We did have a functioning regulator; I agree there were issues, but these were not unsurmountable. There were criteria for assessment that people knew and understood that were at least relatable to the service being provided. There were also descriptors of the different ratings that meant services had an idea of the level of quality they needed to provide to be awarded a particular rating, and conversely what the inspector needed to see evidence of.
But it seems like the wheels have fallen off the CQC, and the issues are now coming thick and fast and it's hard to see how it can continue as a credible organisation in its current format.
How did the single assessment framework come about?
This situation has been over three years in the making, and started when the idea of the Single Assessment Framework was shared. Alarm bells should have rung straight away as how can you have one framework for a small home care provider and an NHS Foundation trust? It doesn’t make sense in practical terms, but CQC carried on and tried to make square pegs fit into round holes.
This was all compounded by the increased reliance on remote data collection, less observation of care being provided, the development of rigid evidence categories, a very complex scoring system, lack of transparency on what makes good evidence, the transfer of old ratings to the new SAF assessments, massive internal structural change at CQC and a failing portal system.
What happened when the framework went live?
So, the scene was set, but warnings were not heeded and the big ‘go live’ button was pressed in November last year, with CQC beginning the phased rollout of the Single Assessment Framework among providers in the south of England from 21 November 2023, without clear information, or way to make changes based on how well things were going for the first users of the SAF framework.
Since then, problems have become more apparent and are growing exponentially. Issues include staff discontent within CQC, backlogs of registrations and assessments, escalating technological difficulties and provider confusion on what the SAF means for them in practical terms.
Alarm bells should have rung straight away
What is the government doing about it?
The Government have now intervened and are undertaking an investigation to CQC and their effectiveness. In May 2024 the Department of Health and Social Care asked Dr Penny Dash to conduct a review into the operational effectiveness of the Care Quality Commission, and her interim report was published on 26 July 2024. The Chief Executive has ‘left’ very quickly, with Ian Trenholm announcing his resignation on 25 June 2024 according to CQC's own news release, and the replacement interim Chief Executive, Kate Terroni, has publicly released a ‘problem statement’ that is blunt in the extreme and states that the CQC are not keeping people safe!
It is obvious that things cannot continue as they are, and the new Government will have to address the issues as a priority by either undertaking wholesale change at the top of the organisation, scrapping the SAF or even in the extreme scrapping the CQC.
I truly hope things improve as good regulation is vital to ensure that people using services receive care and support that is at least safe and of good quality, and providers need to know what is expected of them and how they are going to be assessed.
Whatever, we better strap in because it's going to be a bumpy ride and if you want a front seat the next CQC Board Meeting will be an interesting watch and may give us more of an insight and hopefully some answers.
