The healthcare regulator is so badly run that patients in England cannot trust the safety ratings it issues for hospitals, care homes or GP practices, the health secretary has said.
Wes Streeting said the Care Quality Commission was in such deep crisis it was not able to do its basic job reliably. His warning came after an interim report by the public care doctor Penny Dash found the CQC was plagued by low levels of physical inspections, a lack of consistency in assessments and problems with a faltering IT system.
Streeting told BBC Radio 4’s Today programme on Friday: “I would take those ratings today with a pinch of salt. One of the reasons why I’ve chosen to publish the interim report from Dr Penny Dash is, firstly, to be open and transparent and honest with the public urgently, but secondly, to make sure that we ask the CQC to urgently qualify those ratings by providing the background information on how the rating was determined, so that people can make more informed decisions.”
Streeting has promised to “grip the crisis” at the CQC by taking immediate action to increase oversight of the body and give patients more confidence in their care.
He said: “How can you tolerate a situation where one in five of your health and care providers has not received a rating? How can you tolerate ratings being reached on the basis of only a partial inspection of the organisation, melded in with inspection reports dating back over a number of years?”
Streeting has announced four immediate steps the government and CQC will take to restore public confidence and give patients a more accurate picture, including recruiting a senior cancer doctor to review the body’s assessments.
Dash found that about a fifth of the locations the CQC had the power to inspect had never received a rating, while other organisations had not been reinspected for years. One inspection was about a decade old.
There was a lack of experience among inspectors, the report said, some of whom checked hospitals despite never having visited one before. Another inspector of a care home had never met a person with dementia.
Dash, who began her investigation in May, also found that social care providers were waiting too long for their registration and rating to be updated, with implications for local capacity.
Health officials said the watchdog’s failings meant it was unable to consistently judge the quality of health and care services, including those in need of urgent improvement.
After taking over the Department of Health and Social Care, Streeting asked for an interim report so that the government could immediately begin making improvements, before the publication of a full report this autumn.
“When I joined the department, it was already clear that the NHS was broken and the social care system in crisis,” he said. “But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings. It’s clear to me the CQC is not fit for purpose.
“I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care. I want to reassure them that I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed. This government will never turn a blind eye to failure.”
The CQC apologised this month after care organisations complained of a “hostile” inspection regime and a major new computer system failing to work properly. Its former chief executive, Ian Trenholm, quit at the end of last month midway through the implementation of changes that were supposed to improve assessments. One of Streeting’s first tasks will be to recruit a permanent replacement.
Other initial steps include the appointment of Prof Sir Mike Richards, the CQC’s first chief inspector of hospitals in 2013 and a senior oncologist, to overhaul the inspection and assessment system.
The government wants to increase the transparency with which the CQC determines its ratings for health and social care providers, to rapidly improve operational performance, and to increase oversight. The body will be expected to give regular updates on its progress to the department.
Dash, who over the last two months has spoken to hundreds of senior managers, caregivers and clinicians across the sector, has also been asked to review the effectiveness of all patient safety organisations.
The CQC regulates close to 15,000 care homes, 13,000 home care agencies, 11,500 dentists, 8,600 GPs and 1,200 hospitals as well as community services and supported living facilities.
Prof Martin Green, the chief executive of Care England, said: “This report acknowledges the severe and systemic problems that sit at the very heart of the CQC and gives a specific set of steps that the regulator must take to improve performance and re-establish the sector’s long-eroded trust. This is going to be a long and difficult journey for the CQC, but one that is entirely necessary.”
The chief executive of NHS Providers, Sir Julian Hartley, said: “Trust leaders will welcome this announcement. Based on their clear and consistent feedback, we have been calling for urgent reform of the CQC. We fully agree with these recommendations.”
The National Care Association, which represents independent care home operators, in February publicly warned that “the culture in CQC remains hostile at the ground level” and was forcing providers to consider closing.
“For some time now, the CQC has not been responsive to the challenges that the sector has faced because of poor inspection methodology,” said the NCA chair, Nadra Ahmed, this month when welcoming the earlier apology. “Many providers have found the process very challenging, intimidating, and staff have been left in tears.”
