Care Quality Commission

The CQC has set targets for the number of assessments it plans to complete, and is reporting regularly on progress. In part it has facilitated this new approach by refocusing on operational inspectorates built around sector expertise. Recognising that its assessment approach is too complex and inflexible, it has also been consulting on changing the content of its assessment framework – its ‘Better regulation, better care’ consultation, which closed in December, received over 1,600 responses and will inform the new framework that the CQC aims to publish this year.

An independent review concluded that the regulatory platform, the CQC’s much-criticised IT system, was “salvageable but [requires] substantial development and rebuilding work.” The CQC accepted the review’s recommendations and is now taking a phased approach to fixing its deeply flawed system, focusing on resolving the highest priority and most challenged areas first. Priorities for the coming year include upgrading the data platform and improving the provider portal.

The Richards review concluded that there had been a “widespread and severe” loss of confidence in the CQC, among not only providers but also local authority commissioners of social care. The CQC has highlighted ways in which it hopes to restore confidence including supporting the improvement of the delivery of services by sharing best practice, offering clarity on standards, and reporting regularly on themes and issues. Ultimately, though, confidence will rest on the effectiveness of the improvement programme. Says CMS partner Rachel Cooper: “The CQC is entering a new chapter – moving beyond past shortcomings with a sharper focus on intelligent regulation, sector expertise, and real-time responsiveness. Its commitment to improvement is reshaping how quality is measured and supported across health and social care. But providers are asking: will it work, and how long will it take? In the meantime, many face the daily reality of delivering regulated services in the absence of an effective regulator”.

The government’s ten-year health plan for England envisages transitioning the CQC towards a data-led and intelligence-driven regulatory model, with inspection teams being rapidly assembled when concerns are identified. This way of working would be supported by giving the CQC statutory powers to access all NHS and publicly held datasets relating to care quality – as well as by the changes to data and analytics in healthcare outlined by the ten-year plan, such as the introduction of the single patient record, and by an AI-led warning system able to flag concerns across the NHS. This reform is hardly the most ambitious part of the ten-year plan. But given the CQC’s travails and the pressures it already faces, implementing it successfully will be a challenge. And if data-led regulation increases the reporting burden on those the CQC regulates, it may also prove challenging for some of them.

The health plan also says the government will extend the three-year period in which the CQC can bring legal action against a provider, to allow more cases to be comprehensively reviewed. When this will happen and what the new limit will be is not clear, but it would be surprising if this did not result in additional prosecutions – not least because the most complex cases are often also the most serious ones.