Streeting says health watchdog not fit for purpose and needs ‘radical reform’

England’s health and social care watchdog is “not fit for purpose” and needs “radical reform”, Health Secretary Wes Streeting has said as he pledged immediate action to restore public confidence.

Mr Streeting was reacting to an independent review into the Care Quality Commission (CQC), the body that monitors and inspects all health and adult social care providers to ensure safety and quality standards.

The Health Secretary said he was “brutally honest” with the public before the election that problems with the NHS would “take time to fix”, but he had not anticipated that the regulator would have “failed to such an extent”, in comments to BBC Radio 5 Live.

Members of the public looking at ratings on the website should “take them with a pinch of salt”, he told ITV’s Good Morning Britain, adding that he had asked the commission to “urgently qualify” its ratings.

Asked if there was a fix that did not involve spending more money, Mr Streeting said: “I don’t think money is the issue here. I think it’s culture.”

He said there needs to be a “radical reform” of the organisation.

“Leadership is vital. We need a new permanent chief executive at the Care Quality Commission and a new chief inspector of hospitals that we can work with to turn the regulator around,” he told BBC Breakfast.

He added: “I never expected to be told that one in five health and care providers had not received a rating, that some health and care providers have not been inspected for a decade, that some of those ratings are effectively manufactured and invented using partial views and inspections combined with historic ratings and judgments.

“I am absolutely appalled.”

The review, led by Dr Penny Dash, chairwoman of the North West London Integrated Care Board, found some organisations had not been reinspected for several years, with the oldest rating for an NHS hospital dating from more than 10 years ago while the oldest for a social care provider was from 2015.

It also revealed a lack of experience among some staff, including examples of inspectors visiting hospitals and saying they had never been in a hospital before, as well as an inspector of a care home who had never met a person with dementia.

The report found inspection numbers were still well below pre-Covid levels, a lack of consistency in the watchdog’s assessments and issues with its IT system.

Mr Streeting said: “When I joined the department, it was already clear that the NHS was broken and the social care system in crisis.

“But I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings.

“It’s clear to me the CQC is not fit for purpose.

“We cannot wait to act on these findings, so I have ordered the publication of this interim report so action can begin immediately to improve regulation and ensure transparency for patients.

“I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care.

“I want to reassure them that I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed.

“This Government will never turn a blind eye to failure.”

Transparency regarding how the regulator determines ratings for health and social care providers will also be improved and the Government will have increased oversight of the CQC, the department said.

Dr Dash was asked to carry out the review of the CQC in May and has spoken to about 200 senior managers, caregivers and clinicians working across the sector, along with more than 50 senior managers and professional advisers at the body over the last two months.

She said: “The contents of my interim report underscore the urgent need for comprehensive reform within the CQC.

“By addressing these failings together, we can enhance the regulator’s ability to inspect and rate the safety and quality of health and social care services across England.

“Our ultimate goal is to build a robust, effective regulator that can support a sustainable and high-performing NHS and social care system which the general public deserves.”

Professor Martin Green, chief executive of Care England, said: “This is going to be a long and difficult journey for the CQC, but one that is entirely necessary.

“Care England stands ready to work with the regulator to help them deliver an effective and supportive regulatory system that will be the cornerstone of public protection and delivers fair judgments across health and social care.

“The CQC must embark on a radical improvement programme that should not only include some tangible improvements in their performance, but also needs to move away from a culture of blame.

“We all want proportionate and effective regulation, and the challenge now is for CQC to take action and work with organisations across the sector to deliver it.”

Kate Terroni, CQC’s interim chief executive, said: “We accept in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed.

“Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong.

“We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.”

Progress will be monitored over the summer and the full independent report will be published in autumn, the Department of Health said.