the health and social care sector who have expressed concerns about several issues, including technical issues with accessing the provider portal, delays in registration and inspection, issues with the way that the CQC is conducting and reporting on inspections and loss of dedicated relationship managers.  We are also aware that providers are not receiving auto responses upon submitting notifications.

Evidence gathering and stakeholder engagement

According to Cabinet Office guidance, reviews of Public Bodies usually involve a combination of both internal self-assessment and external research, as well as inspections and interviews with the leadership and staff of the body, and with key stakeholders, including the public where appropriate. The guidance further explains that “key stakeholders should have the opportunity to provide input into the review. Departments and lead reviewers are strongly encouraged to consider whether users or customers are considered in this. Review teams may consider approaching key stakeholders directly. This should be noted in the terms of reference and can also be reflected in the review report and recommendations.” In this context, we hope the review team will engage and call for evidence from provider representatives.

Commenting on the announcement, Professor Martin Green OBE, Chief Executive of Care England says:

“It is vital that the review spans all the sectors regulated by the CQC, including not just healthcare, but social care too. The NHS is already treated differently by the regulator, so it is imperative this disparity does not extend to the review conducted by government.

We have heard concerns from providers about a number of issues, including the CQC’s overreliance on outdated data, the lack of transparency in their regulatory approach, and vast inconsistencies between assessments. It would be remiss of the review not to examine these issues carefully.

The announcement of the ministerial review is the first step towards progress, but for it to be deemed a success, we need action.”

This article first appeared in the June issue of the Caring Times

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