Will services get a chance of being re-rated upwards by the CQC?

23rd May 2024

A woman marking off a checklist

It would appear that the Care Quality Commission (CQC) has been listening to the sector.

A lot of concerns have been raised as the Single Assessment Framework has been rolled out, about providers ability to improve their ratings, especially those who are currently rated Requires Improvement yet not considered to be posing a risk.

This has been a fairly long-standing issue for the sector when the CQC shifted its inspection practices to services of concern during and following Covid, and highlighted further with the publication of inspection reports under the new regime when a very small proportion of Quality Statements were reviewed, whilst the majority of the “updated” rating was based on historical ratings.

The CQC has stated that 70% of its planned assessment category will be made up of the following:

  • High and very high-risk services
  • Services rated Inadequate or Requires Improvement where it will open up enough Quality Statements to re-rate, “if that is the right thing to do”.

As of 27 March 2024, 1325 new style assessments have either been completed or were in progress. It’s unknown what proportion of these, if any, were services rated Requires Improvement or Inadequate. As at 2 April 2024 there were 6373 services rated Requires improvement, and 497 rated Inadequate. Given these figures, the fact that only a proportion of the 70% planned assessments will be RI and Inadequate services, and the fact that it has taken the CQC about 4 months to complete the 1325, means it’s highly likely that it will be some time before all RI and Inadequate services are re-rated. On some very crude maths it could take over 3 years to complete (assuming that these types of assessment make up half of the 70% planned assessments.) On top of this, the CQC’s 12-month sickness rate (as reported for 2023-2024 Q3) is 4.6%, 2% higher than the national average (ONS, 2022) so it could be further delayed without full staff capacity.

Whilst it is encouraging that the CQC has heard the sector’s concerns, and whilst we all know it can’t wave a magic wand and re-inspect everyone instantaneously, something needs to be done to speed this process up. The CQC hasn’t said whether there will be any criteria for deciding which RI and Inadequate services will be inspected first. A few months ago, there was talk of the CQC asking local authorities which services it should re-inspect, on the basis that improved services could re-open its doors to commissioners. This could be an opportunity for providers to ask their inspectors for a reinspection (providing evidence of change and improvements). Of course, if the Provider Portal was working sufficiently and fully operational, providers could submit evidence there, but that is also creating a barrier.

We all know the difficulties that a rating less than Good can cause to a business and a service. Between 2021-22 and 2022-23, the number of CQC registered care home beds decreased by 1807 (ONS, 2022-23). Whilst bed reduction may happen for a number of reasons, we’ve all heard stories of providers leaving the sector due to the increased pressures they’re facing commercially, regulatory and operationally. Having a rating that is not reflective of the service you are providing with no end date for review is going to impact you negatively, as well as the sector overall.

So well done CQC for listening to the sector, but please find a way of getting those nearly 7000 services inspected ASAP!