The new single assessment framework

Source: CQC website

Our assessment framework is built on our five key questions and well-known ratings system and is what we use to set out our view of quality and make judgements.

We will start to introduce it in phases and be clear when it will directly affect health and care providers. We are publishing our new framework now so that providers and other stakeholders can start to become familiar with it.

From today, 18 July 2022, providers and others will be able to read more about our quality statements and evidence categories. We’ll build on this with more detail about how it will work in practice over the coming weeks and months. For example, information on the evidence we’ll require in our assessments of each service type and what our assessments will look like.

Why we’re changing

There are three main reasons why we need to change:

• We need to make things simpler so we can focus on what really matters to people.
• We need to better reflect how care is actually delivered by different types of service as well as across a local area.
• We need one framework that connects our registration activity to our assessments of quality.

What’s different

We’ve already confirmed that our quality ratings and five key questions will stay central to our approach. But we’re replacing our existing key lines of enquiry (KLOEs) and prompts with new ‘quality statements’. These will reduce the duplication that’s in our four current separate assessment frameworks to allow us to focus on specific topic areas under each key question, and will link to the relevant regulations to make it easier for providers.

We call the quality statements ‘we statements’ as they’re written from a provider’s perspective to help them understand what we expect of them. They draw on previous work developed with Think Local Act Personal (TLAP), National Voices and the Coalition for Collaborative Care on Making it Real. We wanted to maintain that ethos when developing our assessment framework.

Importantly, we’ll base our assessments of quality in all types of services, and at all levels, on this single assessment framework. For local authorities and integrated care systems, we will use a subset of the quality statements being published today.

To make our judgements more structured and consistent, we have also developed six categories for the evidence we collect:

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

We want to be clearer with providers and the public about how we use the information we have about care in a service or local area. So, for each quality statement we’ll state which evidence we will always need to collect and look at. This will vary depending on the type of service. For example, the evidence we can collect for GP practices will be different to what we’ll have available when assessing a home care service. It will also depend on the level at which we’re assessing. For example, the evidence we have when a new service is registering for the first time will be different from a service that has been operating for a while. 

To fulfil the ambitions in our strategy, the assessment framework emphasises the need to create cultures that learn and improve, and we set expectations for how services and providers need to work together, and within systems, to plan and deliver safe, person-centred care.

Building on strong engagement

We’ve developed our new assessment framework following almost nine months of engagement and thousands of interactions with providers, people who use services and other stakeholders.

Feedback told us that stakeholders support the simplicity of our new framework. Having just 34 topic areas across the five key questions means that providers will be much clearer about what we’re looking for in our assessments.

Although people valued the simplicity of the approach, many felt the language was too complex. In response, we carried out some user research and have reviewed the wording of the quality statements to make them easier to read.

As a result of our engagement with providers, we’ve also created some guidance that shows examples of the evidence we collect for each category.