The Care Quality Commission (CQC) in England plays a significant role in assessing and regulating health and social care services to guarantee adherence to fundamental quality standards and ensure safe, effective, and compassionate care.
In 2021, the CQC announced updates to its inspection framework and assessment methodology, changing how social care services are evaluated.
While these changes have yet to be fully implemented, it’s important to understand what's coming. This blog post provides an overview of what we know so far —what's changing, what's staying the same, and how you and your team can prepare for the new assessment framework.
Why is the CQC changing its assessment framework?
The CQC's ultimate aim with the new assessment framework is to enable a simpler and smarter regulatory approach that meets the needs of a changing health and social care sector. This entails a streamlined process geared towards prioritising the needs of individuals accessing care services and their families, timely and holistic assessment of care providers, and a robust learning and safety culture to improve the quality of care where it's most needed.
What's staying the same?
The 5 Key Questions
These are the same questions that the CQC asks of all care services they inspect and are at the heart of their regulatory process:
1. Are they safe?
Are all individuals protected from abuse and avoidable harm?
2. Are they effective?
Does your care, treatment, and support achieve good outcomes? Does it help maintain quality of life and is based on the best available evidence?
3. Are they caring?
Do staff involve and treat individuals with compassion, kindness, dignity, and respect?
4. Are they responsive to people's needs?
Are the services organised so that they meet the needs of all individuals?
5. Are they well-led?
Do the organisation's leadership, management, and governance ensure that it provides high-quality care based on every individual's needs? Does the organisation encourage learning and innovation and promote an open and fair culture?
While these five key questions remain the same, how the CQC assesses health and social care services in accordance with them will be changing.
The 4-point rating scale
The CQC will continue to give an overall rating for care services as one of the following:
Outstanding
Good
Requires Improvement
Inadequate
However, how this rating is calculated will be changing.
What's changing?
CQC's Single Assessment Framework
Until now, the CQC has had three separate assessment frameworks—one for hospitals, one for adult social care, and one for primary medical services. The Single Assessment Framework streamlines and simplifies the assessment process by combining all three frameworks. The new model will consist of only one set of expectations that clearly define 'quality' care and 'good' service.
How the 5 key questions are used in inspections: KLOEs to Quality Statements
Historically, each of the five key questions was dissected into a further set of questions called the "Key Lines of Enquiry" (KLOEs), which served as the focal points during CQC inspections.
With the introduction of the single assessment framework, the KLOEs are being replaced by quality statements framed as "we statements," demonstrating the provider's commitment to being safe, effective, responsive, caring, and well-led. Unlike the extensive 330+ prompts associated with KLOEs, there are only 34 quality statements, simplifying the assessment process for both regulators and providers. They set clear expectations for providers based on people’s experiences and the standards of care they expect.
Evidence Categories
Until now, care services were monitored primarily through in-person inspections, scheduled based on the previous rating and the CQC’s risk assessment.
Moving forward, the CQC will employ a dual approach to monitor services, combining in-person inspections with ongoing assessments and evidence gathering. To determine a service's adherence to each quality statement, the CQC will now evaluate evidence from six distinct categories:
People's experience of health and care services
Feedback from staff and leaders
Feedback from partners
Observation
Processes
Outcomes
Each category outlines the types of evidence used to assess both the quality of care provided and the service's performance against each quality statement. This restructuring aims to enhance the transparency and consistency of the CQC's evaluations.
Scoring System
While retaining the 4-point rating scale, the CQC is introducing a scoring system to improve the clarity and consistency of their assessments concerning:
the quality of care within a service
the efficacy of a local authority in delivering its duties under the Care Act
the performance of an integrated care system
Each quality statement will be assessed based on the evidence gathered from each key evidence category. Depending on the findings, a score will be assigned to each evidence category as follows:
4 = Evidence shows an exceptional standard
3 = Evidence shows a good standard
2 = Evidence shows some shortfalls
1 = Evidence shows significant shortfalls
The scores from evidence categories are combined to determine the score for the corresponding quality statement. These quality statement scores are then combined to calculate a total score for the relevant key question. This cumulative score generates a rating for each of the five key questions, and the collective scores for all key questions determine an overall rating based on the 4-point scale: outstanding, good, requires improvement, or inadequate.
This scoring methodology provides providers with clear insights into which specific quality statements require attention to boost their total score for a key question and, consequently, improve their overall rating.
As the CQC transitions away from conducting assessments at a single point in time, future evaluations will likely occur periodically across different areas of the framework. This approach allows for updating scores for various evidence categories at different intervals.
What can providers do to prepare?
Stay up-to-date with the CQC
Keeping abreast of the latest developments as the new framework unfolds will enable providers to navigate the transition smoothly. Here are some valuable resources to assist you:
Videos and webinars on the new regulations
CQC's digital engagement platform to share feedback
CQC's email newsletter for all updates
Review and understand the new framework
As an organisation, take some time to thoroughly review the CQC's new Single Assessment Framework. Understand what's changing, what's staying the same, the scoring criteria, and the new key evidence categories. This will help you align your practices with the updated expectations.
Conduct Internal Assessments
Perform internal assessments of your services based on the new framework's quality statements and evidence categories. Talk to internal stakeholders, gather feedback, and identify areas where you excel and areas where you can improve. This proactive approach can help you identify and correct shortcomings long before the official CQC assessment.
Improve Data Collection and Documentation
Strengthen your data collection and documentation processes to ensure accurate and comprehensive evidence collection. Consider implementing a digital auditing system to replace cumbersome paper-based processes. These systems streamline processes, ensuring you efficiently capture all the necessary information and evidence for your regulatory and accreditation requirements.
How can MEG help?
MEG, with its comprehensive digital auditing and management capabilities, can help care providers prepare for and navigate the new CQC Single Assessment Framework through:
1. Customisable Audits
MEG allows for the creation of custom audits tailored to the specific requirements of the CQC framework. Providers can design audit forms based on the quality statements and evidence categories, ensuring that they gather relevant data during internal assessments.
2. Real-time Monitoring and Reporting
MEG monitors compliance status in real time and generates comprehensive reports on care quality. This allows providers to quickly identify areas of strength and those that need improvement, aligning with the CQC's emphasis on ongoing assessment and improvement.
3. Comprehensive Document Management
MEG offers a centralised platform for managing and storing policies, procedures, protocols, quality statements, and evidence categories in alignment with the new CQC guidelines. This ensures that care providers can readily access all the necessary documentation whenever needed.
Book a call with our team to know more!