Prepare for change as CQC rolls out its new single assessment framework

Prepare for change as CQC rolls out its new single assessment framework

A new single assessment framework for health and care providers, delivered by the CQC, is about to change the way care is assessed – and the timetable of change is significant for all businesses in the sector.

The framework, supported by a new provider portal, is designed to be more dynamic and data led, with an aim to put people’s experiences at the forefront of regulation and assessment.

It’s a big change to what has gone before, not least because the CQC used to have three assessment frameworks: one for hospitals, one for adult social care and one for primary medical services.

The new single assessment model will bring together one set of expectations, with an ambition to make the exact definitions of ‘quality’ care and ‘good service’ clearer.

For care providers, understanding the pace of change is crucial as they adapt to a new way of doing things.

More than 10,000 participants took part in a CQC webinar in August 2023 as updates were provided along with an opportunity to explore the new portal, which is already being rolled out. [1]

Providers will be notified individually when they are able to sign up and are being urged to look out for further webinars and communications from the CQC.

The pace of implementation, however, depends on location, with England split into four regions for regulatory purposes.

The South will be the first to adopt the new framework in November 2023, with all regions on board by March 2024.

CQC Chief Executive, Ian Trenholm said: “Our new assessment approach will be more flexible and proportionate and will be the driving force behind giving an up-to-date view of quality.” [2]

Why has a new system been created?

The CQC’s aim is to simplify the system, suggesting this will enable them to focus on what matters most to people and to better reflect on how care is delivered across different service types.

The starting point is a single framework on which assessments of quality, for all service types, will be based on.

The CQC has laid out the framework as a pyramid. At the top are the 5 Key Questions – used to determine whether your service has been safe, effective, caring, responsive and well-led.

Below this sit quality statements and then evidence.

For local authorities and integrated care systems, a subset of the quality statements will be used in the middle of that pyramid. But the intention is for one single framework that covers all the health and care sector.

As part of the process, the CQC was equipped with new powers in April 2023 to assess Integrated Care Systems (ICS) [3]  - as well as local authority-provided adult social care services.

The one big thing missing from the process is the former CQC Key Lines of Enquiry (KLOEs). The KLOE prompts, and ratings associated with them, are being retired.

Going forward there will be:

• One single assessment framework across Health & Social care to provide greater consistency
• Continuous feedback on health and care services, including feedback from staff and partners. By collecting evidence on an ongoing basis, the CQC can update ratings at any time and respond more flexibly to changes in risk.
• A new scoring system:

4: Evidence shows an exceptional standard of care

3: Evidence shows a good standard of care

2: Evidence shows shortfalls in the standard of care

1: Evidence shows significant shortfalls in the standard of care

• An improved turnaround time.
• Shorter and simpler reports, showing the most up-to-date assessment.
• The use of data and insight to decide which services to visit.

The new assessment will continue to use the same ratings scale (Outstanding, Good, Requires Improvement and Inadequate) that all care providers will be familiar with.

It will also retain the traditional five key questions asked of care providers:

• Are they safe?
• Are they effective?
• Are they caring?
• Are they responsive to people’s needs?
• Are they well-led?

But as part of the changes there will be six new ‘evidence categories.’

These are:

• People’s experience of health and care services
• Feedback from staff and leaders
• Feedback from partners
• Observation
• Processes
• Outcomes

Quality statements will focus on ‘specific topic areas’ under key questions, setting ‘clear expectations of providers, based on people’s experiences and the standards of care they expect.’

These are also known as 'we statements’ because they are promises that begin with ‘we will.’

What social care providers should think about:

• The range of ways that they can work with CQC staff and what processes and tools could be used to improve services before, during and after inspection.
• How to encourage and support their staff to engage in open, improvement-focused discussions with CQC inspection teams and other stakeholders.
• How they can use the coming months to improve and prepare. The CQC will schedule assessments by considering factors such as the level of risk, so not all providers will have an immediate assessment.
• Regions outside of the South of England will continue to be assessed under the current framework until the new one is rolled out in their area.

Insurance implications to consider:

Good communication with your insurer is important at all times and especially around inspections.

Aspects of service which the CQC say ‘Requires Improvement’ (RI) can impact the cost of your premium and reduce the scale of the market willing to offer terms.

A quicker turnaround under the new framework will assist homes into moving out of RI and into Good. But also consider that it could work the other way around, requiring you to respond quickly if a rating is downgraded.

Whatever happens, always keep insurers up to date with your rating. This ensures that you remain covered and pay the correct premium.

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