‘Urgent need’ for rapid turnaround in how care regulator is run, after review finds significant failings

A review ordered by the last government has found “significant failings” within England’s care and health regulator.

The final report into the effectiveness of the Care Quality Commission (CQC) was published this week, and it found an “urgent need” for a rapid turnaround in the way CQC operates.

Analysis of the commission’s own figures by the review found that, over the last five years, the proportion of health and care settings that had never received a rating had risen from 13 per cent to 19 per cent.

And the average age of a rating (the time since it was published) had almost doubled, from two years in 2020 to three years and 11 months in 2024.

By the end of July this year, it was taking on average 132 days for social care settings to be re-inspected after receiving a rating of “inadequate”.

In 2023, there were just 6,700 inspections and assessments, compared with nearly 15,800 in 2019.

The concerns about CQC have focused on a new strategy – announced three years ago – which led to the implementation of a new assessment framework.

The framework was intended to “make the assessment process simpler and more insight driven by drawing on a wide range of data about quality of care, with the ability to prioritise assessments and inspections”.

But the review found that many people within CQC tried to raise concerns about the new framework and other changes, but “did not feel listened to” by the regulator.

The review found seven concerns with the new framework.

Among its other conclusions, the review found that “poor operational performance is impacting CQC’s ability to ensure that health and social care services provide people with safe, effective and compassionate care, negatively impacting the opportunity to improve health and social care services, and, in some cases, for providers to deliver services at all”.

It also concluded that the Department of Health and Social Care, the government department that monitors CQC’s work, “could do more to ensure that CQC is sponsored effectively”.

Dr Penny Dash, who led the independent review, said she had spoken to hundreds of people in the sector and nearly all raised “considerable concerns about the functioning of the organisation”.

Her review concluded: “The review has found significant failings in the internal workings of CQC, which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improve quality – and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much-needed improvements in care.”

It offered seven key recommendations for improvement, including action to improve the “quality and timeliness of reports”; to rebuild “expertise” within the organisation; and to make the results of inspections more transparent.

Health and social secretary Wes Streeting said he supported the seven recommendations.

He said: “Patient safety is the bedrock of a healthy NHS and social care system.

“That’s why we are taking steps to reform the CQC, to root out poor performance and ensure patients can have confidence in its ratings once again.”

CQC welcomed the review and accepted its recommendations.

Among the steps it is taking, it will appoint “at least” three chief inspectors to lead on regulation and improvement of hospitals, primary care, and adult social care services.

It will also “modify” its new assessment framework to “make it simpler and ensure it is relevant to each sector”.

Ian Dilks, CQC’s chair, said: “We welcome the final part of Dr Penny Dash’s review – we accept the findings and we will address the recommendations with urgency.

“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.”

The concerns over how CQC operates have been long-standing.

Five years ago – before the pandemic – Disability News Service obtained freedom of information figures which showed that nearly one in five adult social care settings had not been inspected by the care regulator in the previous two years.

The figures had been requested after it emerged that a care home run by the National Autistic Society – Mendip House, in Somerset – where autistic people were taunted, abused and ill-treated by staff, had itself not been inspected by CQC for more than two years when whistleblowers came forward and exposed the abusive regime in 2016.

Picture by Andrew Parsons/No 10 Downing Street 

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