Dash CQC Review

Recommendation 1: rapidly improve operational performance, fix the provider portal and regulatory platform, improve use of data, and improve the timeliness and quality of reports The interim chief executive of CQC is already making progress towards redressing poor operational performance including bringing in more staff, particularly those with prior experience of working in CQC. CQC should agree operational performance targets or KPIs in high-priority areas, in conjunction with DHSC, to drive and track progress. CQC will need to set out how, and by when, it will make the changes required to the provider portal and regulatory platform. CQC should also ensure that there is far more consideration given to working with providers to seek feedback on progress. Urgent action is needed to ensure a timely and appropriate response to concerns raised around safeguarding and serious untoward incidents. The quality of reports needs to be significantly improved with clear structure, labelling and findings.

Recommendation 2: rebuild expertise within the organisation and relationships with providers in order to resurrect credibility There is an urgent need to appoint highly regarded senior clinicians as Chief Inspector of Hospitals and Chief Inspector of Primary and Community Care. Working closely with the chief inspectors and the national professional advisers, there should be rapid moves to rebuild sector expertise in all teams. The review heard a strong message from providers across sectors about the opportunity to create a sense of pride and incentive in working as a specialist adviser with CQC. Consideration should be given to a programme whereby the top-performing managers, carers and clinicians from across health and social care are appointed or apply to become assessors for 1 to 2 weeks a year with a high accolade being given to those accepted on the programme. The executive leadership team of CQC - which should include the 3 chief inspectors - should rebuild relationships across the health and care sectors, share progress being made on improvements to CQC and continually seek input.

Recommendation 3: review the SAF and how it is implemented to make it fit for purpose There needs to be a wholescale review of the SAF to address the concerns raised. Professor Sir Mike Richards is now working with CQC to initiate this. Specifically, to:

• improve the quality of documentation on the CQC website
• appropriately describe each key question
• set out clear definitions of what ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ looks like for each evidence category and for each quality statement, as per the previous lines of enquiry
• request credible sector experts to revisit which quality statements to prioritise and how to assess and measure them
• give greater emphasis to the ‘effective’ key question
• give greater emphasis to, and use of, outcome measures.

Recommendation 4: clarify how ratings are calculated and make the results more transparent, particularly where multi-year inspections and ratings have been used The approach used to calculate ratings should be transparent and clearly explained on CQC’s website. It should be clear to all providers and users. The use of multi-year assessments in calculating ratings and in reports should be reconsidered and greater transparency given to how these are being used in the meantime.

Recommendation 5: continue to evolve and improve local authority assessments CQC has been clear that the assessment process for local authorities will evolve during baselining. It is now 9 months into the 2-year baselining period. CQC should consider feedback it has received, alongside the findings in this review, in order to improve the process of assessment, continuously improving its robustness and the experience of local authorities.

Recommendation 6: pause ICS assessments Given the difficulties to date in agreeing how best to assess ICSs, a need to ensure alignment with the NHS England Oversight Framework and considerable challenges within CQC, it is recommended that ICS assessments be paused for now with the nascent ICS assessment team redeployed within CQC.

Recommendation 7: strengthen sponsorship arrangements to facilitate CQC’s provision of accountable, efficient and effective services to the public Given the need for DHSC support, CQC and DHSC should work together to strengthen DHSC’s arrangements for sponsorship of CQC, reaching an advanced level of maturity against the Arm’s length body sponsorship code of good practice. This should be underpinned by more regular performance reviews between DHSC and CQC to reinforce and check progress against the recommendations in this report. Metrics for performance review should be enhanced with clear performance targets set for the next 6 to 12 months. Meetings should include senior civil servants at DHSC (ideally the relevant directors general) and should take place on a monthly basis. CQC should consider strengthening partnerships with those it regulates, including setting out more clearly what providers can expect from the regulator. Strengthened sponsorship arrangements will further reinforce accountability. It is recognised that a number of the recommendations made within this report will require wider system consideration - for example, how to ensure a sufficient focus on effectiveness and outcomes, and that use of resources is woven through all quality assessments and recommendations. DHSC will need to lead or co-ordinate this work. As part of it, the terms of reference of the NQB should be reviewed.