Government takes action after report highlights failings at health and social care regulator  

• Interim report finds significant failings in the effectiveness of the Care Quality Commission (CQC)
• CQC told to take immediate steps to restore the confidence of health and care providers and the public

• Secretary of State for Health and Social Care takes immediate action to boost oversight of CQC

• The regulator has recruited senior cancer doctor to review CQC assessments

• Progress will be monitored over the summer and the full independent report will be published in the autumn

An independent review of the Care Quality Commission (CQC) has identified significant internal failings which is hampering its ability to identify poor performance at hospitals, care homes and GP practices.  

The interim report, led by Dr Penny Dash, chair of the North West London Integrated Care Board, found inspection levels were still well below where they were pre-Covid, a lack of clinical expertise among inspectors, a lack of consistency in assessments and problems with the CQC’s IT system.

These failings mean the regulator is currently unable to consistently and effectively judge the quality of health and care services, including those in need of urgent improvement. The report also found that social care providers are waiting too long for their registration and rating to be updated, with implications for local capacity.

The government will now take immediate steps to restore public confidence in the effectiveness of health and social care regulation, including by increasing the level of oversight of the CQC, ahead of a full report by Dr Dash which will be published in the autumn.

This works forms part of the government’s wider efforts to identify the challenges facing the NHS and take action to address them head on as part of its mission to build a health service fit for the future.

Health and Social Care Secretary, Wes Streeting, said:

“When I joined the department, it was already clear that the NHS was broken and the social care system in crisis.

“But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me the CQC is not fit for purpose.

“We cannot wait to act on these findings, so I have ordered the publication of this interim report so action can begin immediately to improve regulation and ensure transparency for patients.

“I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care. I want to reassure them that I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed. This government will never turn a blind eye to failure.”

The Health and Social Care Secretary has announced four immediate steps the government and CQC will take to restore public confidence in the regulator and ensure patients can get an accurate picture of the quality of care available.

These include:

• The appointment by the CQC of Professor Sir Mike Richards to review CQC assessment frameworks. Sir Mike was a hospital physician for more than 20 years and became the CQC’s first Chief Inspector of Hospitals in 2013, retiring from this role in 2017.
• Improving transparency in terms of how the CQC determines its ratings for health and social care providers
• Increased government oversight of the CQC, with the CQC regularly updating the department on progress, to ensure that the recommendations in Dr Dash’s final review are implemented
• Asking Dr Dash to review the effectiveness of all patient safety organisations.

Dr Dash was asked to carry out a review of the CQC in May 2024. Over the last two months she has spoken to around 200 senior managers, caregivers, and clinicians working across the health and care sector, along with over 50 senior managers and national professional advisors at the CQC.

Some of Dr Dash’s emerging findings include:

• Of the locations the CQC has the power to inspect, it is estimated that around 1 in 5 have never received a rating
• Some organisations not being reinspected for several years – with the oldest rating for an NHS hospital dating from over 10 years ago and the oldest rating for a social care provider dating from 2015
• A lack of experience among some inspectors – with the review hearing of inspectors visiting hospitals and saying they had never been in a hospital before and an inspector of a care home who’d never met a person with dementia.

Commenting on her findings so far, Dr Dash said:

“The contents of my interim report underscore the urgent need for comprehensive reform within the CQC.

“By addressing these failings together, we can enhance the regulator’s ability to inspect and rate the safety and quality of health and social care services across England.

“Our ultimate goal is to build a robust, effective regulator that can support a sustainable and high-performing NHS and social care system which the general public deserves.”

To start to rebuild its credibility Dr Dash has highlighted urgent actions the CQC can take, including overhauling the inspection and assessment system, rapidly improving operational performance and fixing faltering IT systems.

Professor Martin Green OBE, Chief Executive of Care England said:

“It is clear that Dr Dash has listened to the voices of care providers, resulting in a clear set of recommendations. This report acknowledges the severe and systemic problems that sit at the very heart of the CQC and gives a specific set of steps that the regulator must take to improve performance and re-establish the sector’s long-eroded trust.

“This is going to be a long and difficult journey for the CQC, but one that is entirely necessary. Care England stands ready to work with the regulator to help them deliver an effective and supportive regulatory system that will be the cornerstone of public protection and delivers fair judgements across health and social care.

“The CQC must embark on a radical improvement program that should not only include some tangible improvements in their performance, but also needs to move away from a culture of blame. We all want proportionate and effective regulation, and the challenge now is for CQC to take action and work with organisations across the sector to deliver it.”

This government has already recognised the need for change within the health and care sector. Dr Dash’s interim report comes just days after the announcement of Lord Darzi’s independent investigation into the NHS, the findings of which will inform the government’s 10-year plan to radically reform the NHS and build a health service that is fit for the future.

Background information

• All providers of healthcare and adult social care regulated activities in England must register with the Care Quality Commission (CQC), which monitors, inspects, and regulates these services to ensure they meet fundamental standards of quality and safety.