The Department of Health and Social Care has published a report examining the operational effectiveness of the Care Quality Commission (CQC), led by North West London ICB’s chair Dr Penny Dash. A particular aim of the report was to explore whether CQC’s regulations and processes are deemed fit for an age of digital healthcare.
Overall, the report identifies “significant internal failings” at the regulator leading to a “substantial loss of credibility”, a deterioration in ability to identify poor performance and support a drive to improve quality, and an impact on the capacity and capability of healthcare sectors to deliver such improvements. It follows the interim report shared over the summer and covered by HTN here.
The main conclusions highlighted within the report include challenges around CQC’s provider portal and regulatory platform; data challenges around the production and quality of reports; and concerns around the single assessment framework (SAF), which was designed to help develop a single shared view of quality across the sectors by collecting data in advance across all areas of care to provide an “always on” assessment model.
Looking in more detail, conclusions indicate a lack of data – particularly timely data – due to delayed inspections, a “stark” reduction in inspections overall and a backlog in registrations for new providers. The report notes that this makes it difficult for patients and users to compare services and choose care, and also means that providers lack the data provided from an expert inspection to identify opportunities for improvement.
On the matter of delayed reporting, as well as the quality of reports, the review highlights challenges including poorly structured reports which are hard to follow; different messages in summaries than in the main report; some sections copied over from other providers; and a lengthy, complicated scoring system that is difficult to understand. “The review has heard that some of this is due to challenges with the information technology within CQC,” the report comments. It calls for greater consistency and suggests that CQC could learn from “examples of better-quality outputs”.
The report raises various issues with the provider portal and regulatory platform, such as issues with how the platform manages safeguarding concerns; reports of serious untoward incidents; difficulties with “simple things” such as evidence upload and auto-responses. It concludes that “poorly performing IT systems are hampering CQC’s ability to roll out the SAF and appropriately manage concerns”, along with causing frustration and time loss for CQC staff and providers.
Regarding the SAF, the report states that the description of the SAF is “poorly laid out on the CQC website” with issues around clear communication. Additionally, questions are noted about how data on user and patient experience is collected and used, and “more could be done to support and encourage innovation in care delivery”.
The report states that CQC “could do more” to support improvements in quality, and suggests that the regulator could do this through the description of best practice and improved sharing of new models of care delivery, including those utilising innovative approaches and technologies.
Looking at other areas for further consideration – described as areas raised within the review team but not yet considered in detail – the report emphasises the need to ensure that the federated data platform “results in a single ‘data lake’ across the health and social care sectors”. The review heard how this would benefit CQC and all healthcare organisations by bringing a “more streamlined and efficient approach” to performance management and improvement across services.
The report concludes by offering seven key recommendations. Regarding digital and data, these are summarised as fixing the provider portal and regulatory platform (with a need for CQC to set out how and by when these chalenges will be made, and feedback sought from providers); improving use of performance data; and improving quality and timeliness of reports (with particular focus on clear structure, labelling and findings).
To read the report in full, please click here.
Reporting on healthcare
Last month HTN took a deep dive into Lord Darzi’s investigation into the state of the NHS, focusing on all things digital, data and tech.
We also sought insight from across the industry with regards to the Darzi report; check out how health tech professionals reacted here.
