Major Challenges and Reforms Needed in the UK Care Sector
The UK care sector is under significant scrutiny following the release of an interim report by Dr. Penelope Dash, which has revealed critical failings within the Care Quality Commission (CQC). Health and Social Care Secretary Wes Streeting has declared the CQC “not fit for purpose,” bringing to light various issues that hinder the regulator's ability to ensure the quality of health and social care services.
Key Findings
- Inspection Shortfalls: Inspection levels have dramatically decreased post-Covid, with only 7,000 inspections conducted in 2023-24 compared to 16,000 in 2019-20. This decline compromises the CQC’s ability to effectively monitor service quality.
- Inconsistent Assessments: The report highlighted a lack of consistency in assessments and a deficiency in specialist expertise among inspectors. This inconsistency makes it difficult for providers to understand and meet required standards.
- Operational Performance Issues: Various operational shortcomings were identified, such as delays in provider registration and outdated ratings. At the end of 2023-24, 54% of provider registration applications were over 10 weeks old, and some services had not been re-inspected for several years.
- IT System Failures: The CQC’s IT systems, including the provider portal, have caused significant issues for users, such as difficulties in uploading documents and lengthy wait times for password resets.
- Lack of Expertise: There has been a notable reduction in specialist knowledge among inspectors, impacting the credibility of the CQC and its ability to drive improvements in care quality.
Recommendations for Improvement
Dr. Dash suggests several recommendations to address these issues:
- Enhance Operational Performance: Increase the number of inspections and reduce delays in registration and rating updates.
- Fix IT Systems: Urgent improvements to the provider portal and other IT systems are necessary to support the regulatory process.
- Rebuild Expertise: Invest in developing specialist knowledge within inspection teams and re-establish strong relationships with care providers.
- Review the SAF: Conduct a thorough review of the Single Assessment Framework (SAF) to define what constitutes good or outstanding care.
- Improve Transparency: Clarify and make the rating calculation process more transparent to restore trust among providers and the public.
Government and CQC Responses
The Department of Health and Social Care (DHSC) has committed to several actions, including appointing Professor Sir Mike Richards to review the CQC’s assessment frameworks and increasing oversight of the CQC to ensure the implementation of recommendations.
CQC’s interim chief executive, Kate Terroni, has acknowledged the findings and outlined steps to rebuild trust and improve performance. These include increasing the number of inspections, improving the provider portal, and working closely with service users and providers to define good care.