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The Care Quality Commission: Changes to the Framework

30 January 2023

Later this year, the Care Quality Commission (CQC) will introduce its new Single Assessment Framework, which will replace the four individual frameworks currently in place in England to assess quality of care in all health and social care services.

The new Framework hopes to streamline and simplify the current assessment process and reduce duplication to foster efficiency and consistency.

What is changing?

The Single Assessment Framework will retain the five 'Key Questions' the CQC ask to care providers to assess their quality of care (i.e. are they safe, effective, caring, responsive to people's needs and well-led), and the four point quality ratings scale (outstanding, good, requires improvement and inadequate) will also remain. The CQC however will replace 'Key Lines of Enquiry' and Prompts with 'Quality Statements'.

Quality Statements will give examples of 'high quality, person-centred care' under each 'Key Question'; they are phrased as 'we' statements, written from a provider's perspective to help providers understand what the CQC expects of them. The aim of these statements is to phrase the Key Questions as real life examples and to encourage organisations to take ownership of the Key Question topics. Each Quality Statement will link to relevant Health and Social Care Act 2008 (Regulated Activities) Regulation 2014, which should make it easier for providers to comply with such standards of care and use this as reference points.

The CQC has also developed six evidence categories, which comprise of qualitative and quantitative collections of data, such as people's experiences of care and feedback from staff, observations, processes and more. The evidence from these categories will be applied across each Quality Statement within the five Key Questions and will be used during inspection. The evidence categories used will vary depending on the service type (i.e. GP practice, care home) and level of assessment (service, provider, local authority, or integrated care system) and the CQC will be able to collect evidence on an ongoing basis, meaning they will be able to trigger an assessment at any time. The framework will provide for a continuous assessment of quality, expecting care providers to be accountable for quality of care all year round, and not just at times of an upcoming review. As a result, the CQC will be able to update quality ratings at any time following assessment, and will no longer be constrained to review periods. The new framework therefore provides much needed flexibility in this industry but will undoubtedly put pressure on providers to be more proactive in following guidance to maintain their quality ratings.

What are the effects of these changes on the health and social care industry?

The Single Assessment Framework is designed to ensure judgements about quality of care are formed from a variety of sources and collected at different times, not just through on-site inspections. This advocates for a more accurate reflection of how care is actually delivered, but also enables a structured and consistent assessment process, which will reduce duplication experienced in the current four frameworks it is replacing.

The Framework also intends to reduce health inequalities by aiming the assessment at all types of services and at all levels in different geographies. Assessments will likely be simpler, more transparent and easier to understand as they will draw on evidence from a variety of sources over regular periods of time.

Ultimately, the current economic climate is seeing strains on the health and social care industry, the NHS is facing a workforce crisis around recruitment and retention and there is an urgent need for emphasis on sustainability; the Single Assessment Framework reflects a culture that the CQC wants to foster, to learn and improve, which will hopefully tackle those strains. The CQC aims to set expectations for how services and providers need to collaborate to plan and deliver 'safe, person-centred care'.

Read the latest Regulatory, Compliance and Investigations Insights 

Further Reading