CQC must speed up its efforts to improve or lose further credibility

The unexpected departure of its highly regarded chair, Professor Sir Mike Richards, so soon after the loss of its chief executive, will leave many concerned that the inspection body’s urgent need for a reset and recovery will be delayed even further.

The next 12 months offer the CQC a precious window of opportunity to fundamentally change how it regulates services. But this causes us to confront a bigger question: what is health and care regulation actually for, and is the CQC up to the job?

Regulation should play a vital role in the health and care system, and when done well, it adds real value for patients, providers and the wider public. Patients should know that the services they use are high quality, safe and represent good value for money.

NHS leaders and their teams delivering those services also want assurance that a national regulator will help them uncover issues with services that may have been missed or not fully recognised by their boards. They rightly expect an effective regulator that offers an independent, objective perspective to support them to improve. For now, they are not getting this. There are some reasons to be optimistic.

The CQC’s ‘reset’ won’t start from scratch; it can build on the positive changes already underway. The regulator has already committed to recovering its operational effectiveness in response to stark feedback from both the health sector and the government, and engagement with NHS leaders suggests its leadership is taking a considered approach to rebuilding relationships with NHS providers.

Its early work to restore inspection capacity and update its digital platform shows positive intent to ensure ratings offer a more accurate view of quality and safety. The regulator has also made important steps to bolster sector expertise. The appointment of four new chief inspectors – each well-regarded in their respective sectors and pragmatic about the challenges ahead – is helpful.

The CQC has also committed to recruiting more expert reviewers and specialist advisers – something which should help to embed deeper sector-specific knowledge within inspections. If a strong and credible chief executive and chair are swiftly appointed, these solid foundations on which recovery now depends should work.

Jam tomorrow

However, there is still the risk of ‘jam tomorrow’ as the gap between where the CQC is and where it needs to be is substantial. NHS leaders remain in a position where the services they run are being judged by a regulator they do not yet have full confidence in.

For too long, many NHS providers have felt short-changed – paying annual fees without receiving credible assessments, or in many cases any meaningful information at all. Some providers have not been reinspected for close to a decade, and out-of-date ratings risk misleading patients as well as failing the services they judge.

Meanwhile, the regulator is also failing to assess organisations on their leadership culture when it comes to EDI and racism. This needs to be urgently addressed: without it, patient care is compromised.

The CQC’s current risk-based approach to inspection is leaving some providers with out-of-date ratings, even when they have taken significant steps to address compliance issues, strengthen governance and bolster quality assurance. This has a real-world impact on public trust and staff morale, recruitment and retention.

Ministers have laid down a huge challenge to the NHS – boost performance, integrate care and shift from primarily treating illness to actively improving population health.

The real test for the CQC now is whether it can marshal the resources and the resolve it needs to clear the inspection backlog and deliver the consistent, credible, improvement-focused regulation its legitimacy depends on.

The CQC must keep pace with this, and a health and care landscape that is expected to change rapidly, amid significant internal redesign – it is welcome to see it has already shown some signs of doing just that.

Its new assessment frameworks, for example, respond to a more integrated and multi-layered provider sector and Bola Owolabi, as chief inspector of primary and community services, is leading some work on the assessment of neighbourhood health services.

The real test

NHS leaders, however, want to see quicker progress from their inspector over the next 12 months. They want to see more consistent and timely inspection cycles, and a more responsive model that makes smarter use of data and recognises both risks and improvements to avoid unnecessary reputational damage. They want to see inspections that offer and reflect best practice in organisational development while adding value to patient outcomes.

They also expect clearer support to help them continuously improve, including a more balanced approach to risk, rather than focusing heavily on one dimension, such as process compliance.

While they welcome the renewed emphasis on peer review within inspection teams to strengthen credibility and sector engagement, NHS leaders also want to see this model expanded rapidly. They want to see their regulators speak truth to power and call out where national policy causes issues for services.

The real test for the CQC now is whether it can marshal the resources and the resolve it needs to clear the inspection backlog and deliver the consistent, credible, improvement-focused regulation its legitimacy depends on.

The NHS Alliance* and our members stand ready to support that effort. Failure to do so will further undermine the credibility of the regulator and call into question its future role in the system.

Lord Victor Adebowale CBE is chair of the NHS Confederation.