Further Scrutiny of CQC

Following on from recent challenges brought by independent sector providers to the initial implementation of the Single Assessment Framework, CQC is coming under further scrutiny.  The Health Service Journal (HSJ) reports that the Department of Health and Social Care has commissioned a full scale review under the Cabinet Office's Public Bodies Review Programme of CQC to be led by Dr Penny Dash, Chair of North West London ICB.

It is unclear what has led to the review as CQC was not included in the list of bodies scheduled for a review on 2024/5, although this may have been because DHSC had not provided its public body review plans at the time the list was last updated on 3 May 2024.

Reviews are meant to be completed within six months and will result in a report drawing conclusions and making recommendations back to DHSC.  

Purpose and Scope of Review

The Cabinet Office guidance on undertaking these reviews makes it clear that the main purpose of such reviews is to assure the public and government that the public body's function remains useful and necessary, as well as assessing whether its objectives can be met more efficiently and effectively.

As well as issues of governance, accountability, and efficiency, the guidance requires reviews to look into questions of efficacy – and whether the public body is performing effectively and delivering services that meet the needs of citizens.

The terms of reference for the review are not yet available, although the HSJ reports that it understands the review may cover issues including:

• how the new assessment framework is working, and how it interfaces with the NHS Oversight Framework;
• whether CQC’s ratings properly reward and incentivise the improvement of care;
• how CQC takes into account service user and patient voices;
• whether it has the necessary leadership and staffing for its new role overseeing local government adult social care functions; and
• how the new assessments of adult social care providers are working.

Concerns regarding CQC Registration Delays and Assessments

We have recently been supporting clients in relation to numerous concerns regarding CQC’s delivery of its functions.  Many of these relate to concerns over the robustness of CQC’s assessment reports under the new Single Assessment Framework and whether they will meet the aim of providing an up to date and accurate picture of the true standard of services.  

In addition, however, we are seeing increasing concerns on the part of providers arising from delays in the processing of registration applications.  CQC‘s Corporate Performance Report on Q3, presented to its Board meeting in February 2024, shows that the percentage of applications pending completion that were more than 10 weeks old had increased from 29.8% in June 2023, to 46.3% in December 2023.  Despite CQC introducing a prioritising system for some applications, there remain considerable risks of delays in the opening of new services which would add vital additional capacity to the health and care system.

It is to be hoped that the review will address these issues.

Evidence gathering and stakeholder engagement

It is up to DHSC to determine the terms of reference and from whom the review should collect evidence. However, the guidance does state that key stakeholders should have the opportunity to provide input into the review where relevant and appropriate, and that “review teams may consider approaching key stakeholders directly”.

It is to be hoped that the review will call for evidence from, and engage with, provider representatives in order to properly understand their perspective on CQC’s performance.

 
If you wish to discuss any of the issues related to this review, or CQC regulation more generally, please contact Carlton Sadler or Siwan Griffiths.