In July 2022, the Care Quality Commission outlined its new single assessment framework, focusing on a system that connects its registration activity to its quality assessments while offering a structure with greater transparency. They are looking to move away from their old approach of ‘monitor, inspect and rate’ and work towards a more flexible approach where inspections won’t be determined by frequency and where the ongoing assessment of quality will be proportionate to risk. The new framework is for providers, local authorities and systems. It is concerned with what matters to people who use health and social care services and their families and will help them by providing an up-to-date view of quality. The CQC will regulate in a smarter way by adapting and responding to risk, uncertainty and demand. They will understand the quality of care in a local area or healthcare system to improve it and keep people safe.

The New Framework

The CQC assessment framework is built on their five key questions and well-known ratings system and is what they will use to set out their view of quality and make judgments.

The CQC will start to introduce it in phases and be clear when it will directly affect health and care providers. They are publishing their new framework now so that providers and other stakeholders can begin to become familiar with it. The Care Quality Commission website offers more context on the new CQC regulatory model. 

As of July 2022, providers have been able to read more about the CQC’s quality statements and evidence categories. The CQC will build on this in more detail, exploring how it will work in practice over the coming weeks and months. For example, information on the evidence they require in their assessments of each service type and what their assessments will look like.

Why They’re Changing

• There are three reasons why they need to change:
• The CQC will need to make things simpler to focus on what matters to people.
• They need to better reflect how care is delivered by different types of service and across a local area.
• They need a framework that connects their registration activity to their quality assessments.

What’s Different?

The CQC has already confirmed that their quality ratings and five key questions will stay central to their approach. However, they’re replacing their key lines of enquiries (KLOEs) and prompts with new ‘quality statements’. These will reduce the duplication in their four current separate assessment frameworks, allow them to focus on specific topic areas under each key question, and link to the relevant regulations to make it easier for providers.

The CQC call the quality statements ‘we statements’ as they’re written from a provider’s perspective to help them understand what they expect of them. They draw on previous work developed with Think Local Act Personal (TLAP), National Voices and the Coalition for Collaborative Care on Making it Real. The CQC want to maintain that ethos when developing its assessment framework.

The CQC will base their quality assessments in all types of services, and at all levels, on the single assessment framework. For local authorities and integrated care systems, the CQC will use a subset of the quality statements being published today.

To make their judgements more structured and consistent, the CQC has also developed six categories for the evidence they will collect:

• People’s experiences,
• Feedback from staff and leaders,
• Observations of care,
• Feedback from partners,
• Processes,
• Outcomes of care.

The CQC want to be clearer with providers and the public about how they use the information they have about care in service or the local area. Each quality statement will state which evidence they will need to collect; for example, GP practices will differ from what they’ll have available when assessing a home care service. This is also dependent on the level at which they’re assessing. For example, the evidence the CQC have when a new service is registering for the first time will be different from that to a service that has been operating for a while.

To fulfil the ambitions in their strategy, the assessment framework emphasises the need to create cultures that learn and improve and establishes expectations for how services and providers need to work together and within systems, to plan and deliver safe, person-centred care.

Building on Strong Engagement

The CQC has developed their new assessment framework following almost nine months of engagement and thousands of interactions with providers, people who use the services and other stakeholders.

Through feedback, the CQC discovered stakeholders supported the simplicity of the new framework. Having just thirty-four topic areas across five key questions means that providers will understand what they’re looking for in CQC assessments. 

Although people valued the simplicity of the approach, a lot of people felt the language was too complex. In response, the CQC conducted some user research and reviewed the wording of the quality statements to make them easier to read.

As a result of their engagement with providers, they have also created some guidance that shows examples of the evidence they collect for each category. 

Further information regarding CQC registration support and CQC interview preparation can be found on Care Agency Media’s website.