CQC’s own staff are fearful of voicing their opinions on the CQC’s new regulatory approach due to a closed-culture attitude.
In 2021 the CQC revealed a new regulatory approach, stating that it wanted to drop scheduled inspections in favour of a “more flexible, targeted approach”, using data and other insights in an effort to provide “more dynamic and flexible regulation”.
At Ridouts we have seen this result in the CQC increasingly taking a risk-based approach to inspections with increased oversight where services have had safeguarding and whistleblowing alerts. This has led to a much more aggressive and harsh CQC that appears to look for faults and inspects with predetermined views of the service rather than take the evidence at face value and make an objective decision.
In the CQC’s September board papers, it stated that there was a complete “re-design” of its regulatory operations with a “new regulatory leadership function, as well as the introduction of a centralised hub supported by networks of multi-disciplinary teams.” According to the CQC this will, “provide our people with greater agility and flexibility to respond to risk, as well as strengthening our impact in driving improvement at both a local and national level.” This was due to be implemented on 1 October 2022, but has been delayed.
The Health Services Journal’s (“HSJ”) understanding is that this new structures means there will be two types of inspectors moving forward – those who visit services and those who are desk-based assessors.
A letter from Union leaders at Unison, Royal College of Nursing, Unite, Prospect and the Public and Commercial Services states that the CQC failed to give any advance detail of this new structure and implementation timescales and to provide clear explanations of the rationale behind their decisions. Thus, there could not be any meaningful consultation on this new approach.
The letter has also asked Therese Coffey to urge the CQC to pause its organisational change and enter into “meaningful discussions” with the unions. This was sent in the week commencing 12 September 2022.
The Unions’ main concerns are that these organisational changes have been made with no input from individuals who have frontline experience in health and social care and/or regulation. What is even more concerning is that, according to the letter, the staff who are directly affected by these changes have not had any meaningful input. It also claims that the CQC has failed to utilise the expertise and experience of its frontline staff. As a result, many senior staff with many years of experience have recently left the CQC. According to the letter, “This has resulted in a substantial loss of regulatory knowledge, increasing the risk to people using health and social care services.”
The Union members strongly believe that the changes which the CQC has proposed will pose serious risks to the organisation’s ability to regulate health and social care effectively.
According to a recent survey of trade union members working for the CQC, 43% believed they are never given the opportunity to contribute views before decisions that affect them are made, 36% said they are “only rarely” given the chance to contribute their views, while only 21% said they were given the opportunity to share their views.
Attempts by staff to raise concerns are met with contempt and management deeming them as “negative”, “averse to change”, “disruptive”, or “not committed to the CQC.” Staff have reported that the feel demoralised, patronised, ignored and devalued, with one stating that in the last 20 years working to for the CQC this is, “the worst management of change I’ve experienced within my role as an inspector, the morale within the CQC is the worst I’ve seen it.”
In response to the letter, the CQC has stated that the proposed changes are necessary to enable the regulator to “work more effectively across the health and care system,” and claims that it has engaged with trade unions throughout the process.
Kate Terroni, interim chief operating officer of the CQC, has also said:
“We know we need to make changes to allow us to work more effectively across the health and care system, ensuring that we regulate in a way that better reflects people’s experience of care and leads to better outcomes for all…We have engaged with our joint trade union colleagues throughout this process and have been in discussion with all working at CQC about these proposed changes since June 2021…We are fully engaged with ACAS and will be meeting with them again shortly. The option to re-instate consultation with the unions remains open and we would fully welcome this.”
However, the letter states that these union leader have requested two meetings with the CQC’s chair to discuss these concerns and both times he has refused to meet.
The CQC’s decisions and next steps will be crucial to its survival and reputation as a reliable and effective regulator.