The CQC has agreed to formally pause its inspections of Integrated Care Systems (ICSs) for six months following a major review into the way it operates.
The independent report, commissioned by the government, was led by North West London ICS chair Dr Penny Dash.
Published today, the report made seven recommendations in order for CQC to ‘restore confidence, credibility and support improvements in health and social care’. These included that CQC should ‘formally pause ICS assessments’ (see box for full list).
The CQC was given the duty to review and assess ICSs under the Health and Care Act 2022, which established the systems. It had developed a methodology for this assessment, which was tested in pilots in Dorset and Birmingham and Solihull.
Inspections were due to start in April, but the rollout was paused following discussions with the Department of Health and Social Care (DHSC), and then again in May due to the general election.
Dr Dash said her review highlighted concerns over the rollout of the assessments, with questions as to whether processes or outcomes were being assessed.
The report said the assessment process had not particularly focused on ICS’s four objectives (improving outcomes in population health and healthcare, reducing inequalities in outcomes, experience and access, enhancing productivity and value for money, and helping the NHS support broader social and economic impact) and it was ‘not clear’ how progress against them would be measured.
There was also a lack of descriptors as to what ‘good’ looks like, questions as to what data should be considered to make a meaningful assessment of leadership, integration and quality, and concerns around duplication of provider assessments.
It said: ‘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.’
In its response to the report, CQC said it had paused its assessment of ICSs for six months ‘in agreement with DHSC’.
‘This is to free up capacity to carry out more assessments of providers and enable the regulator to modify its current assessment framework,’ it said.
Seven recommendations from Dr Penny Dash report
- Rapidly improve operational performance, fix the provider portal and regulatory platform, and improve the quality of reports
- Rebuild expertise and relationships with providers
- Review the SAF to make it fit for purpose with clear descriptors and a far greater focus on effectiveness, outcomes and use of resources
- Clarify how ratings are calculated and make the results more transparent
- Continue to evolve and improve local authority assessments
- Formally pause ICS assessments
- Strengthen sponsorship arrangements
Earlier this month, the regulator appointed Sir Julian Hartley as its new chief executive as part of an overhaul.
This was in response to the interim report from Dr Dash, which found that there was a ‘lack of consistency’ and transparency in CQC ratings and led health secretary Wes Streeting to take ‘immediate steps’ to increase oversight, declaring that the organisation is ‘not fit for purpose’.
Following the publication of Dr Dash’s interim report, the regulator asked Professor Sir Mike Richards to conduct an internal review of the single assessment framework and its implementation.
This report, also published today, recommended a ‘fundamental reset’ of the organisation and that while ‘aspects’ of the single assessment framework could be retained, others should be ‘suspended and almost certainly scrapped’.
It suggested that the use of one-word ratings for GP practices should be evaluated.
Dr Dash said: ‘This report reiterates the findings of my interim report while providing further detail and analysis of the CQC’s performance. It builds on insights and perspectives from patients and users, and a wide range of health and social care providers as well as senior leaders from the NHS and local authorities.
‘I am delighted that Sir Julian Hartley will be appointed as the CQC’s new chief executive – he is an outstanding leader, and I am confident he will restore the regulator’s ability to inspect and rate the safety and wider quality of health and social care services across England.’
Mr Streeting added: ‘Patient safety is the bedrock of a healthy NHS and social care system. That’s why we are taking steps to reform the CQC, to root out poor performance and ensure patients can have confidence in its ratings once again.
‘This government will never turn a blind eye to failure. An overly complex system of healthcare regulation and oversight is no good for patients or providers. We will overhaul the system to make it effective and efficient, to protect patient safety.’
Ian Dilks, chair of CQC, said he welcomed the final part of Dr Dash’s review and the regulator will ‘address the recommendations with urgency’.
He added: ‘Today also sees the publication of the review we commissioned from Professor Sir Mike Richards – we are extremely grateful to Sir Mike for his helpful work and will be using his recommendations to help us respond to the serious failings identified by Dr Penny Dash. His review also offers additional suggestions for improvement that we will be exploring as part of our wider recovery work.
‘Both reviews have reaffirmed the support for a robust health and care regulator and recognised the dedication and experience of CQC staff. We are committed to rebuilding trust in CQC’s regulation and are taking action to make sure we have the right structure, processes, and technology in place to help us fulfil our vital role of helping people get good care and supporting providers to improve.’
