CQC ‘Better regulation’ consultation

CQC’s consultation ‘Better regulation, better care: Consultation on improving how we assess and rate providers’ marks the next stage in its rebuilding process following the extensive criticisms of the Single Assessment Framework (“SAF”) (launched in early 2024) and the review of the regulator’s operational failings set out in the reports of Dame Penny Dash, Professor Sir Mike Richards, and the Care Providers Alliance.  

In this article we look at what the Consultation proposes in terms of:

• What change is CQC proposing to the overall ratings of NHS trusts?; and 
• What change is CQC proposing to location-level ratings for NHS acute trusts and independent hospitals?

What change is CQC proposing to the overall ratings of NHS trusts?

As part of the Consultation, CQC is seeking feedback in this consultation on whether we should re-introduce an overall quality rating for NHS trusts, and ratings for all five Key Questions at a trust-level, rather than just for the ‘Well-led’ question.

However, although the Consultation asks for feedback on this approach, the proposal is very hard to evaluate as there is no clarity, in the Consultation, as to the methodology CQC would use to award these trust-level key question ratings and an overall quality rating.

What change is CQC proposing to location-level ratings for NHS acute trusts and independent hospitals?

The Consultation Paper indicates CQC is considering a change to its location-level ratings for NHS acute and independent hospitals.  However, there is confusion on the face of the Consultation paper as to precisely what changes CQC is proposing in this respect.

Although the introduction to this section of the Consultation (on page 25) states that this proposal relates to both NHS acute trusts and independent hospitals, nowhere else in the discussion that follows, or the related consultation question (Question 7b) is there any reference to independent hospitals.

More fundamentally, the Consultation Paper is confusing as to what changes CQC is seeking views on in this respect:

• Initially, the Consultation states that CQC want to explore “whether assessing each hospital service in a trust separately in each location is still the most meaningful way to assess these services, or if some may be better assessed across locations or pathways” (our emphasis).  No further explanation is given about this, but, on the face of it, this wording suggests that CQC may be considering, in the case of providers operating from more than one location, not awarding ratings to core services at a location level at all, and instead just awarding a single set of ratings for each core service that a trust provides, regardless of the number of locations from which it provides that core service.
• However, the Consultation question on this issue (Question 7b) indicates that CQC is merely considering “no longer aggregating key question ratings to produce an overall rating for an individual hospital location”.

Given that the introduction to this section states that this proposal is being considered not just for NHS acute trusts but also independent hospitals, if CQC’s intention is that set out in the first bullet point above, then transferring that approach to an independent hospital provider would mean that an independent hospital provider would be given just a single set of ratings for each core service it provides (eg ‘Surgery’) regardless of the number of different hospital sites at which it provides that service. That would represent a seismic shift in the way independent healthcare services are rated and, because of that, we assume that this is not what CQC are proposing and, instead, that the proposal is not to aggregate core-service level ratings to give location-level ratings for NHS acute and independent hospitals.  However, the lack of clarity in the Consultation document as to precisely what CQC is proposing in this respect is not helpful.

All stakeholders are encouraged to review and engage with the Consultation before it closes on 11 December 2025. 

If you wish to discuss any issues arising from the Consultation with us, please contact Carlton Sadler, Tracey Longfield, or Lindsey McNee.

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