In The News
How bad are things for the CQC and what can be done to reform it?
The Care Quality Commission (CQC) is facing a period of significant change and scrutiny. Ian Trenholm, who had led the CQC for six years, resigned at the end of June, leaving behind a mixed legacy.
Kate Terroni has assumed the role of interim chief executive as the search for a permanent successor begins. The CQC’s leadership transition comes at a critical time when the organisation is under intense pressure to address a series of high-profile failings and implement urgent reforms.
Damning review sparks calls for reform
The CQC’s role in regulating health and care has come under intense fire after an independent review led by Dr. Penny Dash uncovered major shortcomings. The review revealed troubling findings, such as inspectors lacking relevant experience—some had never dealt with dementia patients before.
As part of the Government's response, Sir Mike Richards has been appointed to lead a rapid review of the CQC’s frameworks, while a search for a new chief executive and chief inspector is underway. Interim CEO Kate Terroni acknowledged the issues raised in the review, emphasising that the organization is already working to address the failings and restore public trust. The full review report is expected to be published later in 2024, outlining further necessary reforms.
Apology and sector backlash over reforms
The findings have prompted shock and dismay from sector leaders, with many questioning the CQC’s ability to regulate effectively.
Care organisations, including Care England, have raised concerns over the CQC’s over-reliance on outdated data and inconsistent assessments, with some describing the inspection regime as "hostile."
The CQC’s difficulties are further compounded by challenges in regulating the rapidly expanding community social care sector. A recent analysis by the Homecare Association revealed that 60 per cent of community social care services in England either lack an up-to-date performance rating or have never been rated at all.
As of June 2024, nearly a quarter of services, including home care, supported living, and shared lives services, had never been rated, with many having been registered for over 18 months. Furthermore, 37 per cent of services have ratings that are between four and eight years old.
Within the wider crisis hitting the social care sector, the CQC's troubles may appear minimal. There are nearly 500,000 people on care waiting lists, with around 150,000 care vacancies while the government’s funding of local authorities to support care is universally regarded as too minimal. Moreover, this problem of funding is likely to worsen in the future. The Health Foundation estimates that real spending increases for social care will be needed of around 3.4 per cent per year until the mid 2030s. Given the Labour Government's insistence of difficult fiscal decisions that have to be made, a generous offer on social care seems less than likely.
Nonetheless, for those involved in the sector, ensuring that the regulator is functional, inspections are properly carried out and clear guidelines and leadership are provided is essential. How that can best be delivered we explore below with three leading experts in the sector.
The Future of Social Care: Insights from Industry Leaders
"A thorough review and a substantial transformation of the CQC are needed"
This month, we sat down with care leaders to discuss the biggest areas of concern the sector has and what the CQC has to do to rebuild trust with providers.
In what already feels like an eternity ago, during the general election campaign, Ian Trenholm announced that he was stepping down from his role as the head of the CQC. While a shocking move, it did little to prepare for what followed: the publication of a report into the operational effectiveness of the CQC, which proved nothing short of scathing.
The findings of this review led current Health Secretary Wes Streeting to declare that "the CQC is not fit for purpose". A stunning statement but not without reason. The review found that one in five services, including new care providers, had never received a rating; providers hadn't been re-inspected regularly - with the latest care assessment for one care provider in 2015; and some inspectors were found to have had no previous experience in dealing with dementia patients.
In fact, the scale of failings uncovered at the CQC continues to grow. The Homecare Association has found in a report of its own that poor leadership, failing IT systems, and insufficient resources have all compounded the regulator's lacklustre outcomes, leading to almost two-thirds of homecare providers being either unrated or not having been rated in over four years.
CQC failures
Those with first-hand experience in the sector echo these uncovered failures, most particularly inspection failures. Karolina Gerlich, chief executive of The Care Workers Charity, notes that "the main concerns I've heard about include inconsistency in inspection standards, often due to inspectors' varied backgrounds and personal biases."
Care providers have felt this point is especially damaging. James Tugendhat, chief executive of HC-One, says that "the time between inspections is too long," which means that often, "a home's CQC rating may not reflect the home's current performance." For Tugendhat, this has ramifications for not just care groups, but also for staff.
"[Infrequent inspections] can be misleading for current and prospective users ... and can impact confidence in care homes. It misses an opportunity to value and recognise teams that have improved their care, which can be frustrating and impact morale amongst the home's team."
Although inspections are also noted as a chief cause for concern by Anchor chief executive Sarah Jones, she expands on the role that a greater reliance on technology has had. "We have seen the consequences of moving to the digitalised system without adequate testing and ensuring that the system was fit for purpose", she notes, adding that the move to remote assessments has been made without "assurance on the tools necessary for its implementation."
This is something that Gerlich also felt relevant to the problems with the CQC and its poor reputation in the care sector. "The CQC's response during COVID-19 and its struggles with technology have further eroded trust."
Lessons for the future
Given the current state of the CQC, an essential question is how the organisation can rebuild trust and become fit for purpose once more. Tugendhat sees the immediate priority as fixing the problems that have arisen in the Single Assessment Framework (SAF) since its introduction.
He notes, "[the framework] represents an opportunity to further demonstrate the kind of care we provide." Still, he stresses that "more clarity on what matters most to the CQC" and "clear definitions of what outstanding care looks like" are needed.
Sarah Jones is more critical of the CQC, arguing that the public body needs to fundamentally change its image and build bridges with the sector once more. "We need a regulator that supports transparency and a drive to improve safety and quality across health and social care, and timely ratings prepared on a consistent basis are key to that."
Central to this is the matter of trust, adding that "it is in everyone's interest to improve public trust and confidence" in the care system, which requires regulators to ensure "that ratings are an accurate and up-to-date reflection" of the care being provided.
Building a new relationship to further trust between the regulator and providers resonates with Gerlich, too, who finds it "crucial to focus on clear communication and working together to improve care standards, rather than just imposing penalties."
Part of this means that the CQC "should be more supportive," which can best be done by "offering [more] guidance and education on compliance and best practices [as well as] shifting from a punitive approach to one that fosters improvement".
Is a new regulator required?
Having discussed the scale of dissatisfaction with the CQC, we ended our conversation by asking whether the CQC's reputation had fallen sufficiently that a fundamental change, such as a new regulator, was needed in the sector to restore confidence.
Most were skeptical of the idea. Karolina Gerlich believes that the "significant issues" that have "eroded trust in the CQC" are not grounds for such a change in the regulatory landscape, a view both Tugendhat and Jones shared. Nonetheless, a fundamental, detailed review of the CQC appears paramount in signaling the intent to change.
"A thorough review and a substantial transformation of the CQC are needed," remarks Gerlich. She says that the CQC must become "more transparent and [engage] better with care providers and workers." This is repeated by Sarah Jones, who asserts that the review must be "thorough" and "consult widely [whilst] looking closely at the failures within social care regulation as closely as health."
The specifics of how to move forward are known, but it remains uncertain how well these can be achieved. As James Tugendhat said, delivering a more effective SAF is essential, while fixing the technology problems, as Karolina implored, remains paramount as well. It is clear that the CQC must rebuild trust by addressing these issues and prioritising clear communication and consistent inspections. Only by demonstrating that commitment to improvement can it restore its reputation and deliver the oversight that the care sector urgently needs.