Implications of the Interim Dash Report on the Care Quality Commission (CQC)
Ahead of the anticipated publication of the final Dash report next week, we recap on the key findings of the interim report that caused shockwaves back in July 2024.
In May 2024, the Department of Health and Social Care (DHSC) commissioned a review led by Dr Penny Dash to evaluate the operational effectiveness of the Care Quality Commission’s (CQC) new Single Assessment Framework (SAF). This review followed the rollout of the SAF, designed to simplify the assessment process for healthcare and adult social care providers in England. However, the interim report released in July 2024 revealed significant shortcomings within CQC, prompting urgent calls for reform.
The interim report highlighted alarming deficiencies within CQC, with Health Secretary Wes Streeting confessing he was ‘stunned by the extent of the failings in an institution that is supposed to identify and act on failings’, and describing CQC as ‘not fit for purpose’. CQC’s interim Director, Kate Terroni, accepted the findings and initiated remedial actions, including an independent review of the implementation of the SAF across the NHS estate.
Key Issues Identified
The Dash report focused on several critical areas, revealing that the SAF, introduced in November 2023, had encountered numerous operational issues:
- Operational Inefficiencies: There were long delays in re-inspections and a backlog in registrations for new providers. In 2023-24, only 7,000 inspections occurred, a stark decline from over 16,000 in 2019-20. Many providers had not been re-assessed for years, resulting in outdated ratings that hindered informed decision-making by service users.
- IT System Failures: The new digital portal for self-assessment faced significant issues, causing frustration for providers. Slow processes, such as document uploads and password resets, detracted from frontline care.
- Loss of Expertise: The review identified a decline in sector-specific knowledge among CQC inspectors, leading to distrust in inspection outcomes and missed opportunities for improvement.
- Concerns about SAF: The report outlined critical issues with the SAF, including a lack of clarity on what constitutes ‘good’ or ‘outstanding’ care, poorly organised guidance for providers, and an ineffective assessment of resources for delivering care.
- Unclear Rating Methodology: The ratings process was found to be opaque, with providers questioning the credibility of ratings calculated based on historical data rather than current performance.
Recommendations for Improvement
The interim report presented five fundamental recommendations for CQC:
- Enhance Operational Performance: Focus on targeted staffing to improve the efficiency of inspections and assessments.
- Fix IT Systems: Address the technical issues with the provider portal to streamline reporting and registration processes.
- Rebuild In-House Expertise: Invest in training and recruitment to restore sector-specific knowledge within CQC.
- Review the SAF: Conduct a thorough review of the SAF to ensure it meets the needs of the sector and providers.
- Increase Transparency: Clearly communicate the methodology for calculating ratings to rebuild trust among providers and the public.
Path Forward: Rebuilding Trust and Confidence
Rebuilding public trust in CQC is imperative for all stakeholders. With nearly 54,000 locations registered with CQC, including about 30,000 social care organisations, urgent reforms are essential to restore confidence in the regulator’s ability to ensure safe, effective, and compassionate care.
Both providers and the public need clarity on what constitutes "good" or "outstanding" care. The lack of clear benchmarks under the SAF has created confusion and hindered opportunities for quality improvement. Consistent and timely assessment and clear communication of ratings are crucial to avoid potential financial and reputational harm to providers.
Additionally, insurers require a robust framework for evaluating care quality to manage liability risks accurately. Without clear definitions and transparency in the ratings process, insurers face challenges in assessing risk, potentially jeopardising the stability of the healthcare sector.
As we await the final Dash report and Professor Richards’ review of the SAF’s application in the NHS, it is critical that CQC takes immediate action to address the identified issues. A transparent, effective, and credible CQC is vital for the health and social care sectors, and swift reforms will be essential in setting a pathway to recovery and restoring public confidence in the regulator.
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