As a care manager, you understand the value of achieving a good or outstanding Care Quality Commission (CQC) rating. Your CQC rating is a testament to how safe, effective, responsive, caring, and well-led your service is.
The CQC announced in 2021 that it is updating its inspection framework, changing how adult social care services are evaluated. Rather than offering a snapshot of a single point in time, this new strategy simplifies the process while also offering a more timely and holistic assessment of care providers.
Although the changes have yet to be fully rolled out, it’s important to know what's coming.
This guide will give you an overview of what we know to date—what’s changing and what’s staying the same—so that you and your team can be as prepared as possible.
Why are changes being made?
Understandably, the pandemic put in-person inspections on hold, creating a big backlog and highlighting the need for alternative ways to assess services. Many care providers were left with a rating that didn’t truly reflect the quality of care being delivered.
Since the pandemic, the CQC has recognised the need to update its approach to manage risk and more flexibly meet the challenges of “a changing health and social care sector.” This meant updating and streamlining the assessment process, moving away from relying solely on infrequent in-person inspections.
Taking a more people-centred approach
The CQC’s ultimate aim in changing how they regulate is to improve the quality of care for everyone. Their ambition is for regulation that’s “driven by people’s needs and experiences” when accessing care.
Going forward, the CQC has prioritised a people-centred approach, developing their new strategy in collaboration with the public, service providers and partners.
Assessments of care providers need to be relevant and meaningful to people using or considering their services. This means offering an accurate and up-to-date rating of services in language that’s consistently easy to understand (rather than lengthy reports).
The focus will also be on promoting a stronger learning and safety culture, improving the quality of care where it’s needed most, and addressing inequalities in healthcare.
What isn’t changing?
The five key questions
Currently, the CQC considers how well your service is performing in five important areas, called KLOEs for short:
- Safe: Is your organisation and its residents protected from abuse and avoidable harm?
- Effective: Do your care, treatment and support achieve good outcomes? Do they help you to maintain quality of life and are they based on the best available evidence?
- Responsive: Is your service organised to meet people’s needs?
- Caring: Do your staff treat your residents with compassion, dignity, kindness and respect?
- Well-led: Does the management of your organisation make sure you’re providing high-quality care that's based around your residents’ needs? Do you encourage learning and innovation and do you promote an open and fair culture?
These five key questions will not be changing, but how the CQC judges your service in light of them will be.
The CQC will continue to give an overall rating for care services as one of the following:
- Requires Improvement
However, how your overall rating will be calculated is changing. (More on this below.)
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Fundamental Standards (Regulations 9 to 20) have not changed. The new quality statements outlined below are informed by these key regulations.
What changes are coming?
New single assessment framework
Up until recently, the CQC had three separate assessment frameworks, depending on the type of service: one for hospitals, one for adult social care and one for primary care.
The new single assessment framework will simplify the assessment process and better reflect how care is delivered. This new framework will be based on a single set of expectations that clearly define what good care looks like across the board.
Easier-to-understand quality statements
As mentioned earlier, the four-point rating scale and five key questions will still be part of this new approach.
However, the single assessment framework will be built around a number of quality statements.
Each of these quality statements is associated with a key question and related regulations.
The quality statements are “we” statements that demonstrate your commitment to being safe, effective, responsive, caring and well-led. Care providers will be scored based on how well they are living up to these statements.
While there were over 330 prompts associated with KLOEs, there are only 34 quality statements, streamlining the process for both regulators and providers.
The quality statements are designed to give a very clear definition of what excellent care looks like and what the CQC wants to see from you. As an example, one of the quality statements associated with the key question of caring is all about treating people as individuals:
“We treat people as individuals and make sure their care, support and treatment meets their needs and preferences. We take account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.”
You can review each of the new quality statements on the CQC’s website here.
Six defined evidence categories
Up until now, care services were monitored by in-person inspections, scheduled depending on the previous rating and the CQC’s own risk assessment.
Going forward, the CQC will monitor services through in-person inspections as well as ongoing assessments and collection of evidence.
To determine how well a service lives up to each quality statement, the CQC will now consider relevant evidence from one of six evidence categories.
These categories are:
- People’s experience of health and care services
- Feedback from staff and leaders
- Feedback from partners
For example, evidence from people’s experience might come in the form of survey results or an interview with someone using the service. Evidence from outcome measures could be infection control rates.
The CQC says it will clearly set out the evidence categories it will consider depending on the quality statement being assessed. The number of evidence categories and the sources of evidence required will vary depending on the service.
New scoring framework, faster turnaround and dynamic rating calculation
The CQC will aim to update the information they hold on a service across all of the required quality statements and evidence categories within two years.
Rather than a single-point-in-time assessment, the overall rating for a service can change dynamically based on evidence collected and reviewed at different times.
To make the rating system more transparent, the CQC has introduced a new scoring framework. A score of 1 to 4 will be given to key evidence categories for each quality statement.
4 = Evidence shows an exceptional standard
3 = Evidence shows a good standard
2 = Evidence shows some shortfalls
1 = Evidence shows significant shortfalls
The CQC says it will follow three stages for assessments:
- Review evidence within the evidence categories they’re assessing for each quality statement.
- Apply a score to each of these evidence categories.
- Combine these evidence category scores to give a score for the related quality statement.
The quality statement scores will be combined to give a total score for the relevant key question. This score generates a rating for each key question, and the aggregate scores for the key questions result in an overall rating: outstanding, good, requires improvement or inadequate.
This scoring system will make it easy for you to see exactly which quality statements you need to work on to boost your total score for a key question and, ultimately, improve your overall rating.
Although initially only overall ratings will be published for the public, in the future, the CQC intends to publish score reports too. This will show exactly how the rating for a care provider has been determined and where the service is excelling or needs to improve.
New provider portal
According to a recent update from the CQC, a new online provider portal will start to be rolled out this summer.
This will be done in stages and you’ll be notified directly by the CQC when you’re able to sign up. You’ll be offered support and guidance as you learn to use this new portal as part of the new assessment approach.
What 5 things can you do now to prepare?
According to the CQC, assessments using the new framework will be rolled out more widely later this year. The CQC will tell you in advance when the new framework will be applied to your care service. You will be given time and support to adapt to the new process. However, it’s not too soon to begin your preparation.
Here are five good ways to make a start:
- Keep up to date with the CQC
The best way to make sure you have access to the most up-to-date information is by subscribing to the CQC’s email newsletter here.
- Talk to your team
CQC inspections can be stressful, especially if there’s an element of change or the unknown. The best thing you can do is to keep your team informed about the changes that are coming so they can feel more prepared too.
- Review the new quality statements
The main benefit of these changes is making things simpler. With only 34 quality statements, it’s much easier to understand exactly what the CQC wants to see care providers doing.
It’s worth going through each of these statements now and honestly assessing howwell you feel your service lives up to them. Pay particular attention to new areas of focus for the CQC, such as sustainable development.
Find all 34 “we” quality statements, and the KLOEs they are associated with, by going here and clicking into each KLOE statement - Safe, Effective, Caring, Responsive and Well-led.
- Access the way you collect evidence to showcase high-quality care
Now that you know—thanks to the quality statements—exactly how the CQC defines outstanding care, now is the time to make sure you have the processes in place to collect evidence to back up each quality statement.
- Get feedback (and start acting on it)
Key to a person-centred approach to care is constructively acting on feedback from those in your care and their loved ones.
Talk to these important stakeholders and seek to improve your service based on their suggestions and experiences.
Being able to demonstrate this proactively people-centred approach will only improve your chances of a good or even outstanding CQC rating.
How Florence can help
Working in care, you are often responsible for the needs of the most vulnerable. The changes to the CQC’s framework seek to put those needs first—simplifying and streamlining the assessment process to promote continuous improvement and the highest possible quality of care for everyone.
To deliver excellent, people-centred care, you need a great team of people. That’s where Florence comes in. Our app helps you fill shifts fast with your own staff first, and cover any gaps with high-quality, experienced Florence professionals. With us you can:
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- Download full staff records in seconds to help with reporting, CQC audits and inspection evidence-gathering.
Find out how Florence can help you deliver excellent care. Book a demo below.
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