The watchdog that monitors Social Work England has written to cabinet ministers to raise concerns over chronic delays to fitness to practise (FtP) cases.

In its latest report on the regulator, covering 2024, the Professional Standards Authority (PSA) said Social Work England had failed to meet its standard on the fairness and efficiency of its FTP system, for the third year running. The regulator met all 17 of the PSA’s other standards, in a generally positive review.

Social Work England did not meet the remaining standard (standard 15) because of ongoing delays in completing FTP cases, with no improvement in timeliness during 2024, said the PSA.

Concerns escalated to cabinet ministers

As a result, PSA chair Caroline Corby has written to education secretary Bridget Phillipson and health and social care secretary Wes Streeting to raise its concerns about the situation with them.

While she acknowledged that Social Work England was “taking steps to improve its processes and learn from the delays”, this had not generated improvements.

In separate letters, Corby set out the consequences of the issue to Phillipson and Streeting: “Every stakeholder that we met with for our 2023-24 performance review, and most stakeholders that provided us with written feedback, raised their concerns about this issue.

“For registrants, fitness to practise delays can have a significant impact on their wellbeing and cause financial hardship. For people raising concerns with Social Work England, these delays can mean they are waiting years for a resolution to their concern, which can be particularly difficult where the alleged conduct has had a significant impact on their life.”

Delays at all stages of fitness to practise process

Latest figures show significant delays at all stages of Social Work England’s FTP process:

• Triage: Cases that completed the triage stage in October to December 2024 took an average of 35 weeks to do so, compared with 28 weeks in July to September and 22 weeks in April to June last year. At triage, Social Work England staff determine whether the concerns about the social worker merit investigation.
• Investigation: While the average age of cases that completed the investigations process has fallen steadily, from 68 weeks in January to March 2024 to 60 weeks in October to December last year, the average age of remaining cases rose from 62 to 74 weeks over this time. This compares to a quarterly target of 56 weeks for October to December 2024.
• Case examiner: During October to December 2024, cases took an average of 13 weeks to complete the case examiner process, the same as in the previous quarter and just above the target of 12 weeks. At this stage, pairs of examiners review the investigation report to determine whether the concerns about the social worker could realistically be proved and, if so, whether their fitness to practise could be found to be impaired.
• Final hearings: Social Work England held just five final hearings in October to December 2024, down from 13 in the previous two quarters, and from 64 in April to June 2023. The number of open cases at the hearings stage rose from 386 as of June 2024 to 421 at the end of last year.

Causes of delay 

The causes of the delays are multiple, including the regulator receiving higher than expected numbers of FTP concerns since its inception in 2019 and having cases delayed by family court proceedings.

More recently, it has struggled to adequately staff its triage and investigations teams and has had to reduce the number of hearings it holds due to lack of budget.

The PSA cited action that Social Work England had taken in response, including piloting having two-person, rather than three-person, panels, to increase capacity to conclude more hearings, and reviewing adjournments in hearings to identify opportunities to prevent future breaks in proceedings.

The regulator was also providing more support to investigators to help them progress their most complex cases, while having case examiners share learning with investigators to prevent adjournments being necessary at the case examiner stage, said the PSA.

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Performance ‘comparable to worst performing regulators’

However, the watchdog, which also oversees nine health professional regulators, stressed that these actions had not led to improvements in the timeliness of cases, where Social Work England’s performance was currently “comparable to the worst performing regulators in this area”.

In its report, the PSA referenced a joint statement made by the British Association of Social Workers (BASW), Social Workers Union (SWU) and UNISON in May 2025 raising concerns about the impact of FTP delays on the social workers concerned.

In response to the PSA report, SWU general secretary John McGowan said: “It has been almost a year since SWU, BASW, and UNISON jointly wrote to Social Work England to express our deep concerns about the regulator’s ongoing and increasing delays in processing fitness to practise cases.

“Since that time, the PSA has concluded that Social Work England has not improved performance in this area, its hearing stage backlog has continued to grow, and many people are rightly still raising concerns about how long the process is taking.

Social workers ‘experiencing stress beyond belief’

“The 421 social workers in England with open cases at the end of 2024 deserve better support than this and it is a shame that the regulator has been classified by PSA as ‘comparable to the worst performing regulators in this area’.

“No matter the outcome of their cases these social workers are experiencing stress beyond belief.

“I hope this report convinces Social Work England to continue with their engagement with the four asks in our joint letter to improve their fitness to practises process.”

These were: ensuring investigations were more “collaborative and thorough”; providing case examiners with updated guidance and training, to help them take account of contextual factors in their decisions; developing alternative outcomes for social workers who have been awaiting a hearing for years, and adopting a “more reasonable approach” to the voluntary removal of social workers subject to FTP processes from the register.

Social Work England ‘has plans for improvement’

Giving the regulator’s response to the PSA report, Social Work England chief executive Colum Conway said: “While timeliness in our fitness to practise process continues to be a challenge, we do have a pathway to achieving standard 15 which requires additional funding over time.

“The delays in case progression are unacceptable for us and for everyone involved.”

A spokesperson for the regulator added: “Plans and actions are already in place for improvement, and more details will be published in our business plan for 2025 to 2026.”

Fee rise ‘should enable more resource for fitness to practise’

In relation to increasing funding, Corby told Phillipson and Streeting that Social Work England’s proposed 33% increase in practitioner fees from September “should enable it to devote more resources to fitness to practise”.

The Social Work England spokesperson said that “the additional income from any potential fee increases would support us to deliver all our regulatory objectives and goals with a focus on improving timeliness in our fitness to practise process”.

However, McGowan warned that SWU members were concerned that the regulator was “now considering passing the cost of improvement attempts along to social workers – a workforce already strained by over a decade of budget cuts, ongoing recruitment and retention issues, and the cost-of-living crisis”.

The fee increase will only boost Social Work England’s overall level of income if it is not offset by reductions in DfE grant.

Shifting balance of income from government to social worker

Social Work England’s justification for the increase is to shift the balance of income it receives towards social workers and away from the DfE, whose share rose from 52% to 57% from 2020-21 to 2023-24 to help the regulator deal with rising fitness to practise costs.

The spokesperson added: “Our budget is overseen by the Department for Education and is typically agreed annually, including the level of grant in aid, with no capacity to hold funds in reserve over multiple years.

“We continue to work with our sponsor, the Department for Education, to review our overall resourcing needs. We anticipate that our overall level of income will continue to be determined in this way.”

Sector leaders have urged the government to “change course on social care” after a week in which it cancelled the cap on care costs and a planned increase to workforce training funding.

In an open letter to health and social care secretary Wes Streeting, more than 30 leaders said the decisions had “raised alarm bells” for those working in, and receiving, social care.

And in a reference to the pay settlements granted to public sector staff outside of the sector, they said these were “a bitter pill for social care in a climate where other public services and their workforces are finally having their contribution recognised”.

The letter was signed by the heads of seven of the major umbrella bodies for care providers: learning disability body ARC England, the Association of Mental Health Providers, Care England, the Homecare Association, the National Care Association, the National Care Forum and the Voluntary Organisations Disability Group.

Other signatories included the heads of the Social Care Institute for Excellence, Learning Disability England, which represents people with learning disabilities and their families and several providers and local provider associations.

Ditched social care policies

Their intervention came days after the government first scrapped the adult social care charging reforms, due to come into force in October 2025, and then ditched the adult social care training and development fund proposed by its Conservative predecessor.

Both decisions were made to tackle a £21.9bn projected overspend on public spending, which chancellor Rachel Reeves said had been bequeathed to Labour by the Conservatives. This was despite £9.4bn of the funding gap being down to the incoming government’s decision to accept recommendations on public sector pay made by independent review bodies.

In their open letter to Streeting, the sector leaders acknowledged the “hugely challenging” economic situation. However, they stressed that social care was critical to delivering some of the new government’s key ambitions.

“Without high quality social care, it will be impossible to fix the broken NHS,” they said. “Without high quality social care, it will be impossible to sustain economic growth. Without high quality social care, it will be impossible to lift-up our communities and the people that live in them.”

‘Change course on social care’

The letter added: “We now need to see positive action on social care. There is time, political capital, and the expertise of a united social care sector to make this happen. We urge the government to change course and we stand ready to help you transform social care for the millions who work in it and most vitally, rely upon it.”

The sector leaders also referenced Labour’s two key policy pledges on social care: to introduce a fair pay agreement for the workforce and, over the next decade, to set up a national care service.

The fair pay agreement is designed to raise pay, terms and conditions for staff and will be legislated for in the forthcoming Employment Rights Bill, though the government is yet to say how the improvements will be funded.

It has also not fleshed out what it means by a national care service.

In their letter, the sector leaders said they needed “assurances about the timeframes and support needed to move to a national care service and the introduction of a fair pay agreement for care workers”.

Story updated 29 July 2024

The Care Quality Commission is “not fit for purpose”, health and social care secretary Wes Streeting has declared, after a damning report found significant failings within the regulator.

Dr Penny Dash found that inspection levels were still well below pre-Covid levels, a lack of expertise among inspectors, inconsistency in assessments and problems with the CQC’s IT system.

Also, social care providers were waiting too long to be registered and have their ratings updated, affecting capacity levels in local areas, said the interim report of Dash’s government-commissioned review of the regulator.

As a result of these problems, the CQC was unable to consistently and effectively judge the quality of services it regulates, including residential homes, nursing homes and domiciliary care agencies.

Probe focused on new assessment approach

The review, commissioned in May 2024 by the previous Conservative government, was designed to assess the suitability of the CQC’s single assessment framework (SAF) for assessing and rating health and social care providers.

This was introduced in November last year and was designed to reduce duplication in the previous four separate assessment frameworks and move away from inspections being the CQC’s primary source of evidence of a service’s quality and compliance with regulations.

Instead, it planned to collect data and insights on services on an ongoing basis, for example from feedback from people who used services or partner organisations or from information submitted by providers.

Dash, whose interim report was based on conversations with 170 health and social care leaders and staff and 40 CQC senior managers and professional advisers, identified significant problems with the regulator beyond the implementation of the SAF.

‘Poor operational performance’

She found that the organisation’s operational performance was “poor” and had deteriorated, including that:

• The CQC carried out just 7,000 inspections and assessments in 2023-24, compared with 16,000 in 2019-20.
• At the end of 2023-24, 54% of provider registration applications were more than 10 weeks old, up from 22% at the end of 2022-23.
• Of the services CQC had the power to inspect, an estimated one in five had never received a rating, some of which had registered more than five years ago.
• The average age of providers’ overall ratings was 3.7 years, while some organisations had not been reinspected for several years: the oldest rating for a social care provider dated back to 2015.
• Call centre performance was poor with the regulator taking 19 minutes on average to answer calls about registration from January to June 2024.
• The provider portal – launched last year to enable providers to submit information to the regulator – had resulted in significant problems for some users, who said they were unable to easily upload documents and waited hours for password resets.

Lack of inspection expertise identified

Dash also identified a lack of specialist expertise among inspectors, linked to a decision by the regulator to rely much more on generalists in inspection teams.

Her review was told of care home inspectors who had not met a person with dementia before.

She also found a significant reduction in ongoing relationships between CQC staff and providers, which had previously been useful for sharing good practice and building providers’ confidence in the regulator.

Dash concluded that these trends were “impacting the credibility of CQC, resulting in a lost opportunity to improve healthcare and social care services”.

No description of what constitutes good or outstanding care

In relation to the SAF itself, Dash found that it did not contain a description of what good or outstanding care looked like.

“The review heard time and again from providers that they struggle to know what inspectors are looking for, they are not learning from them and, as a result, they don’t know what they need to do to be better.”

Providers also reported a lack of consistency in ratings, with multi-site organisations saying that differences in ratings between services did not accord with what they knew about differences in performance.

No reference to use of resources in framework

There was also no quality statement within the SAF relating to use of resources or efficient delivery of care, despite it being a legislative requirement for the CQC to assess this.

Dash said this was disappointing as “effective use of resources is one of the most impactful ways of improving quality of care for any provider”.

And though the SAF was designed to increase the emphasis on gathering the voice of service users, the review found a lack of transparency in the data used to measure this, how representative this was and how it was analysed.

Most of the data was apparently harvested from surveys, “which may or may not be representative or statistically significant at a service level, and this is then supplemented by a number of interviews with service users”, Dash said. There could be as few as tens of such interviews carried out even where a service was looking after thousands of people a year, the report added.

Issues with how ratings are calculated

The interim report also identified a longstanding problem of providers’ ratings being based on outcomes from inspections over several years, which it said could not be “credible or right”.

While the SAF was designed to correct this by basing ratings on more frequent assessments of a service drawn from up-to-date information, the problem continued because the regulator was not undertaking sufficient such assessments.

Dash also heard that providers did not understand how ratings were calculated, resulting in a sense that it was “impossible” to change ratings.

She is due to publish her final report this autumn, but made five recommendations at this stage, urging the CQC to:

1. Rapidly improve operational performance.
2. Fix the provider portal and regulatory platform.
3. Rebuild expertise within the organisation and relationships with providers in order to resurrect credibility.
4. Review the SAF to make it fit for purpose.
5. Clarify how ratings are calculated and make the results more transparent, particularly where multi-year inspections and ratings have been used.

CQC ‘not fit for purpose’

“I have been stunned by the extent of the failings of the institution that is supposed to identify and act on failings,” said Streeting. “It’s clear to me the CQC is not fit for purpose.”

He added: “I know this will be a worrying development for patients and families who rely on CQC assessments when making choices about their care.

“I want to reassure them that 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.”

The DHSC said that, on the back of the interim report:

• The CQC has appointed Professor Sir Mike Richards to review its assessment frameworks. A former hospital doctor, he was the regulator’s first chief inspector of hospitals from 2013 until his retirement in 2017.
• There would be improvements in the transparency of how the CQC determined its ratings for health and social care providers.
• The department would increase its oversight of the CQC, with the regulator regularly updating the DHSC on progress, to ensure that Dash’s final review recommendations were implemented.

Last month, Ian Trenholm resigned as CQC chief executive, to be replaced, on an interim basis, by his deputy, Kate Terroni.

Regulator ‘accepts findings in full’

In response to today’s interim report, Terroni said: “We accept in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed. Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong.

“We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.

‘Work is underway to improve how we’re using our new regulatory approach. We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement.

‘We’re increasing the number of people working in registration so we can improve waiting times. We’re working to fix and improve our provider portal, and this time we’ll be listening to providers and to our colleagues about the improvements that are needed and how we can design solutions together.

“We’ll be working with people who use services and providers to develop a shared definition of what good care looks like. And we’re also developing a new approach to relationship management that enables a closer and more consistent contact point for providers.”

Provider leaders demand improvements

Care provider leaders joined Sweeting in heavily criticising the regulator in the wake of Dash’s interim report.

“It is outrageous that social care providers are left waiting interminably for registrations and ratings, directly impacting local capacity, quality of care and sustainability of providers,” said Homecare Association chief executive Jane Towson.

The association cautiously welcomed the DHSC’s response to the report but urged further action, calling for:

• A complete overhaul of the CQC’s inspection and assessment system.
• Immediate action to clear the backlog of uninspected and unrated providers.
• A significant investment in recruiting experienced, sector-specific inspectors.
• Regular, mandated reporting on the CQC’s progress in addressing these failings.

“We want and need an effective regulator and are dismayed that CQC’s incompetence is actively harming the sector it’s meant to regulate and protect,” Towson added.

“This is going to be a long and difficult journey for the CQC, but one that is entirely necessary,” said Care England chief executive Martin Green.

“The CQC must embark on a radical improvement program that should not only include some tangible improvements in their performance, but also needs to move away from a culture of blame.

“We all want proportionate and effective regulation, and the challenge now is for CQC to take action and work with organisations across the sector to deliver it.”

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Wes Streeting and Bridget Phillipson have been handed responsibility for social care in the Labour government, after it took power in the general election.

Prime minister Keir Starmer has appointed both to the cabinet roles mirroring the briefs they held in opposition.

Streeting has become health and social care secretary, giving him responsibility for the NHS and adult social care.

Phillipson, meanwhile, has been appointed education secretary, a role that has oversight for children’s social care, as well as early years, schools, further and higher education and apprenticeships.

As for their Conservative predecessors, a key question facing both Streeting and Phillipson is the degree of attention they will confer on social care compared with the more politically salient elements of their briefs: the NHS in Streeting’s case and schools and childcare in Phillipson’s.

Social care not among Labour ‘missions’

Unlike social care – for adults or children – these policy areas feature in the five “missions” that Labour has set as its key priorities as well as the six “first steps” the party has laid out as its initial actions for government.

And Streeting made no reference to social care in his opening statement as health and social care secretary, which was entirely focused on the NHS.

Labour’s election manifesto did include a number of policies on adult social care – notably establishing a fair pay agreement for care workers, in order to improve their terms and conditions – however, it allocated no funding to any of them.

Though not included in the manifesto, Streeting also confirmed in interviews that the party was committed to introducing the previous government’s planned adult social care charging reforms – including a cap on care costs – by the planned implementation date of October 2025.

However, according to think-tank the Institute for Fiscal Studies, the Conservative government allocated no funding to this, so Labour would have to find the money for this. This is difficult given the new government’s commitments not to raise the main rates of income tax, VAT and national insurance and also be on course to cut public debt, as a proportion of GDP, over the medium-term.

Limited children’s social care offer

On children’s social care, the party’s manifesto offer was much more limited than it was for adults’ services.

The only substantive commitments were to strengthen regulation of the sector and to improve inter-agency information sharing by creating unique identifiers for children and families, but Labour provided very little detail on either.

Phillipson did reference the “need to bring reform to children’s social care children’s social care and to build opportunities for our most vulnerable children” in a speech to Department for Education staff on taking up her role (credit: Schools Week).

This suggests that the party may continue with the previous government’s reforms to the sector, set out in its Stable Homes, Built on Love strategy. 

However, its manifesto made no mention of the reforms, so it remains to be seen whether the new government will take forward their implementation and allocate the required resource.

Phillipson’s letter to staff

She subsequently published a letter to staff working in children’s services, education and early years. Referencing the mission she is responsible for, the letter was framed around the government’s ambition to “[break] down barriers to opportunity and improving life chances for every child”.

The one specific pledge she made in relation to social care was that the government would “work with local government to provide loving, secure homes for children in care”.

More broadly, she said the jobs of practitioners across all services had been made more difficult by “severe financial pressures squeezing all your budgets, high workload, climbing vacancy rates, strain on care, mental health and SEND services, among many other issues”.

The Labour Party has pledged to reform the Mental Health Act 1983 if elected to power at the next general election.

Shadow health and social care secretary Wes Streeting told the House of Commons today that the party would introduce a bill to overhaul the act as part of its first legislative programme after polling day, which is due to take place by January 2025.

The news was welcomed by mental health bodies, in the light of the government’s decision – revealed in last week’s King’s Speech – to drop its manifesto pledge to reform the MHA during the current parliamentary term.

Criticism of government decision to shelve MHA reform

Social work leaders and charities heavily criticised the decision, saying it represented a missed opportunity to tackle high rates of detention, racial disparities in the use of the act and the inappropriate sectioning of autistic people and those with learning disabilities.

Streeting echoed these comments in a debate today on the NHS.

“The treatment of people with learning disabilities and autism under the current act shames our society,” he added.

“The disproportionate impact on black people, who are four times more likely to be sectioned than white people, is appalling. Prisons and police cells are no place for people with mental ill-health.”

Streeting said he could not understand why the government had “broken their promise” to amend the legislation and added that Labour would “reform the Mental Health act in our first King’s Speech”.

Labour’s promise comes with the party about 20 percentage points ahead of the Conservatives in opinion polls (source: UK Polling Report) and widely tipped to win an overall majority at the next election.

Labour pledge welcomed

The news was welcomed by psychiatrist Simon Wessely, who chaired the 2017-18 Independent Review of the Mental Health Act for Theresa May’s government.

Very welcome announcement from @wesstreeting on mental health act reform. There was widespread disappointment it disappeared from the King’s Speech so good to have this commitment. I hope that the support this had received from all the parties now resumes https://t.co/2VrLQcLC8Z

— Simon Wessely (@WesselyS) November 13, 2023

His sentiments were echoed by the Royal College of Psychiatrists and the  charity the Centre for Mental Health, which tweeted: “We welcome Labour’s commitment today to modernise the Mental Health Act in its next general election manifesto. We’re calling on all political parties to take this step, so that this vital but outdated legislation is made fit for practice.”

Minister for care Helen Whately (Credit: Department of Health and Social Care)

In today’s House of Commons debate, care minister Helen Whately said the government remained committed to MHA reform.

“I recognise the disappointment that the mental health bill was not included in the King’s Speech, but I can assure honourable members that this government are committed to achieving genuine parity between mental health and physical health, improving the care of those detained under the Mental Health Act 1983 and bringing forward the bill when parliamentary time allows.”