Speaker 1: 00:05

Well, back to AC Health Check. My name is Peter O'Clark.

Speaker 2: 00:09

And I'm Alice Thabington.

Speaker 1: 00:11

And we're both regulatory lawyers at Osborne Clark. Today, we're looking at recent changes and criticisms of the Care Quality Commission, the CQC. Looking at the rollout of the new single assessment framework, looking at the findings of some recent inquiries questioning the CQC's effectiveness, and discussing some general criticisms that are leveled at the organization.

Speaker 2: 00:32

Yeah. We know this is a really interesting time for the CQC and any health care provider that's regulated by them. It's a period of real change and flux. The single assessment framework was rolled out last year, and already that's been subject to some criticism and may even be subject to further review. And also within the last year, we've had two reports come out that subject the considerable criticism of its effectiveness as a regulator.

Speaker 1: 00:58

And as ever with OC HealthCheck, we'll be getting out our legal thermometer, taking the temperature on developments and making an assessment of how critical they are for the industry. So we're looking at the CQC single assessment framework. This was rolled out from the 2023 and was supposed to improve how providers are assessed by the CQC. But it was one of the issues reviewed and criticised by Doctor. Penelope Dash in her report into the CQC, published in October.

Speaker 2: 01:24

Yeah. The single assessment framework actually replaces the previous system, which used key lines of inquiry. And the new system uses what are known as quality statements. So the single assessment framework is built around five core questions to be considered, which are: Are services safe, effective, caring, responsive, and well led? And the main difference is that this new framework actually refines how the CQC assesses its findings against those questions.

Speaker 1: 01:53

Yeah, it's worth highlighting, isn't it? That these quality statements are now intended to be more descriptive so that feedback can be given to the providers about what good care is supposed to look like using those five key questions. And there seems to be much more of an emphasis now on provider collaboration and integrated care systems as well.

Speaker 2: 02:13

Yeah, absolutely. I think perhaps the biggest change actually is that CQC isn't only going to be using on-site inspections, which is its main way of actually conducting its inspections previously with a one or two day assessment of health care providers, but instead continuing to use on-site inspections, but also data analysis and feedback from people that use health care providers' services. And that feedback can be provided on an ongoing basis. So it's not just provided at the time of assessment, but can be submitted through a portal for CDC to have continuous review and monitoring of health care providers' performance.

Speaker 1: 02:50

But, also, I think, so many people would have seen perhaps coming to this podcast is in the public domain, the mainstream media. It's clear the CQC's been dealing with a few difficulties, think. Famously, been dealing with a high workload, complex assessment process, and scrutiny over inspection outcomes, all seeming as far as we can see affecting staff morale at the CQC as well. And in turn, there's the concern people have that this might have an impact on the quality and the consistency of inspections being carried out on on service providers. On top of that, though, there have been some pretty hard hitting recent inquiries.

Speaker 1: 03:28

What have you seen there?

Speaker 2: 03:29

Yeah. Absolutely. I think in the last year, there have been a couple of really relevant reports that have been published in July and September, and those are the DASH and the DARZI reports. Those were very critical of the CQC as a regulator. Think I the primary one for us to talk about, to begin with, is the DASH report, which was conducted by doctor Penny DASH.

Speaker 2: 03:53

And that highlighted several significant criticisms of the CQC about its operational effectiveness and also its credibility as a regulator. I think that loss of credibility amongst health and social care professionals shows a deteriorating ability for the CQC to actually identify poor performance and to support health care providers who need that support to improve. And there's also operational performance issues that have been highlighted by doctor Dash. So we know that there is a backlog in registrations with CQC, and there are delays with reinspections. And, actually, some health care providers haven't been inspected at all.

Speaker 2: 04:31

So one in five health care providers have never had a CQC inspection.

Speaker 1: 04:35

Yes. Jumping in there, so some of work we do for clients is we have to, particularly in a corporate transaction, just do some due diligence on a target and and see what's available in the public domain to work out if we for our clients can make an assessment over the the risk profile of a potential target. What are some of the issues that might be cropping up here if if there's a lack of inspection of providers?

Speaker 2: 04:57

Yeah. I think it definitely poses difficulty. Of course, if there's no CQC inspection at all, then we don't have any CQC report to let us understand the performance of that health care provider. But I think there's also a concern around the fact that if CQC inspections aren't even adequate, we have no other information to go on when we assess a health care provider's CQC performance other than those CQC reports. But now we're operating in the context of knowing that perhaps those reports aren't completely fit for purpose.

Speaker 1: 05:26

Yeah. So linked to that, the DASH reports also highlighted that the inspectors themselves don't necessarily have the expertise in the areas they're looking at that's supposed to be relevant to their roles. So DASH has highlighted in particular inspections, reports carried out on institutions dealing with patients with dementia, but some inspectors don't have expertise in that area, which leads to concern over, you know, the viability, the usefulness of these reports, full stop.

Speaker 2: 05:57

Yeah. Yeah. Absolutely. And I think, ultimately, what Dash concludes is that there's a need for what she describes as comprehensive reform. So that suggests that we're going to see further changes perhaps to how the CQC operates as a regulator, perhaps even to its very new single assessment framework, particularly given that the CQC has been quite accepting of Dash's criticisms.

Speaker 2: 06:20

They published their response to her report in October. They've acknowledged themselves that they'll be looking to proactively look at how they can remediate those failings that she's identified.

Speaker 1: 06:30

Yeah. So that was Dash. And where does Lord Darcy's report fit into this picture?

Speaker 2: 06:34

So that report ran in parallel to doctor Dash's report. And the purpose of Dasey's report wasn't directly to assess the CQC, but nonetheless, it does offer some criticisms of the regulators' effectiveness. Dasey ultimately concludes that the CQC hasn't been effective in driving high quality health care outcomes through its regulatory assessment. So, again, effectively saying that the assessment process isn't fit for purpose. There's a particular criticism from Lord Darsey that I think is quite interesting, where he says that the CQC seems to believe that the solution to any problem is just to add more staff, rather than to look into deeper root causes.

Speaker 1: 07:16

Yeah. And I think if you take Darcy and Dash together, the sort of fundamental problem here is that you the CDC was set up in the first place because the public needs to have confidence in institutions which are providing care. You know, for example, care for the elderly. But if there aren't enough inspections taking place and if there are concerns that reports aren't particularly comprehensive or they're out of date, then that does have a knock on public confidence in the in the system. And with the, you know, the new government having come in, commissioned the Dasey report and and acting pretty quickly, to be fair, alongside the CQC on the DASH report, clearly, collectively, their work is cut out, but at least there seems to be a direction of travel.

Speaker 2: 07:58

Yeah. Yeah. I think that's certainly true. And I think you and I have discussed quite recently the CQC's response to those reports and that they have been quite accepting and I think proactive in what they're going to be doing next.

Speaker 1: 08:10

So with all this uncertainty about the CQC's performance and how much third parties can rely upon their findings, what's one of the impacts it's having for clients in this area?

Speaker 2: 08:20

Yeah. I think we often advise clients on their regulatory duties, and as part of that, we also advise on the risk of enforcement action where they don't fulfill those duties. And I think in a period like this, where the CQC is going through quite a lot of flux and potentially further reform to how it acts as a regulator, it makes it much more difficult to predict where enforcement action might actually take place and the risk level for clients.

Speaker 1: 08:45

So if we're gonna take the OC health check thermometer out on on this area, take a temperature check, any provider in this area or maybe a company thinking of investing in this area, take a temperature check on it. How's it looking, do think?

Speaker 2: 08:57

I think there's a lot of uncertainty at the moment around the CQC, particularly for health care providers who are getting to grips with this new single assessment framework. It's been in place for about a year now, and I think a lot of health care providers probably still don't feel completely certain of what that means for their operations.

Speaker 1: 09:13

Mhmm.

Speaker 2: 09:14

And they're now operating in the context where that new system might be overhauled again. And there might be a new enforcement regime, there might be a new inspection regime, and health care providers will have to get to grips with that and understand how that affects the services that they provide.

Speaker 1: 09:29

Yeah. And I think on top of that, just generally staying on top of government reform, what comes out of these reviews in the years ahead, and see whether CQC might be taking its own proactive steps to try to improve its service. Certainly, we've had some hard hitting reviews, but to be fair, the CQC has responded to that saying that service needs to be improved. So I think for any company operating in the sector or thinking of investing in it, keeping on the developments, Go to our microsite. We'll be keeping everybody up to date on developments as they happen.

Speaker 1: 09:58

So, Alice, thanks very much for joining us. It's been great to have you on this episode of OC Health Check.

Speaker 2: 10:02

Been great to talk at all three p, and I'm there'll be plenty more for us to discuss on the CQC.