Operational Effectiveness of the Care Quality Commission: What It Means for Care Home Operators

In May 2024, the Department of Health and Social Care appointed Dr Penny Dash to lead a thorough review of the Care Quality Commission (CQC) to assess how effectively it functions as the independent regulator of health and social care services in England. The review’s findings, published in October 2024, provide insights and recommendations for addressing operational challenges at the CQC.

Why this matters to care home operators

The CQC is pivotal in setting and enforcing standards of care in health and social care services, including care homes, to ensure safe, effective, and compassionate care. Yet, there have been growing concerns recently about the CQC’s efficiency, timeliness, and overall impact on the sector. Dr Dash’s report comes at a time when care home operators are experiencing heightened scrutiny and an increased need for clarity on regulatory expectations. The review outlines seven recommendations aimed at improving the CQC’s operational effectiveness.

Key findings impacting the care home sector

Dr Dash’s review identified several areas where CQC’s current operations have affected care home providers:

Reduction in inspections – There was a sharp decrease in CQC inspections, from 15,800 in 2019 to 6,700 in 2023. This backlog affects care home operators awaiting registration and re-inspection, causing uncertainty and delays.

IT system challenges – New IT systems introduced since 2021 have been problematic, impacting both CQC staff and providers. This issue has hampered the Single Assessment Framework (SAF) rollout, which was intended to streamline assessment criteria.

Quality of reporting – Delays in producing inspection reports and concerns about report quality have undermined the credibility of CQC assessments, making it harder for providers to act promptly on regulatory feedback.

Loss of expertise– A 2023 restructuring saw a shift to generalist inspectors, resulting in the loss of industry-specific expertise. This has weakened established relationships and hindered inspectors’ understanding of sector-specific challenges.

Inconsistencies in the SAF – Stakeholders reported that the SAF’s language was vague, and its implementation inconsistent, leaving providers uncertain about the standards they need to meet.

Key recommendations

To address these issues, the report proposes several key changes to enhance CQC’s effectiveness, including:

• Increasing Inspections and Assessments to clear backlogs and provide timely re-inspections.
• Resolving IT Issues to improve operational efficiency and user experience.
• Improving Report Timeliness and Quality by refining processes for more credible assessments.
• Reintroducing Sector-Specific Expertise within CQC to rebuild relationships and regulatory insights.
• Clarifying SAF Guidance and ensuring its consistent application across assessments.
• Encouraging Innovation by adopting more flexible regulatory approaches to support improvements in care delivery.
• Strengthening Engagement with Stakeholders to rebuild trust and ensure CQC activities align with sector needs.

What practical steps can care home operators take?

Given the findings, care home operators can start to proactively adapt to the anticipated regulatory changes:

Familiarise with quality statements – Review the SAF’s criteria, especially around areas like safety, learning culture, and environmental sustainability.

Stay Informed on CQC Updates – Sign up for CQC bulletins and attend relevant webinars to stay current on changes and best practices.

Review Internal Procedures – Conduct a self-assessment to identify areas needing improvement to meet updated standards.

Document Compliance – Ensure records are up-to-date and easily accessible to demonstrate compliance during inspections.

Invest in IT Upgrades – Consider digital tools for auditing and reporting, and train staff on new systems for smoother adoption.

Engage Staff – Regularly discuss the CQC’s framework and inspection readiness in team meetings.

Emphasise Professional Development – Encourage staff to stay informed on industry standards and compliance.

Collect Feedback – Set up feedback mechanisms for residents, families, and staff to support continuous improvement.

Conduct Mock Inspections – Regularly assess internal processes to identify and address any compliance issues.

Prepare Action Plans – Based on internal reviews and mock inspections, implement action plans for consistent quality improvements.

Adopt Innovative Practices – Identify ways to improve care quality and efficiency, aligning with the CQC’s support for innovative approaches.

Proactively adopting these steps will improve operational readiness and contribute to providing high-quality care within a robust framework.

The CQC’s recent challenges have presented obstacles for care providers, but the recommendations in Dr Dash’s review offer a pathway toward restoring the CQC’s effectiveness. It remains to be seen how these changes will filter into the CQC’s approach to interventions and as such, care home providers should stay informed about their rights and responsibilities regarding any CQC interventions, ensuring they are well-prepared and their position is safeguarded. Also, in such situations, time is often of the essence and so if providers are in any doubt as to their position, it is always sensible to seek legal advice.