What are the five key questions asked by the CQC?

Every year, thousands of health and social care providers in England undergo inspections from the Care Quality Commission (CQC), the independent regulator for these services. But what does the CQC look for? The answer is surprisingly simple: it all boils down to five key questions.

In this article, Dr Richard Dune takes a deeper dive into these criteria and explains how they form the backbone of the CQC's assessment framework.

CQC inspectors ask the following five key questions:

• Is the service safe?
• Is the service effective?
• Is the service caring?
• Is the service responsive?
• Is the service well-led?

Is the service safe?

Safety is paramount in health and social care settings. The CQC wants to know if service users, such as patients in a hospital or residents in a care home, are protected from abuse and avoidable harm.

Inspectors will look at aspects like staffing levels, cleanliness, infection control, medication management, and whether incidents are reported and learned from effectively.

Is the service effective?

Effectiveness is evaluated based on outcomes and people's experiences. Are patients receiving treatments that meet their needs and conform to evidence-based guidelines? Is their pain managed appropriately? Are their nutritional needs met? Does the service promote a balanced lifestyle?

Inspectors also consider whether staff receive the necessary training to perform their roles and whether the service complies with relevant legislation.

Is the service caring?

Caring is about the way staff interacts with service users. Do they treat individuals with compassion, kindness, dignity, and respect?

The CQC will talk to service users and their families, observe interactions and look for evidence that people's emotional and social needs are understood and met.

Is the service responsive?

A responsive service is one that meets people's needs. This involves timely access to care, individualised planning, and the ability to handle complaints effectively.

The CQC will examine whether services are designed and organised to meet the needs of the diverse population they serve, including those with complex or multiple needs.

Is the service well-led?

The last key question pertains to leadership and management. The CQC wants to know if the organisation's leadership, management, and governance assure the delivery of high-quality care, encourage learning and innovation, and promote an open and fair culture. They assess the culture within the organisation, the clarity of the vision and values, and how well these are understood by staff at all levels.

Implementation and rating

Now that we understand the five key questions, let's delve into how the CQC uses them during inspections.

The CQC uses a combination of data, information from providers, and feedback from service users and the public to help them decide when, where, and what to inspect. Once on-site, inspectors use these five key questions to structure their investigation.

They speak with service users, staff, and managers and observe care to gather evidence against each key question.

Once the evidence has been collected, each question is rated on a four-point scale:

• Outstanding
• Good
• Requires improvement
• Inadequate.

The ratings for each of the five key questions contribute to an overall rating for the service. This rating is then published, alongside a detailed report, providing a comprehensive picture of what the service does well and where it needs to improve.

Conclusion

The CQC’s five key questions provide a comprehensive framework that captures the essence of what high-quality care should look like. By understanding these five key areas, health and social care services can ensure they are delivering the highest possible standard of care and that their staff and managers are prepared for their next CQC inspection.

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