CQC: Assessment Framework Focus

The new Single Assessment Framework is coming

This is the first alert in a series of updates on CQC’s new ways of working. In this series we will explore CQC’s new way of assessing services, update you as more detail emerges from CQC on how the new system will work and provide analysis of these changes and their likely impact.

Our first alert provides background to the new Single Assessment Framework itself.

Key Insights at a Glance:

• CQC plans to roll out use of the Single Assessment Framework in 2023 (though when specifically remains unclear). This one framework will apply to all sectors registered with CQC. It will also be used to assess local authority commissioning of social care and Integrated Care Systems.
• CQC will assess services on an ongoing basis meaning that ratings can change more frequently.
• The 5 Key Questions and the ratings scale (Outstanding – Inadequate) are not changing.
• Key lines of enquiry (KLOEs) will be replaced with new Quality Statements.
• CQC will be collating evidence under the Quality Statements using six new Evidence Categories.
• The same new Framework will be used to assess new services when making applications for registration, as well as ongoing assessment once they are registered.

A Single Assessment Framework

The new Assessment Framework was introduced by CQC in July 2022 having been outlined in 2021 as one of CQC’s main priorities for the first year of its new 5 year strategy. To read more about CQC’s 5 year strategy, please see our previous update here: CQC Launches its 5 Year Strategy. Whilst CQC has started to pilot the new Assessment Framework with some providers since August, it is indicating on its website that it will be rolled out for use in the assessment of all providers from January 2023. However, we are hearing that this is now unlikely and rollout is more likely to be pushed back further into 2023.

According to CQC, the new Framework is being introduced to make things simpler so it can focus on what really matters to people and to better reflect care being delivered by different types of services in local areas. CQC also wants the new Framework to connect its CQC registration activity with its assessments of quality. This means that all new providers seeking CQC registration will be assessed under this new framework.

The well-known 5 Key Questions (Safe, Effective, Caring, Responsive, and Well led) will remain central to CQC’s approach under the new Framework and there will also be no change to the Quality Ratings System (rating services on a scale of Outstanding– Inadequate).

Under the new approach, CQC will be dispensing with the Key Lines Of Enquiry (KLOES) and replacing these with Quality Statements (also known as “We Statements”). Whereas there are currently 2 sets of KLOES (one for healthcare providers and one for adult social care providers), there will be a single set of Quality Statements and these will apply across all sectors. They will also apply when CQC starts to assess local authorities and their commissioning of adult social care, as well as Integrated Care Systems next year.

The Quality Statements will sit under each of the Key Questions and are intended to be clearer than the KLOES (which were often seen as repetitive in nature). They are phrased as “We statements”, written from a provider’s perspective (in terms of what “we” (ie providers) should do to ensure the quality of services experienced by people who use services); they are intended to ensure that CQC’s expectations of a provider are clearer.

In our next Focus update in this series, we will consider the new Quality Statements in detail.

Evidence Categories

CQC is also introducing six Evidence Categories to demonstrate the types of evidence that will be used to assess the quality of care being delivered against the Quality Statements. The Evidence Categories are:

• people’s experiences
• feedback from staff and leaders
• observations of care
• feedback from partners
• processes
• outcomes of care.

CQC states that it hopes that these Evidence Categories will make its judgments under each of the Key Questions more structured and consistent. CQC is expected to publish specific guidance on the types of evidence sitting under each Evidence Category. There will be different sets of guidance reflecting different types of evidence for the different sectors registered with CQC.  

Ongoing Assessment

As part of CQC’s move towards ongoing assessment of services (rather than the snapshot of a provider on an inspection day), evidence will be collected on an ongoing basis enabling it to respond more flexibly to risk. The intention is that this will enable CQC to update a service’s ratings more frequently, enabling it to give a more up to date picture of the quality of care. The timetable for collecting evidence will be based on national and local risk analysis and priorities, and this will be the minimum timetable for how often CQC will collect evidence. CQC will use data and insight to decide which services to visit, and may monitor evidence more frequently depending on each service.

Further Developments

As CQC starts to test out its new Assessment Framework, more information is being revealed as to how this will work in practice. At the present time, providers will have a number of questions which are unanswered. For example, how will CQC migrate ratings from the current assessment framework to the new Framework once fully launched? What will be included in the detailed Evidence Category guidance for the different sectors? How frequently will CQC will be reassessing services and potentially changing their ratings? And, how will a provider be able to challenge that rating if they need to? We hope to explore these issues further in the coming Focus series.

Next Steps for Providers

• Become familiar with the new Quality Statements and Evidence Categories at this stage. You can find these in the following links: Key questions and quality statements - Care Quality Commission and Evidence categories - Care Quality Commission.

Look out for our next alert focusing on the new Quality Statements.

Please contact Carlton Sadler or Siwan Griffiths for more information or to discuss your questions or how we may be able to support you.