In response to the Review into the operational effectiveness of the Care Quality Commission: Interim Report, published on 26 July 2024 [ https://www.gov.uk/government/publications/review-into-the-operational-effectiveness-of-the-care-quality-commission/review-into-the-operational-effectiveness-of-the-care-quality-commission-interim-report ], Wes Streeting’s statement that the Care Quality Commission (CQC) is “…not fit for purpose” is a damming assertion, but also an indictment of the public sector as a whole.
Whilst, perhaps not surprising for many practitioners and users in the sector, this review will nevertheless cause alarm, given the weighty mandate of the CQC to safeguard and protect the quality of care and lives of the most vulnerable. Ultimately, the CQC is the last line of defence for those entering the health and social care system, to have some modicum of trust and confidence. Comprehensive reforms are long overdue, and the Care Workers Union welcome the swift measures being implemented to grip the situation.
But there are also major concerns surrounding quality of leadership and internal accountability to be factored into these considerations. Those at the helm of CQC did not sleepwalk into this catastrophe. What this situation reveals is an inability to be open and transparent about internal failings. The CQC’s annual report and accounts 2022 and 2023, published on 25 July 2024 (https://assets.publishing.service.gov.uk/media/66a20f6bce1fd0da7b592cbf/CQC-annual-report-and-accounts-2022-2023.pdf), presented to Parliament and the public, flagged no cause for concern. In this report, the CQC’s performance assessment highlighted:
“Outcomes:
- We are an effective, proportionate, targeted and dynamic regulator.
- We provide an up to date and accurate picture of quality.
- It is easy for health and care services, the people who use them and stakeholders to exchange relevant information with us, and the information we provide is accessible, relevant and useful.”
[Extract from: Care Quality Commission Annual Report and Accounts 2022/2023]
This latest annual report painted an encouraging picture of the CQC coping with the delivery of its mandate in an efficient and cost-effective manner. This includes additional responsibilities for care in a local area from April 2023, under the Health and Care Act 2022. Unfortunately, such reports normally only share what has been done (real of perceived), but never what has not been done or where failures are occurring. The cover-up culture prevalent across many public bodies has contributed to this situation. Leaders are encouraged to grin and bear and to do more with less resources, rather than raise concerns and challenge decisions which erode internal accountability and the ability to deliver. This culture undermines the very premise of oversight bodies, whose role is to expose shortcomings and prioritise public interest. The interim findings of the Dash Review were fully accepted by the CQC, with its leadership indicating that many recommendations chime with their ongoing actions and pointing to the need for honesty about what has gone wrong. Indeed, honesty sits at the heart of this matter, because watchdogs should not need to be watched.
Overall, this is a very important step towards greater openness, transparency and hopefully a recalibration of relationships and communications within the sector. It is also important to consider lessons learnt for other existing regulatory bodies and new ones planned by Government. CQC’s failings creates a contagion effect. Watchdogs must first bolster their own internal accountability, to appear credible in the eyes of those they seek to regulate. Finally, CQC remains a critical stakeholder in implementing future reforms and has made some valuable contributions to the sector, which is important not to diminish completely. But rather focus on the important challenge ahead of building public trust and confidence.
Contact point:
Sonia Warner, Director, Business Development CWU.
sonia.warner@careworkersunion.org
Care Workers Union
