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Our summary of what the CQC’s CEO, Sir Julian Hartley, said at a Patient’s Association webinar on how the CQC is working to rebuild trust with people who use health and social care services
Sir Julian Hartley joined the CQC in December 2024 as CEO during a time of turbulence following the Dash report, which found that England’s health and adult social care regulator was not fit for purpose.
Having spent his whole career in the NHS and the health and social care sector, he recognised that “this was concerning for people who use services since the CQC exists to protect patients who use services and the improvement of services is enshrined in how the CQC was set up.”
He said that the CQC had lost its way for two key reasons:
1. The regulator moved from a specialist to a generalised approach in assessing services. The Single Assessment Framework, used to inspect services, moved assessments away from being service-specific to a more generalised approach. This was a mistake as teams need a solid understanding of the services they are inspecting, and patients need to know that the CQC has expertise in specific areas of care. In reality, one size does not fit all.
2. There was a major failure in IT implementation under the Single Assessment Framework. Inspectors couldn’t get reports out in a timely way, and operational effectiveness suffered as a result. There has been an independent review into this headed by Sir Mike Richards which is available on the CQC website.
The Single Assessment Framework was based on 34 quality statements which were open to interpretation. The CQC will now be developing more service-specific assessments and focus on the outcomes patients want to see.
Sir Julian Hartley said that the assessment framework should be measurable, transparent and clear. Judgements made need to be consistent. The assessment framework should be accessible to everyone and there should be clarity around what good care looks like. It’s important that patients shape this.
Over the past six months, the CQC has focused on rebuilding confidence in the organisation as a priority. This includes both internally in terms of staff confidence and public confidence in the regulator. Patients need to feel confident that the CQC will take action where needed.
The CQC has gone back to a specialist expert approach to regulation, with the appointment of four new Chief Inspectors to cover key areas – primary care, hospitals, social care and, for the first time, mental health.
“Each Chief Inspector is experienced and skilled in their sectors. They come with demonstrable diversity and understanding, and will be looking at how to improve service delivery”, Sir Julian Hartley said.
“We have assembled a really strong team with expertise in those areas which I hope will put right the generalised approach that the CQC took before. The new Chief Inspectors are people who understand care and the purpose of the health and adult social care regulator in England”.
Sir Julian Hartley said the CQC would also be working to rebuild trust by:
The CQC are working on being clear about what good care looks like and on how the regulator can help improve services by using the feedback on care it receives.
The Dash report said the CQC doesn’t focus enough on outcomes for patients, and so the CQC is focusing on doing more to find out what matters most to people who use services as a way to measure outcomes, in addition to more traditional, clinically-led assessment.
Sir Julian Hartley stated that the CQC needs to understand the context of care they regulate in terms of region, demographics and inequalities. He said the CQC needs to make sure providers are looking at waiting lists to understand and ensure there are no inequalities inbuilt into the health and care system; including by looking into the makeup of waiting lists in terms of ethnicities and whether people with learning disabilities are overrepresented.
To ensure anti-racism approaches, as the Race and Health Observatory identifies, the CQC will work to recognise systemic racism and to call it out where they find it.
He said the CQC needs to understand the issues on the ground and that the Single Assessment Framework did not allow for this. This means working to gain a more granular-level understanding of the health and care landscape, and being open to being challenged as a regulator, which is part of their drive to gather feedback.
“We can use our independent voice, as an independent regulator, to spotlight good and poor experiences to policy makers and for the annual State of Care report, based on direct feedback”, he said.
The CQC should be holding providers to account in their coproduction and communications. The CQC should ensure that services are empowering and involving patients to challenge assumptions made by staff.
The CQC is aware that people who use different health and care services are having to retell the same story. Records need better integration and follow-up care needs a connectivity of services which are currently not joined up.
Culture within services is fundamental to good patient experiences. This is at the heart of how services deliver safe and effective care. When a service culture is open, positive and focused on learning, staff feel psychologically safe and this in turn fosters compassionate care.
Where cultures are closed, defensive and where there is a fear of speaking up, this is not a conducive environment for safe and effective care. The CQC is looking at its own internal culture as well, as it should be setting an example.
The CQC wants to gain clear and unvarnished feedback, which is vital to its work. They are looking into how to involve people who use services, including in the Experts by Experience programme and by developing a feedback loop.
The CQC should be feeding work back publicly so everyone can see what is being done as a result of the feedback they receive. This involves looking at the CQC’s capacity and training.
There can be a fear of speaking to the CQC in case of negative repercussions on the health and care people receive. The CQC preserves the anonymity of feedback to services in such a way that services cannot trace where feedback has come from. Feedback is dealt with in a way that is thematic with a focus on volume and the CQC doesn’t deal with individual complaints but holds services to account for their delivery of care.
“We need to develop a culture where people know their feedback is going to be taken seriously by the CQC, and to have their experiences recognised – including in the CQC’s annual ‘State of Care’ report, using feedback to help services to improve”, Sir Julian Hartley said.
He concluded that “we need to see the whole process through they eyes of patients, not just institutions.”
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