Julian Hartley: Challenges At CQC Are "Even Deeper" Than Expected
Sir Julian Hartley, chief executive of the Care Quality Commission (Photography by Dinendra Haria)
7 min read
England’s healthcare watchdog is in a sorry state. The man hired to clean it up, Sir Julian Hartley, tells Noah Vickers its problems are worse than he feared
It’s not a job many would envy. In December last year, Sir Julian Hartley took over as chief executive of England’s healthcare watchdog, the Care Quality Commission (CQC). His arrival came after a scathing independent review found “significant failings” across the organisation, meaning it is carrying out far fewer inspections than in previous years. While 15,800 inspections were carried out in 2019/20, this had dropped to 6,700 by 2023/24.
As a result, many of the CQC’s reports – which provide ratings for care homes, GP surgeries and hospitals – are growing several years out of date.
The backlog has largely been caused by the introduction of a new assessment framework, which was intended to simplify the process of producing reports but instead made it more complex. This was then compounded by the introduction of “poorly performing” IT systems, which staff found “demoralising” to use.
To top it off, an internal restructuring within the organisation – described as “bonkers” by one staff member – led to a loss of expertise in inspection teams, which has dented the CQC’s “credibility” in the wider health sector.
Turning the organisation round will take enormous effort – an undertaking from which most people would run a mile. But Hartley, 58, a former chief executive of Leeds Teaching Hospitals NHS Trust, tells The House the job’s difficulty was part of what drew him to it.
“I do love a challenge,” he says, pointing out that he has spent his whole career working in health and social care. “I’ve had the experience both of working in care homes and, of course, a career in the NHS, but I’ve also had experience as a patient after a very severe cycling accident.”
Hartley was knocked off his bike at a junction in 2011, breaking his neck and arm, and requiring emergency trauma surgery. The episode helped him “realise that the gaps between services need attention”.
“We’ve got to be far more integrated as a health and care system and, also, I believe good regulation acts as a spur to improvement. We want to be a regulator that protects people that use services, as we should, but also encourages providers to improve and share best practice – and that really motivates me.”
It's been tough, I wouldn't pretend it hasn't
He admits, however, that the CQC’s problems are firmly entrenched. Fixing them will be harder than he had expected before taking the job.
“It’s been tough, I wouldn’t pretend it hasn’t,” he admits. “But I’ve been encouraged and impressed by the quality of colleagues I’m working with. I feel that if we create the right culture in the organisation and role-model the kind of behaviours and approaches we want to see in those sectors we regulate, we’ll be on the right track…
“The depth and scale of the challenges have been probably even deeper than I had a sense of before I joined. But equally, I’ve been really encouraged by the response that the organisation is making to them, so I’m optimistic about our ability to do that.”
Last year’s review into the state of the CQC, authored by the NHS’s former head of strategy Dr Penny Dash, found that the average age of the watchdog’s reports was 3.9 years – the highest in its history. The oldest of those reports, an inspection of the surgery service at Crawley Hospital in Sussex, dates back to June 2014.
Yet since Hartley’s appointment seven months ago, that report remains up on the CQC’s website, and no fresh inspection has been carried out. Why?
“What we’re doing with our approach to more inspections is we’re looking at both the age of ratings and the risk profile,” he explains. In other words, because the service was awarded a ‘good’ rating 11 years ago, it hasn’t been a high enough priority for re-inspection since Hartley took over.
Sir Julian Hartley, chief executive of the Care Quality Commission (Photography by Dinendra Haria)
“We’re doing more inspections, but we need to make sure we account both for services that we know are at risk – that we need to get inspectors into, where concerns have been expressed – but also tackle some of the oldest ratings, like the one you’ve mentioned,” he says. “So that is very much in our sights in terms of making sure we strike the balance between risk and age of ratings.”
But even for those care homes and healthcare facilities where there are known to have been serious issues, Hartley is concerned that the CQC cannot bring prosecutions where offences took place more than three years ago.
The chief executive has been lobbying Health Secretary Wes Streeting to lift the three-year limit, arguing that other regulators such as the Health and Safety Executive are not constrained by it.
Asked whether any progress has been made in those talks, he chooses his words carefully: “Well, we’ve raised the issue. We’ve been clear about why we think it is important to allow more time and to review that time limit. So, I feel we’ve had constructive conversations with the department, and we’re awaiting further developments on that.”
He doesn't have long to wait. Days after our interview, the government confirms in its 10-Year Health Plan for England that it will indeed "change" the time limit, but does not make clear what the new limit will be.
Aside from that, does the CQC need more teeth? Hartley is satisfied with the watchdog’s enforcement powers, though he suggests the government should give the CQC access to a wider range of healthcare data. Doing so, he says, would enable a more targeted strategy to root out the worst examples of poor care and neglect.
“There’s a lot of outcome data across the [health] service and it’s how we marshal that, to use that to best effect,” he says. “It’s how we have access to all the data that bears on people’s experience of health and care, so that we can have an intelligent, responsive approach to using that, as well as the regular rhythm of inspection.”
As with the three-year time limit, however, his lobbying appears to have made an impact. The 10-Year Health Plan states that the CQC will be given access to “all NHS and publicly held data sets relating directly or indirectly to care quality”.
Hartley is confident that the CQC is already making improvements under his leadership. The organisation has set itself a target of conducting 9,000 inspections between April 2025 and September 2026. As of 30 June, 1,451 had been done, with an expectation that the pace will increase over the coming months.
In the Dash review, staff complained that they felt ignored when raising concerns, including about the organisation’s troublesome IT system. The chief executive insists he has taken steps to change that, including through an ‘Ask Julian’ channel which enables staff to contact him directly.
Fixing the IT system itself is proving to be the hardest part of his job, Hartley admits. The new IT system was brought in as part of a wider “transformation” programme which has cost the CQC £99m since July 2019. Yet despite that level of funding, a separate review commissioned by Hartley found earlier this year that the programme had delivered just five per cent of the benefits it was expected to produce.
The review argues however that the “root cause” of the IT failure was “a failed organisational transformation” across the CQC, adding: “When an organisation transformation fails, the IT will also fail, as it exists to enable/underpin the core processes being transformed. If the core processes are unclear or unstable, designing the technology will be like trying to hit a moving target.”
Hartley acknowledges that the resulting technical problems “really have set the CQC back”. He concludes: “That is going to be a major set of challenges to get right, but it’s absolutely essential we do so. It will enable us to do more inspections to improve the experience of providers that we regulate, and indeed of staff, and hopefully give us that intelligent outcome data we need to regulate better.”
