The effectiveness of regulation was under the spotlight in 2024, most notably with the publication of independent reports on the CQC (interim and full) and Ofsted.
Both reports were critical of aspects of the inspection regime used in each organisation. As a regulatory body it was important for us to use these reports as an opportunity for self-reflection to see where we could make improvements. This article looks specifically at recommendations from these reviews relating to inspections.
In May 2024 the Department of Health and Social Care (DHSC) asked Dr Penny Dash to carry out a review of the CQC. The interim report was published in July and the final report in October. The review found significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality. The final report called for a rapid turnaround of the CQC recognising the health and care sector needs a high performing regulator.
Dame Christine Gilbert was asked to carry out a review of Ofsted following the tragic suicide of a headteacher in January 2023, following an Ofsted inspection. The review reported in September 2024.
While there are aspects of the CQCs and Ofsted’s approach and responsibilities which are different to the work of the HFEA, there is much in the reports which is relevant and allowed us to analyse where our strengths and weaknesses lie and where we have opportunities to improve.
The HFEA inspection regime has undergone significant change in the last few years including a new Compliance and Enforcement Policy and introduction of a hybrid approach to inspection (utilising desk based analysis and on-site visits). These changes were independently audited by the Government Internal Audit Agency (GIAA) on two separate occasions (March 2021 and April 2022) and the regime as a whole was independently assessed by the Public Body Review of the HFEA in 2023.
Looking at the reviews of the CQC and Ofsted we judge that it is clear where our strength lies: expertise of the inspectors and clinical governance team, a robust regulatory regime which ensures clinics are inspected in a defined timeframe and PRs have a named inspector to communicate with. We have strong oversight from our board (the Authority) and are held accountable by our sponsorship team at DHSC.
However, opportunities to improve were identified especially regarding our IT platforms and we have prioritised replacing our inspection and licencing system and clinic portal over the next 18 months. We have regular formal training for inspectors - including in November 2024 – with a focus on identifying stress in individuals on inspection and how to handle these situations calmly, confidently and with empathy (to help address concerns raised in the Ofsted report).
A learning point raised in the review of Ofsted was that the essence of a good inspection is respectful and productive engagement between inspectors and those inspected. Direct feedback from clinics helps us to gauge whether this is the case for HFEA inspections. After every inspection the PR receives a questionnaire regarding the entire inspection process. We analysed the survey findings from the first quarter in 2024 and found that 89% of responses were positive about the support provided by inspectors at inspection and in the feedback given within the report. Importantly, 80% of respondents strongly agreed/agreed that that the inspection visit had promoted learning and improvement to the way that they work. We strongly encourage PRs to complete these post-inspection surveys, and we will formally review the responses on an annual basis going forward.
