Home CQC Can CQC exit “special measures” in 2025? 

Can CQC exit “special measures” in 2025? 

by Kirsty Kirsty

Mei-Ling Huang, Partner in the health and social care team at law firm RWK Goodman, explores what the Care Quality Commission should do in 2025 to improve the regulation of social care. 

The Dash report into the effectiveness of the Care Quality Commission, (CQC), and the Richards report on the implementation of the Single Assessment Framework (SAF) both made it clear that CQC have a lot to do if they want to continue as the regulator. They are effectively in “special measures”. 

To correct the situation, CQC should focus on seven fundamentals: 

  1. Outcomes: Many will remember the “mum test,” which focused on the outcomes achieved for people. For social care, outcomes have been completely disregarded under the SAF but if care is to be person-centred, CQC should ditch their system of record-based box-ticking and ask: “Are the outcomes for this person good?” 
  1. Improved culture: For the last six years, the culture at CQC has been very “command and control”. Services are nit-picked and penalised for minor infractions. CQC need to take a less paternalistic approach and work to build mutual respect with providers. Creating a positive culture will not be quick but the items below will provide some of the basic building blocks. 
  1. Transparency:  We need to be able to understand how the evidence and inspectors’ judgments result in ratings and compliance action. The SAF scoring system was supposed to be easier to use but most providers (and some CQC staff) didn’t understand it. The system must be transparent and challengeable. A “computer says no” answer is simply not acceptable. 
     
  1. Better communication:  During inspections and when difficult issues arise, you need to be able to talk to your inspector. CQC often jump to conclusions either because they don’t understand the detail or context of a situation, or they have a predetermined view and are not willing to listen. CQC need to be open-minded and willing to engage in dialogue so that providers and inspectors can discuss issues sensibly. 
  1. Simplicity:  Between December 2023 and September 2024, CQC undertook only 885 SAF assessments in social care.  This equates to 3% of the nearly 30,000 adult social care services assessed during a ten-month period. In addition to IT failures, a major reason seems to be that the SAF was overly complicated. CQC need to simplify their system so that it’s usable and practical, not overly bureaucratic and complicated. 
     
  1. Proportionality: Over time, CQC have lost sight of the need for proportionality in decision-making. This is largely a result of their propensity to look for risks on paper and ignore outcomes achieved for people. One flawed risk assessment is not necessarily a breach of regulation 12 but CQC may say that it is. They’ve also been escalating the level of compliance action taken, though the compliance decision tree has not changed. To achieve proportionate decisions, CQC need to step back, look at outcomes, and use common sense. The provision of care can never be entirely risk-free; the key is to manage risk at an acceptable level.  
  1. Right to reply:  After inspections, providers need to be able to correct misperceptions about the evidence so that the ratings and judgments set out in a draft report are correct. In 2024, CQC imposed a character limit on factual accuracy responses but this wasn’t enshrined in guidance or announced. It was snuck in under the radar with the implementation of the portal. This kind of reduction of a provider’s right to reply detracts from CQC’s credibility. If their judgements are correct, then they should be willing to allow full and proper scrutiny of them. 

CQC now say that they are listening. Providers therefore have an unprecedented opportunity to make their voices heard and influence changes to the system. Although we have had a crisis of confidence in the regulator, I’m cautiously optimistic that the pendulum will swing back towards “sensible”. CQC are effectively in special measures. If they don’t fix their systems, we may have an entirely new regulator in 2026. 

@ RWKGoodman 

rwkgoodman.co.uk 

Image depicts, Partner at RWK Goodman 

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