‘Scrap single-word CQC ratings’, say trust bosses

NHS Providers said written feedback from its annual regulation and oversight survey showed leaders thought the ratings – of “outstanding”, “good”, “requires improvement”, and “inadequate” – were “too simplistic”. They are currently used to rate providers overall quality, sites, services, and performance on particular domains such as safety.

Staff often found the ratings “demoralising” while patients thought they were “confusing”, according to the findings, shared with HSJ ahead of publication (see report attached below).

NHSP, which represents trusts and foundation trusts, has itself said it wants a review of the ratings, and that ”a single-word rating will inevitably oversimplify what happens in a very complex organisation”. However it has not gone as far as recommending they be scrapped.

The survey findings come with an overhaul of the CQC’s regulation approach highly likely to be instigated later this year. Wes Streeting, the new health and social care secretary last month published a damning interim report by integrated care board chair Penny Dash, which found major flaws across its processes, methodology, staffing, and systems.

The CQC categories, introduced in 2013, were aimed at increasing public accountability, aiding choice, helping improve performance, identifying failures, and providing public reassurance for the quality of care. Based on the Ofsted approach to schools, the ratings became a major focus of NHS regulation and management.

Some respondents to the survey said they favoured a descriptive judgement, which they felt would be “fairer and better at capturing differences in the quality of care between trusts with the same rating”.

And one unnamed medical director at an acute trust described the system of single-word assessments as “deeply flawed” and called for them to be removed.

“In statistical terms it [is] like assuming that a mean is a true representation of the data ignoring range, mode, median, or any nonparametric measure – totally excluding any qualitative methodology,” the medical director said in testimony to the survey.

Dr Dash’s final report will come in the autumn. Mr Streeting has implied he thinks robust quality inspection is needed, however, and said last month: “I want to reassure [the public] I am determined to grip this crisis and give people the confidence that the care they’re receiving has been assessed. This government will never turn a blind eye to failure.”

Trust bosses also told the NHSP survey they were concerned regulators did not sufficiently consider the “reality of hospitals operating environment”, with an “increased regulatory burden” over the past year. They raised concerns about regulators’ leadership behaviour.

Updated at 9.20am on 8 August to correct mistake about NHSP’s position.