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Patient safety at heart of government’s plans for healthcare reform as Health and Social Care Secretary orders action to improve regulator performance.

Patient safety across health and social care is set to be bolstered as the government takes action to improve the effectiveness and efficiency of key patient safety organisations.  

The move – aimed at ensuring the country has the best system in place to keep patients safe – comes as a major review of the CQC’s operational effectiveness is published in full.

The report, led by Dr Penny Dash, Chair of the North West London Integrated Care Board, identifies significant internal failings at the regulator which are hampering its ability to identify poor performance at hospitals, care homes and GP practices.

Its interim conclusions, published in July, prompted the Health and Social Care Secretary to order immediate action to restore public confidence in the effectiveness of health and social care regulation.  

The full report confirms significant failings at the CQC in regard to its operational effectiveness - including poor performance in relation to inspections and a lack of capacity and capability to deliver improvements.     

The report provides seven specific recommendations for improvement, which the Secretary of State for Health and Social Care fully supports. This includes recommending that the CQC formally pauses the implementation of its assessments of Integrated Care Systems as it works to restore public confidence in health and care regulation. This will allow the CQC to focus on getting the basics right when assessing the organisations it regulates. 

The Health and Social Care Secretary has now asked Dr Dash to conduct two further reviews moving her focus from operational effectiveness to patient safety and quality. The first review will examine the roles and remits of six key organisations and make recommendations on whether patient safety could be bolstered through a different approach. These are:    

• Care Quality Commission (CQC) including the maternity programme (MNSI)    
• National Guardian’s Office (NGO)       
• Healthwatch England (HWE) and the Local Healthwatch (LHW) network.    
• Health Services Safety Investigation Body       
• Patient Safety Commissioner        
• NHS Resolution (quality and safety functions only) 

A further review will focus on quality and its governance. This will guide the government’s next steps as it continues its drive for positive cultural change across health and social care.

All findings will also inform the government’s 10-Year Health Plan to transform the NHS and social care and make them fit for the future.   

Wes Streeting, Secretary of State for Health and Social Care, said:    

Patient safety is the bedrock of a healthy NHS and social care system. That’s why we are taking steps to reform the CQC, to root out poor performance and ensure patients can have confidence in its ratings once again.  

This government will never turn a blind eye to failure. An overly complex system of healthcare regulation and oversight is no good for patients or providers. We will overhaul the system to make it effective and efficient, to protect patient safety.

The CQC has already taken its crucial first steps to rebuild its approach to regulation, including announcing Sir Julian Hartley, former Chief Executive of NHS Providers, will be appointed as its new chief executive.   

Following the publication of Dr Dash’s interim report in July, the CQC Board also asked Professor Sir Mike Richards to conduct an internal review of the single assessment framework and its implementation. Sir Mike was Chief Inspector of Hospitals at CQC from 2013 to 2017. That review has also been published today (15 October) by the CQC.     

However, Dr Dash’s full review makes clear that there is still much work to be done in the CQC and beyond to ensure that that the public can be confident in the quality and safety of the care they are receiving.   

Commenting on her findings, Dr Penny Dash said: 

This report reiterates the findings of my interim report while providing further detail and analysis of the CQC’s performance. It builds on insights and perspectives from patients and users, and a wide range of health and social care providers as well as senior leaders from the NHS and local authorities. 

I am very grateful to the large number of staff within the CQC who have come forward to share their experiences of the last few years and to make recommendations for the future. They have shown exceptional patience and professionalism throughout this difficult period. 

I am delighted that Sir Julian Hartley will be appointed as the CQC’s new Chief Executive - he is an outstanding leader, and I am confident he will restore the regulator’s ability to inspect and rate the safety and wider quality of health and social care services across England.

Recent inquiries and reports, including the Infected Blood Inquiry, have highlighted how the patient safety space has developed in a way which means that multiple organisations are involved in related activities, leading to a complicated system without clear leadership.   

Vic Rayner OBE, Chair of the Care Provider Alliance, said: 

As both the Penny Dash Report and the review by Sir Mike Richards show, it is clear that urgent action is needed by the CQC to take on board the reality of how assessment and inspection is currently experienced by the tens of thousands of registered adult social care services across England.  

What is also evident is that a step change is required in regulation going forwards, and care providers’ voices need to be heard in the coproduction of a regulatory framework that is fit for the future.

Matthew Taylor, Chief Executive of the NHS Confederation said:  

Our members recognise the importance of regulation in supporting patient safety and care improvement but for far too long CQC’s operating model has not been fit for purpose. Many of our members contributed to the review, and we welcome Dr Penny Dash’s findings, which aim to improve the regulatory model for health and care professionals.  

Given the stark findings, we believe the decision to pause ICS inspections is the right one and we will continue to work with CQC colleagues to ensure the approach adds value for systems and the public.  

We will review both Dr Dash’s and Professor Sir Mike Richards’ findings in detail. These, alongside the government’s response, will strengthen patient safety and drive necessary improvements. We also look forward to contributing to the two new reviews announced today.

Findings of the Safety Landscape Review can be expected in the new year. Meanwhile, the Health and Social Care Secretary will continue to monitor the CQC’s progress and support Sir Julian Hartley on its road to reform.