CQC’s new framework for assessing health and social care providers in England is underway. While we still do not know all of the details, the CQC website provides a lot of useful information we will try to summarize in this article.
Let’s see what are the main changes being introduced, what are the details of the rollout , what is CQC trying to accomplish with this, and most importantly — what can healthcare providers do to prepare.
What does the CQC framework cover?
The CQC (Care Quality Commission) framework refers to the set of standards and guidelines established to ensure safe and effective care in health and social care services.
The CQC is an independent organisation that conducts regular inspections. After an inspection, services are rated on the following scale:
- Outstanding: The service is performing exceptionally well.
- Good: The service is performing well and meeting our expectations.
- Requires improvement: The service is not performing as well as it should and we have told the service how it must improve.
- Inadequate: The service is performing badly and we've taken action against the person or organisation that runs it.
These ratings are public and aim to help people choose care services.
During an inspection, the CQC focuses on five key questions to assess the quality of a service:
- Is it safe?
- Is it effective?
- Is it caring?
- Is it responsive to people's needs?
- Is it well-led?
To answer those questions and show compliance with set standards, service providers can present the inspectors with all kinds of evidence — from patient feedback and records to staff rotas, incident reports, and even cleaning records.
What are the main changes that are being introduced?
So far, the CQC used three somewhat different assessment approaches: one for hospitals, one for primary medical services, and one for social care services. In an effort to improve transparency and standardize its assessment processes, the CQC is switching to a more universal assessment approach.
What does that mean in practice?
The aforementioned 5 key evaluation questions and the four point rating scale will continue to be used as is. However, there will be significant changes in how and when the inspections are performed, as well as a new scoring system.
Let’s quickly go through each of the major changes.
Different approach to gathering evidence
Here is how CQC is revamping its evidence gathering approach:
- More diverse evidence sources: Expands beyond on-site inspections to include digital submissions and feedback from people receiving the actual service, staff, and partners.
- Less reliance on on-site inspections: Complements physical inspections with more off-site evidence collection.
- Targeted risk-focused assessments: Inspections and evidence gathering will be more targeted, focusing on areas of risk and concern identified through ongoing monitoring and intelligence gathering.
- More dynamic and responsive process: This allows the CQC to quickly respond to any significant changes or issues within a service, ensuring that the most current and relevant information is used in assessments.
- Going digital: The CQC is embracing digital solutions to streamline evidence gathering. This includes digital forms and a new provider portal.
- Broader stakeholder engagement: Encourages active participation from providers, users, and stakeholders in the evidence gathering process.
All in all, the CQC will collect feedback across six different evidence categories. The overarching goal is to understand the quality of care being delivered and the the performance against your quality statements (more on that later). You can get a quick overview by watching the video below.
More dynamic assessment frequency
It seems that the provider's previous ratings will no longer be the main driver behind the timing and frequency of assessments. Instead, their timing will be more flexible, prompted by specific triggers.
This shift means inspections are more likely to occur in response to specific risk indicators, significant incidents, or feedback from service users and staff — rather than at predetermined intervals.
The new framework will emphasize ongoing monitoring of services through various means and data sources. This continuous oversight should enable quick identification of risk areas or significant changes in service quality, leading to prompt and focused assessments.
The CQC wants to be more proactive, using assessment frequency as a tool for continuous improvement rather than solely for compliance.
Replacing “KLOE’s” with “quality statements”
While the current evaluation revolves around the Key Lines of Enquiry (KLOEs), the new single assessment framework is built around Quality Statements:
Quality statements are the commitments that providers, commissioners and system leaders should live up to. Expressed as ‘we statements’, they show what is needed to deliver high-quality, person-centred care.
There are 34 quality statements, each relating to one of the 5 key questions (5-8 statement per question).
Let's explain it on an example. The second key question is "Is it effective?". One of the quality statements for that question is as follows:
We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.
How can a healthcare organization prove that they are providing effective care and living up to that statement?
The most straightforward way to do that is to create and send out patient surveys containing relevant 'I statements':
- I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally.
- I have care and support that is co-ordinated, and everyone works well together and with me.
- I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and goals.
Each statement could contain a 1-5 scale (fully disagree to fully agree). Going forward, getting positive feedback directly from people using your healthcare services will be a very strong evidence.
To recap, quality statements offer a more streamlined and focused approach than KLOEs, providing clear, concise expectations of what good care looks like. In theory, it should now be easier for providers to understand and meet CQC standards.
Introducing a new scoring system
The rating system used so far was tied to KLOEs. The new rating system will be aligned with the newly introduced "Quality Statements" and is designed to offer a more granular assessment of service quality.
The quality statement scores will be combined across different evidence categories to give a total score for the relevant key question. Check out this scoring example on the CQC site for more details.
While we can still see only the final ratings, CQC does plan to eventually publish the scores behind those ratings as well. This should offer greater transparency and granularity — e.g. for a rating of 'requires improvement', we will see if the provider is closer to the 'good' or to the 'inadequate' rating.
The timeline of the single assessment framework rollout
The rollout started in November 2023 in the South region with an early adopter program involving a small group of providers. By the end of March 2024, the new assessment process should reach the rest of England.
You can find more information and the exact timeline for all of the regions here.
In the first half of 2024, CQC plans to gather feedback from providers regarding the new single assessment framework so they can update their guidelines and polish their processes.
What is CQC trying to accomplish with these changes?
The CQC is trying to introduce greater flexibility, enabling regular updates to service provider ratings and more targeted inspections. The new system is designed to show how a service's current rating compares to the next higher or lower rating (based on the CQC's latest evaluation), thereby promoting consistency and transparency in rating assessments.
As stated on their site, there are three main reasons for these changes:
- We need to make things simpler so we can focus on what really matters to people.
- We need to better reflect how care is actually delivered by different types of service as well as across a local area.
- We need one framework that connects our registration activity to our assessments of quality.
This new approach is set to make CQC’s assessments more structured and fair, as well as entice providers to embrace the culture of continuous improvement.
What can healthcare providers do to prepare?
In order to evaluate how well providers are matching their services to the quality benchmarks (the five key questions), CQC will collect evidence in six different categories.
What can service providers do to prepare?
For starters, you should implement a system for continuously collecting feedback from patients. Platforms like InsiderCX offer a simple way to automate patient feedback collection and analysis, allowing healthcare practices to produce required reports as needed. For example, you can use it to create your 'I statements' surveys and start gathering evidence for upcoming inspections.
Aside from that, health and social care providers should also:
- Maintain a record of all complaints, outcomes, and actions taken in response to complaints.
- Make sure people feel that staff are attentive to their concerns, listen to them, and communicate with them appropriately, using language and methods they can understand.
- Establish a process that includes a continuous search for trends and areas of risk.
- Make sure people using your services and their families feel heard, and that their negative experiences are acted upon to improve care.
Download our full list of the preparation steps to ensure an outstanding score in the new CQC framework.