What is the CQC single assessment framework?

The Care Quality Commission (CQC) framework is undergoing changes right now. CQC will implement a new Single Assessment Framework to regulate health and adult social care in England.

A single assessment framework will be used for all types of services at all levels, aiming to reduce health inequalities and improve services for people. As the changes are rolled out in 2023, CQC will gradually release information concerning the above strategy.

Dr Richard Dune discusses the changes in the CQC regulatory framework in this article, focusing mainly on the single assessment framework, key questions, and quality statements.

Current CQC framework

Currently, CQC uses quality ratings and five Key Questions to assess care providers under multiple assessment frameworks. The Key Questions asked are services:

• Safe
• Effective
• Caring
• Responsive
• Well-led.

The KLOEs then provide prompts to assist in assessing each Key Question above. For example, under ‘Safe’, the KLOEs include this prompt - How does the provider ensure the proper and safe use of medicines?

Although CQC will continue to rely on the quality ratings and five Key Questions above, it will replace KLOEs with Quality Statements under the new Single Assessment Framework. Essentially, instead of providing prompts, the Quality Statements will give examples of ‘high quality, person-centred care’ under each Key Question. For example, under ‘Safe’, the Quality Statements include this example - We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

Furthermore, each Quality Statement will link directly to the relevant Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC single assessment framework

CQC will use a single assessment framework in 2023. The new framework affects health and social care providers, local authorities, and integrated care systems. The existing CQC ratings and five key questions will remain central to the assessment process.

The CQC will continue to use the following:

• Five key questions, i.e. safe, effective, caring, responsive and well-led.
• Four-point rating scale, i.e. outstanding, good, requires improvement and inadequate.

Each key question is accompanied by a set of topic areas and quality statements. As part of the statements, the regulations will be linked to what good care is. As part of their effort to make judgements more structured and consistent, CQC has also developed six categories for the evidence they collect. CQC collects evidence depending on the type of service, for example, GP practices, and the level at which they assess, for example, registration. As part of these assessments, they will provide clear information about the evidence they require.

Key questions

• Safe
• Effective
• Caring
• Responsive
• Well-led.

Key question: Safe

Leaders must embed a culture of openness and collaboration to ensure safety. The rights of people are always protected, and they are never bullied, harassed, neglected, abused, or discriminated against. Following the law, people's liberty is protected where it is in their best interest.

As people raise concerns about safety and ideas to improve, the primary responsibility is to learn and improve continuously. It is well-known which areas pose the most significant safety risks, and solutions are developed collaboratively. Providers plan and organise services in a way that improves the safety of people and communities across their care journeys. People are supported to make choices that balance the risk of harm with positive choices. Leaders must ensure that there are enough skilled people to provide safe care that promotes individual choice, control, and well-being.

Key question: Effective

The best possible outcomes are achieved because the needs of people and communities are assessed. These needs and any protected equality characteristics are reflected in their care, support, and treatment. The care provided by services is in harmony with the needs of the people. Leaders cultivate a culture of improvement, where understanding current outcomes and exploring best practices are part of everyday work.

Continuous improvement is guided by quality indicators, which help everyone see what is working and what isn't.

Key question: Caring

Kindness, empathy, and compassion are always shown to people. They know they matter, and their experiences of being treated and supported matter. The privacy and dignity of the individual are respected. People are supported in living as independently as possible while respecting their wishes and achieving their best outcomes.

Key question: Responsive

Care is always centred on people and communities. People and communities' health and care needs are understood, and they are actively involved in planning care that meets those needs. There is easy access to care, support, and treatment, including physical accessibility. Care can be accessed to match a person's personal circumstances and protected equality characteristics.

There is easy access to information, advice, and advocacy for people, those who support them, and staff. As a result, they can manage and understand their care and treatment. Partnerships are formed to ensure that care and treatment meet the diverse needs of communities. People are encouraged to provide feedback, which is acted upon and used to improve the service.

Key question: Well-led

There is a culture of continuous learning and improvement that is inclusive and positive. All leaders and staff share the commitment to meeting the needs of people who use services and wider communities. By proactively supporting staff and collaborating with partners, leaders ensure that care is safe, integrated, person-centred, sustainable, and reduces inequalities.

Governance and management systems are effective. Care is improved by using information about risks, performance, and outcomes.

Key questions and quality statements

Providers, commissioners, and system leaders are responsible for living up to quality statements. The quality statements are ‘we statements’ that describe what it takes to provide high-quality, person-centred care.

According to the quality statements, providers and services must work together to provide high-quality care. They are directly related to the regulations CQC would consider in their judgements.

CQC refers to 'people' as those who use services, their families, friends, and unpaid carers, including:

• People with protected equality characteristics under the Equality Act
• People who are more likely to experience poorer care or inequalities.

Evidence categories

CQC uses six evidence categories to ensure consistency and structure in its assessments. To assess quality against a quality statement, CQC uses different types of evidence, i.e. 'require evidence'.

CQC will collect evidence from different sources depending on the following factors:

• Model or type of service
• The level of assessment, i.e. service, provider, local authority or integrated care system
• Whether the assessment is for an existing service or at registration.

The evidence categories are:

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

Assessing services

Gathering evidence - In the future, CQC will use more information, including data about people's experiences with care services. In addition to on-site inspections, they will gather evidence in various ways and at different times to support their judgements. As a result, they will use on-site inspections to support this activity rather than as the primary means of gathering evidence.

Frequency of assessments - When deciding when to assess a service, CQC will no longer rely on its rating as the main factor. Any evidence they collect or information they receive can trigger an assessment.

Assessing quality - As opposed to only inspecting after an inspection, the CQC will make judgements about quality more frequently. For this, they'll look at various quality statements and evidence from various sources. As part of the assessment framework, they will use evidence categories and give a score for what they find. It will be easier to understand how they make rating decisions.

CQC will refine and improve this approach as they begin to test it and introduce it to providers.

Up-to-date, transparent assessments of quality

CQC's assessment framework allows them the flexibility to:

• Assess evidence more frequently to update the ratings for key questions and overall ratings.
• CQC may collect evidence about people's experiences more frequently than processes, for example.
• Select which quality statements to examine; for example, they can review one or more statements.

How often CQC assess services

The frequency of assessments will depend on the information CQC receives and the evidence they collect about the service rather than its type and previous rating. Based on their approach, the CQC decides:

• Whether they focus on sectors or individual providers
• The frequency with which they conduct assessments
• Evidence-gathering activities they use.

CQC can collect evidence in both a planned and responsive manner because of its flexibility.

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