The CQC and Single Assessment Framework Reviews: Care England Summaries

Between May and October 2024, Dr. Penny Dash conducted an extensive review of the Care Quality Commission (CQC), gathering input from senior managers in primary and secondary care, integrated care boards, caregivers, clinicians, patient groups, and CQC staff. Additionally, Professor Sir Mike Richards, former Chief Inspector of Hospitals at the CQC, was commissioned to review the CQC’s Single Assessment Framework (SAF) as a complement to Dr. Dash’s broader evaluation.

In October, Dr. Dash’s full report was published alongside Professor Sir Mike Richards’ initial findings. You can access Dr. Dash’s report [here] and Professor Richards’ report [here]. For Professor Martin Green OBE, Chief Executive of Care England, response to both reports, click [here] and [here].

In July, following the publication of Dr. Dash’s interim report, Kate Terroni, then interim Chief Executive of the CQC, issued a public apology, acknowledging mistakes and the resulting erosion of trust in the sector. She expressed regret for the impact these errors have had.

Wes Streeting, Secretary of State for Health and Social Care, described the CQC as “not fit for purpose,” noting its failure to adequately regulate and safeguard those reliant on its services for safe, high-quality care.

Care England has produced summaries of both reports to assist providers in understanding the key findings and implications.

Dr. Penny Dash’s independent review raised several significant concerns, including:

• Poor operational performance, particularly issues with the provider portal and the regulatory platform.
• Inadequate presentation of reports, leading to diminished credibility within the health and care sectors, exacerbated by a lack of sector expertise.
• Concerns with the SAF, including unclear criteria, inconsistent care assessments, and insufficient focus on outcomes and innovation.
• A lack of transparency in how ratings are calculated, often relying on outdated inspection data.
• Missed opportunities to strengthen the CQC’s role in improving care quality across health and social care.
• Concerns about early Integrated Care System (ICS) assessments and recommendations to improve the CQC’s relationship with the Department of Health and Social Care (DHSC).

The review also identified further areas of investigation, such as the use of one-word ratings, CQC finances, and the broader regulatory landscape. Ultimately, seven key recommendations were outlined:

1. Urgently improve operational performance, fix the provider portal, and enhance the quality of reports.
2. Rebuild sector expertise and restore credibility through stronger relationships.
3. Revise the SAF with clearer criteria and a greater focus on effectiveness, outcomes, and innovation.
4. Improve transparency in the calculation of ratings.
5. Evolve local authority assessments.
6. Pause ICS assessments.
7. Strengthen governance and sponsorship to ensure CQC accountability and effectiveness.

Professor Sir Mike Richards’ review highlighted critical failures in the SAF, including its overcomplicated structure, delays in inspection reporting, and the negative impact of the new regulatory platform. Care England welcomes the call for a reset of the CQC’s structure and operations, stressing that the organisation must refocus on its core mission: ensuring safe, effective, and high-quality care.

Care England has raised the following key concerns:

• A reduction in the number of inspections and significant delays in report publication have undermined the CQC’s regulatory effectiveness, creating confusion and uncertainty for providers.
• The disconnect between operational delivery and clinical leadership, noted in the review, has contributed to a loss of expertise and accountability in the inspection process.
• High staff turnover and low morale have resulted in delays and inconsistencies in inspections, further exacerbating issues with the CQC’s restructuring.