Are you ready for the CQC single assessment framework?

Over the last few years, the health and social care sector has undergone substantial regulatory changes. During the COVID-19 pandemic, the Care Quality Commission (CQC) sought alternative methods of regulation, some of which have been incorporated into the new inspection framework. Hence, the CQC aims to implement a more dynamic, data-driven approach that places people's experiences at the centre of regulation and assessment.

The CQC have developed a new framework which early adopters are expected to start implementing in April 2023. You should understand how these significant changes may affect how they regulate and inspect your organisation.

In this article, Dr Richard Dune gives an overview of the new CQC inspection and assessment framework. He will outline the reasons for these changes and how health and social care organisations can prepare for them.

The CQC regulatory framework

The CQC regulates and inspects all adult social care providers in England. These inspections are determined by the provider's previous rating and the CQC's risk assessment. The reviews ensure that health and social care services provide safe, effective, caring, responsive, and well-led care.

It is standard practice for inspectors to listen to people receiving care, their families, members of staff, as well as other health and social care professionals during an inspection. If standards are unmet, the CQC will take appropriate action to ensure that people receive care that meets the regulatory requirements.

The new CQC inspection model

The CQC's new single assessment framework will be implemented in phases to ensure that health and social care providers understand how they will be affected. CQC has released information about the new framework so that providers and other stakeholders can become familiar with it.

CQC's new single assessment framework emphasises the importance of safety cultures that helps to deliver safe and effective person-centred care.

There will be no changes to the Outstanding, Good, Requires Improvement, and Inadequate CQC rating scales. In addition, the CQC's five key questions, Safe, Effective, Caring, Responsive, and Well-led, will remain the same.

However, there is a significant change in how CQC will assess whether you meet those five standards and determine your overall rating. The five areas of focus for CQC inspectors are as follows:

• A single assessment framework
• Quality statements and topic areas
• Different types of inspections
• Changes to inspection frequency
• Improved turnaround time.

A single assessment framework

Historically, the CQC has had three assessment frameworks; one for hospitals, one for adult social care, and one for primary medical care. The CQC has now developed a single assessment framework to streamline and simplify the assessment process for all health and social care providers in England.

In the new CQC single assessment model, there will be one set of expectations, allowing for a clear understanding of what constitutes "quality" care and "good" service.

Quality statements and topic areas

The CQC has outlined the new single assessment framework as a pyramid (see below). The criteria guide health and social care providers through their assessment process. Five key questions are at the top of the pyramid, and the next step is to provide quality statements and evidence.

CQC Key Lines of Enquiry (KLOEs) and related prompts will be retired and replaced by quality statements.

Under the 'Safe' domain, for example, these are the following topics:

• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Safe environments
• Safe and effective staffing
• Infection prevention and control.

You will find a set of quality statements or 'we statements’ within each topic area. This is similar to how the KLOEs and KLOE prompts worked previously.

Under the topic area of 'Learning culture', you could include the following quality statement:

“As part of a proactive and positive safety culture, we listen to concerns about safety, investigate and report incidents thoroughly, and continuously identify and embed best practices.”

Under the topic area 'Safeguarding', you could include the following quality statement:

“We aim to understand what being safe means to people and work with our partners on the best way to accomplish this goal. Our mission is to improve people's lives while protecting their right to live safely, free of bullying, harassment, abuse, discrimination, avoidable harm, and neglect. We aim to share concerns as soon as possible and on time.”

The bottom of the pyramid consists of specific evidence and quality indicators, flowing from the five key questions, topic areas, and quality statements. At this stage, the single assessment framework gets more complex and bespoke. Data and information will be collected based on the scope of assessment, delivery model, or population group.

Different types of inspections

Currently, the CQC assesses services solely based on inspections. During the inspection visit, evidence will be collected at one key point. CQC inspections will remain an integral part of its assessment process but will be incorporated into a broader approach in the new model.

Therefore, the CQC will take a more continuous approach to gather information about your service and assess its quality. This evidence will be collected using the following methods:

• Provider submissions
• Contact with people using the service
• Structured conversations with managers and other leaders
• Provider Information Returns (PIRs).

CQC inspectors will continue to conduct site visits. It is anticipated that the CQC will make an iterative assessment of the service and will use these new methods to form a picture over time of the quality of the service. To increase flexibility when assessing individual providers, they are moving away from the current one-size-fits-all method.

Changes to inspection frequency

Currently, CQC inspections are based on the previous rating of a service, which will vary based on the last rating and risk analysis. Using the new regulatory model, CQC will assess quality and risk continuously and establish their inspection frequency accordingly.

Improved turnaround time

Lastly, you can expect to see a change in the turnaround time of the CQC regulatory model. CQC recognises that service providers often have to wait a long time to receive the results of their inspections, which is likely to cause stress and anxiety among staff members. Their reporting process will be streamlined and sped up, improving turnaround times.

These changes are not likely to be implemented by most providers until well into 2023, but early adopters could have begun implementing these changes as early as the end of 2022.

What is not changing?

There will be no changes to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Fundamental Standards.

In addition, CQC will continue to use the following:

• Five key questions - Safe, Effective, Caring, Responsive, and Well-led
• Four-point rating scale - Outstanding, Good, Needs Improvement, and Inadequate.

CQC evidence collection and ratings

To make its decisions, the CQC will collect evidence from six categories as follows:

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

The overall rating of the care organisation will be based on the evidence presented against the quality statement and key questions. To promote better transparency, CQC will publish the evidence scoring system. These changes will result in more consistent judgements from the CQC, but it will take time to see if the new method is more successful.

Staying up-to-date

Health and care staff can feel stressed during CQC inspections. Keeping them informed and sharing relevant information will enable them to understand the changes as they are implemented and will relieve some of their concerns.

You can stay up-to-date by signing up for the CQC-regulated provider newsletter, registering for their webinar updates, and checking their dedicated website frequently.

Preparing for the CQC inspection framework

Click here to register for our CQC compliance framework guidance to learn more about these changes and future updates.

Implementing tools that will improve compliance, quality, and rating is one of the best ways to prepare your organisation and team for the CQC's new inspection framework.

A complete suite of software is available from The Mandatory Training Group that will help you manage your care service, improve the quality of your care, and increase the efficiency of your operations.  ComplyPlus CQC Compliance Software will assist you in auditing and improving care quality, giving you the necessary tools to improve your CQC rating. We can help you maintain regulatory compliance with our health and social care policies and procedures package.

Contact us today for more information about the compliance management solutions we offer for health and social care organisations.

ComplyPlus software has proven effective for many providers, and we wish to assist others so they may also benefit from it.

Conclusion

Despite the substantial changes, the CQC's primary objective is to improve the quality of health and social care services in the UK. To achieve this goal, they are shifting their focus to place a stronger emphasis on assessment over inspection and conduct more continuous assessments based on evidence.

By continuously assessing service providers, the CQC will be able to determine if it is achieving its aims. As a result, providers can identify what needs improvement and take appropriate measures.

Click here to see online courses and resources to help you and your organisation prepare for the new CQC single assessment framework.

About Dr Richard Dune

Dr Richard Dune is a leading health and social care governance expert. Throughout his career, he has worked in various settings across the UK, including NHS Trusts, research and development, academic institutions, and private companies.

His work primarily focuses on developing, deploying and evaluating technologies, such as clinical decision support systems, educational technologies, workforce development and regulatory compliance solutions.

Dr Dune regularly writes about topical issues affecting the UK's health and social care sectors. Additionally, he speaks at conferences, stakeholder workshops, and professional forums. Dr Dune is also a research fellow at University Hospitals Coventry and Warwickshire in the Research, Development and Innovation department. His other passions include content development, education, and coaching. Click here to read more articles by Dr Dune.

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