Regulators under review: Government to review Care Quality Commission’s effectiveness

It has been announced that the independent regulator of health and social care in England, the Care Quality Commission (CQC), will face a government review into its ‘operational effectiveness’.

The review was commissioned by the Department of Health and Social Care and forms part of the Cabinet Office’s Public Bodies Review programme, which was launched in 2022 and aims to review 125 public bodies. It will be led by Penny Dash, a senior NHS figure and chair of the North West London Integrated Care Board (ICB).

Although the terms of the review are broad at this stage, it is expected to examine:

• The effectiveness of the CQC’s new assessment framework
• Whether the regulator’s ratings are effective in incentivising the improvement of care
• How the CQC takes into account the voices of patients and service-users
• How the CQC’s new assessment framework links to NHS England’s inspection framework

The CQC’s Single Assessment Framework was launched in 2021 with the aim of simplifying the assessment process. The idea of the new framework is to be more transparent in terms of scoring and to do away with the stress of overarching inspections and requests for copious amounts of documentation. The scoring will now be applied  by adopting 34 ‘quality statements” and related topic areas which in turn will result in a rating for the questions of Safe, Effective, Caring, Responsive and Well-led. By setting out clearly what the score is for each topic, it is proposed that regulated services will be able to drill down into the detail from which the score has derived – rather than the old system based on characteristics. 

In addition, it also moved from a schedule of inspections to a more targeted approach, only focussing on selected service providers, and introducing a portal for all other services to submit information in place of an holistic inspection.  

However, it seems that there are already problems brewing in relation to the new regime. It may be a coincidence but the review of the regulator might arise from ongoing complaints and concerns from service providers that the ratings provided by the new framework are misleading and do not reflect their service. The concern is that new ratings are being affected by scores being carried over from previous inspections and do not fairly reflect the improvements made to services. A provider can try very hard to improve a rating and can be performing very well, yet this might not be reflected in their assessment. By way of example, a service which has had a targeted review culminating in scores to denote a Good rating in, say, Well Led and Caring, may still only achieve a Requires Improvement score overall if the CQC is basing its overarching score on evidence it has held from the last inspection, which might have taken place years before. That is despite the fact that the service has evidence it wants to show the regulator that would indicate a Good overall rating. In short, the new regime appears to be a hybrid of old and new which Good providers may consider unfair.  This outcome will be demoralising and hardly incentivises the improvement of care.  

We anticipate that the review of the regulator will be welcomed by many service-providers, and it will be interesting to see what the Department of Health reveals. The review might result in changes to the operations of the CQC, is leadership and the assessment framework. The upcoming general election on 4 July 2024 may also have an impact the review and its leadership team. So, just when services have been getting their “house in order” it seems it might be all change again.

For those who specialise in the field of regulatory law, this review is welcome, although what our clients need is consistency in approach and certainty so that they can budget and plan accordingly. Regulatory bodies set standards of practice and conduct in order to protect and safeguard consumers, and to ensure that consumers receive quality services from professionals. This is all the more important in healthcare. We have recently seen just how difficult it is for those providing services to push back against the powerful regulator, whether that it is in the context of CQC, Ofsted or issues revealed in the Post Office enquiry. It is vitally important that regulators are seen to carry out their functions fairly and proportionately. It is right that their performance is reviewed.

We will be awaiting the outcome of the review with interest.