Is CQC fit for purpose

There has been a number of announcements from the Care Quality Commission in the past few weeks, and it really begs the question whether they are fit for purpose.

Let’s explore some of these announcements, challenges and issues:

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CQC's People Survey

The concerning news started at the beginning of the year, when CQC released their staff survey results which highlighted internal issues, with these being the standout five for me:

• Only 15% of CQC staff felt that changes were effectively implemented
• Only 23% of CQC staff felt concerns would be acted upon
• Only 27% felt of CQC staff felt the CEO and Executive Team were consistent with their organisation’s values.
• Less employees intended to stay for the next 12 months compared to the previous survey (just over half of employee’s plan to stay)
• A low number of CQC staff felt that their work helped to improve care for people who use services.

The two biggest areas of dissatisfaction from the survey were around Leadership and Management and Training and Development and this brings into question the culture within the organisation.

It is worrying that 19% of employees had witnessed abuse, bullying or harassment in the workplace, with 11% of staff stating it had impacted them directly. When you consider that most of the roles are working from home, you have to ask, what really was going on.

Dive deeper into the organisations bullying culture, and you find that the majority of those being bullied, harassed or abused were at the hands of the senior manager team (executive director, director, deputy director and heads of functions). A little deeper and you find that those who identify as disabled are also treated less favourably, with 7% facing discrimination and 11% witnessing it.

I guess this answers the golden question in some of the manager forums as to why CQC can’t retain their staff.

CQC Effectiveness to be officially reviewed

In May 2024 the Health Service Journal reported that the government is reviewing the Care Quality Commission's new inspection process, the single assessment framework with Dr Penny Dash, Chair of the North West London Integrated Care Board leading this inspection.

Whilst this is a his is a pre-planned assessment as part of the Cabinet Office Public Bodies Review Programme, we can only hope this will dive into the continued concerns from providers about the portal, registration delays, inspection concerns and overall concern around the new inspection framework (including the removal of on-site visits, being replaced with data driven outcomes)

Ian Trenholm, Chief Executive resigns

On 25th June, Ian Trenholm stepped down from his role as both CQC’s Chief Executive and as a board member, leaving his role 5 days later, at the end of June 2024. You have to wonder whether the staff survey had any impact, whether the official review made him jump before he was pushed, or just coincidental timing. I guess we may never know, but one thing for sure is that with the lack of diversity at the top, it is definitely time for a shakeup at the top

Kate Terroni makes shock announcement

As they say you ‘can’t make this up’ and Kate Terroni’s statement was one of those moments. She has admitted that the CQC has failed to keep patients safe, leading may not wonder if this is the reason why Ian Trenholm resigned.

Kate confirmed what many of us working in social care and using care services already knew, with more pinch me moment statements including:

1. Stakeholders are losing confidence in the CQC’s ability to deliver their purpose
2. The way we work is not working and we are not consistently keeping people who use services safe
3. Our people are not able to effectively identify and manage risk and encourage improvement and innovation.
4. Our organisational structure, flow of decision making, roles, internal and external relationships do not promote a productive and credible way of working.

Kate has stated that the CQC will be transparent about their actions for improvement to the public, providers and stakeholders. Ironic as this is something they judge against, although let’s not knock her yet, it appears she has just taken the first step in the transparency game.

Technology failures

The roll out of the CQC’s new portal has been diabolical, with many providers and Registered Managers still unable to access their accounts. The new portal launched on 11th March, although CQC did not formally acknowledge this until 23rd May, with many providers, Nominated Individuals and Registered Managers being led to believe they were the only ones facing the issue. Perhaps someone was copying the post office scandal rhetoric that it is only one issue and not countrywide, but why not be honest and open? The CQC have had to put into place measures for workarounds, but the issue doesn’t look like it’s going away anytime soon. We know there are still Registered Managers who have left their roles, still registered for services they do not oversee, newly appointed Registered Managers whose organisations are unable to add them onto the portals.

The new portal isn’t the only thing affected by their poor technology infrastructure, with factual accuracy check processes and assessment reports both being delayed. With the CQC having spent over ￡￡thousands on IT support in May, you’d have thought these issues would be resolved!

I can’t help but think that if this was a provider with tech issues impacting day to day operations, they would have been slapped with a Requires Improvement for Well-Led, Effective, Safe and Responsive!

Responsiveness and Transparency Concerns

There appears to be less collaboration between CQC and providers/social care professionals and unfortunately with this has come more people bad mouthing the regulator over the years, many groups outing issues, and it appears a quick search on social media finds a number of issues highlighting the CQC’s responsiveness and transparency. Here are just some of the things people have raised freedom of information requests/concerns about:

• Lack of gender pay gap report – the last one was released in 2022. Ironically under the new framework for Well-Led, the Workforce, Equality, Diversity and Inclusion Quality Standard highlights the need for providers to have a gender pay gap report.
• Lack of transparency from staff – Kate Terroni has previously declared her family’s role within social care and the legal system, although her 2024 declaration, this is missing.
• Executive team, board members and other expenses have not ben declared since December 2023.
• Annual accounts not declared since 2022.
• Adverts and job benefits are not meeting current legal Flexible Working Regulations.

The list goes on, with a whole Reddit channel dedicated to people’s frustrations over their transparency, ongoing communication concerns and much more.

Single Assessment Framework

I guess I should mention the elephant in the room! The Single Assessment Framework… love it or hate it, it’s been rolled out and here! Sadly, rolled out with lack of resource both in terms of inspectors and staffing within the CQC and also resource to support providers with the questions they have. It did feel like they dropped the framework and expected providers to get on with it, and this has seen many “cowboys” enter the social care space, profiting off services and managers who are keen to understand the framework better. It is interesting that the CQC appear to acknowledge that they need to do more and are seeking feedback on the areas you understand well, and where you might need more detail. You can find the survey here

Ian Trenholm previously acknowledged that providers rated Requires Improvement have real concerns about the frequency of inspections and CQC were due to announce the schedule of re-inspections over the next couple of months but time will tell if they keep to this commitment. Given CQC inspections have dropped by two thirds since 2019, they sure have some way to go to increase it back to the baseline levels we once knew. Add the backlog of currently registered services waiting for inspections to the thousands that are registering new services and awaiting registration inspections and interviews, and we have a recipe for disaster. I guess time will tell, but from speaking to those I know within the CQC, it doesn’t appear they have the capacity (and dare I say it… the tech!)

Final thoughts

I guess we really will need to see whether the CQC can effectively turnaround their service. What started as me planning to write a small update on the CQC changes, has led me down a rabbit hole of information, issues and lack of transparency from our regulator.

I personally welcome the audit of their effectiveness, and hope that actions will be put in place to ensure we have a regulator that is fit for purpose, who collaborates with providers and social care professionals, that is transparent and acknowledges its faults, learns from its mistakes, ensures high-quality services and above all, sets an example to the services it is inspecting and in turn becomes less hypocritical.

Let me know what you think in the comments below