1. Poor operational performance
2. Significant challenges with the provider portal and regulatory platform
3. Considerable loss of credibility within the health and care sectors
4. Concerns about the Single Assessment Framework
5. Lack of clarity around how ratings are concluded and the use of outcomes from previous inspections being used to calculate a current rating

Professor Richard’s report is strongly worded, baldly stating that the three key initiatives – major organisational restructure, creation of the Single Assessment Framework (SAF) and the development of a new IT system –set out by the CQC in the 2021 had failed to deliver.

Professor Richards observed that the current CQC structure (achieved by combining three sector teams into one Operations group) has separated the responsibilities of developing regulatory policy and strategy from operational delivery – resulting in ‘operational reality …not been reflected in policy and strategy.’ It appears the left hand does not know what the right is doing.

Professor Richard’s view is that a ‘fundamental reset’ is needed, he advocates a return to the previous organisational structure with Chief Inspectors leading sector-based inspections.

The concerns of providers have been echoed in the report with the SAF being described as ‘far too complex’ and not allowing for the vast differences in the services regulated by the CQC. Professor Richards ultimately believes the SAF should be scrapped but advocates serious modification with some aspects removed in the short term – including the evidence category and scoring system. He recognises that the evidence categories and scoring has complicated the production of reports and caused significant delays.

On analysis, the much criticised scoring system was found to give an inaccurate picture – with the scoring system creating a ‘good’ outcome’ where multiple breaches of the regulation had occurred – this was identified in 10% of the assessments undertaken to date. Professor Richards agreed that the combining of old and new scores ‘did not make sense’.

Whilst the IT issues were not within Professor Richard’s remit and he has sensibly decided to leave that issue to the experts – he makes a point to comment on the adverse impact that the IT problems are having on CQC staff and providers alike.

Hot on the heels of the Professor Richard’s report, Dr Dash published her long-awaited final report the same afternoon, declaring 10 conclusions:

1. Poor operational performance
2. Significant challenges with the provider portal and regulatory platform
3. Delays in producing reports and poor-quality reports
4. Loss of credibility within the health and care sectors
5. Concerns about the SAF and its application
6. Lack of clarity regarding how ratings are calculated
7. Improvement of CQC’s assessment of local authority Care Act duties
8. Concerns about ICS assessments
9. Doing more to support improvements in quality across the health and care sector
10. Improve sponsorship relationship between CQC and the Department of Health and Social Care (DHSC)

Dr Dash highlights that concerns about the new structure and SAF were raised but apparently ignored by ‘top brass’ – providers now seemingly have every right to say ‘I told you so’. A detailed analysis of Dr Dash’s report will be a matter for another article but on the whole her report and recommendations mirrors those put forward by Professor Richard.

The root of this upheaval was the CQC’s ‘A new strategy for the changing world of health and social care – our strategy for 2021’ which set out a number of ambitions and outcomes – Professor Richards sums the whole issue up rather neatly, stating that ‘while these outcomes are aspirational, the strategy does not provide any indication of how its vision might be achieved. Nor are there any metrics against which progress towards the stated outcomes might be measured’. Similarly, there was no formal consultation undertaken when the SAF was first developed and ‘very little piloting’ prior to its rollout. Essentially, the CQC forged full steam ahead with a vision and no actual plan.

The CQC have given the appearance of being alive to the inevitable criticism and seem to have taken a ‘proactive approach’ – announcing on 3 October 2024 that they would be making ‘immediate changes to support [their] response to the recommendations in the interim report of Dr Penny Dash’ – those immediate steps were/are the recruitment of a new Chief Executive and three Chief Inspectors, reviewing longer term improvements to the SAF and pilot projects looking at a better way of managing their relationship with providers and how their operation managers can manage teams in specific sectors.

In relation to the SAF itself, the CQC said, at that time, that they will be scoring at Quality Statement and rating at Key Question level –with no clarity on how this was to be done, what constitutes each rating and how the evidence in each category will be evaluated.

They have issued a further statement on receipt of both reports re-iterating their commitment to recruiting three Chief Inspectors (with consideration being given to a fourth), amending the SAF and fixing the IT platform issues.

The CQC is in a precarious position – the criticism made of it are fundamental, wide ranging and damning.  Whilst they have been provided with a step by step guide on how to row back from this situation, it remains to be seen whether they will be willing or able to do so effectively. Either way it will be a baptism of fire for Julian Hartley who will be appointed as the CQC’s new Chief Executive.

If your service is experiencing any issues with the CQC it can be helpful to seek specialist legal advice. Our lawyers at RWK Goodman can assist with this. For further information, call: 02030 069727.