A recent review by Dr Penny Dash, known as the 'Dash Report', has identified significant failings in England's Care Quality Commission ('CQC') new Single Assessment Framework ('SAF'). 

Historically, the CQC had used multiple assessment frameworks for different types of services, but the SAF consolidated these into a single set of criteria with the intention of streamlining and simplifying the evaluation process for health and social care services in England. The SAF was gradually introduced starting in November 2023, with the roll-out completed in March 2024

The Dash Report

In May 2024, Dr Penny Dash, chairwoman of the North West London Integrated Care Board, was asked to carry out a review of the CQC. In July 2024, the report’s interim findings were published. 

Dr Dash found that there were “significant failings in the effectiveness of the CQC”, including with regard to the implementation of the SAF. In particular, the interim report identified that there were issues with the level of inspectors’ experience and knowledge, inconsistencies between assessments, and insufficient clarity on rating scores and how they are assessed. 

The interim report recommended a wholesale review of the SAF by sector experts, concluding that due to the failings identified, the regulator is unable to consistently and effectively judge the quality of health and care services.

In response to the report, Health and Social Care Secretary Wes Streeting declared that “It’s clear to me that the CQC is not fit for purpose”, adding that the “government will never turn a blind eye to failure”. 

What’s next?

Dr Dash is due to publish her final report later this autumn, but has made five recommendations at this stage:

1. Rapidly improve operational performance; 
2. Fix the provider portal and regulatory platform;
3. Rebuild expertise within the organisation and relationships with providers to restore credibility;
4. Review the SAF to make it fit for purpose; and
5. Clarify how ratings are calculated and make results more transparent, especially for multi-year inspections and ratings.

In response to the interim report, Mr Streeting has announced four immediate steps the government and CQC will take to restore public confidence in the regulator. These include:

1. Appointing professor Sir Mike Richards, the CQC’s first chief inspector of hospitals, to review CQC assessment frameworks; 
2. Improving transparency in the way ratings are determined; 
3. Increasing government oversight of the CQC, with the CQC regularly updating the government on its progress in implementing Dr Dash’s recommendations; and
4. Asking Dr Dash to review the effectiveness of all patient safety organisations. 

On 3 October, the CQC announced several steps it was taking to "re-build trust" in its regulation. These include: 

• Recruiting a new Chief Executive and appointing three Chief Inspectors; 
• Running pilot projects looking at approaches the CQC can take to improve its relationships with providers and streamline the management of specific sectors; 
• Recruiting more staff to increase the number of monthly assessments; and
• Making changes to the SAF to improve clarity around scoring.

However, we still await details in relation to the frequency of assessments and a handbook to explain what providers can expect from the assessment process. Furthermore, providers are eagerly awaiting the CQC's update on improvements being made to the provider portal (which is causing much frustration in the sector).

Whether all the anticipated changes will represent a comprehensive overhaul of the regulator's operations, is yet to be seen.

In the meantime it is important to note that the CQC is continuing to inspect services under the SAF. It is hoped that the findings from the aforementioned reviews will lead to greater CQC engagement with providers, and a fairer and more transparent scoring system, making it easier for providers to successfully challenge unfair and inconsistent adverse findings.