30th October 2023

8 mins read

CQC Updates Inspection Framework: What You Need to Know and Six Tips to Prepare

By Therushie Botejue

In April 2023, the Care Quality Commission (CQC) launched a new inspection framework to assess the quality of care provided by social care services. This framework has been developed after extensive consultation with care providers, people who use their services, and other stakeholders. While further developments are still underway, the ultimate goal of this framework is to provide a more simplified and holistic view of outstanding care. In this blog, we will delve into what is changing, what will stay the same, and what you can expect from these changes.

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A Single Assessment Framework

The CQC previously had three separate frameworks for assessing the quality of care in hospitals, adult social care, and primary medical services. Each framework had around 300 Key Lines of Inquiry (KLOEs) used to set standards for care quality. The CQC is introducing a new single assessment framework that will apply to all care providers, simplifying what constitutes "quality" care across the board.

5 Key Questions and Quality Statements

CQC will still assess care providers based on the same five key questions:
1. Are they safe?
2. Are they effective?
3. Are they caring?
4. Are they responsive to people’s needs?
5. Are they well-led?

However, they will replace the Key Lines of Inquiry (KLOEs) with 34 quality statements, also known as “we statements”. This will help reduce the duplication of KLOEs and prompts that can be noted in the current assessment frameworks and make it easier for care providers to understand what is expected of them.

Under each key question, there are several related topic areas. For example, the question of safety encompasses topics like learning culture and prevention control. The question of effectiveness entails areas like collaboration, while the question of well-led touches on subjects like sustainability and equality.

The quality statements have been written from the point of view of a care provider for the relevant topic areas. This ensures that providers understand how quality care must be planned and delivered.

I Statements

The CQC is committed to ensuring that people receive exceptional care that meets individual needs. To this end, they have introduced a series of I statements based on what people have said matters to them. The statements are written in simple language from the point of view of the person receiving care so that everyone can understand what it means to receive quality care. Each I Statement is linked to a relevant quality statement, enabling the CQC to prioritise the needs of people at each point and make decisions accordingly.

New Categories of Evidence

Traditionally, the CQC has heavily relied on on-site inspections to rate health and social care providers. These inspections provide a glimpse of the quality of care at a specific moment. The frequency of these inspections has also often been tied to the rating given to a care provider.

While on-site inspections will remain crucial, they will no longer be the sole method for assessing the quality of care. The CQC has introduced six new categories of evidence to support their assessments:

- People's experiences of health and care services
- Feedback from staff and leaders
- Feedback from partners
- Observation
- Processes
- Outcomes

These can be gathered from various sources such as phone calls, emails, surveys, feedback, complaints, patient records, policy documents, in-person conversations, and on-site observations.

CQC will determine the evidence to be collected and the technique depending on the service or type of organization. This means inspectors can focus on the most essential tasks during on-site inspections, such as talking to people receiving care and making observations.

A New Scoring System

While the CQC will continue using the existing four ratings - Outstanding, Good, Requires Improvement, and Inadequate - they have introduced a new evidence-scoring framework to their assessment method. The evidence is scored on a scale of 1-4 with:

4 = Evidence shows an exceptional standard
3 = Evidence shows a good standard
2 = Evidence shows some shortfalls
1 = Evidence shows significant shortfalls

Here is how the new rating system will operate:

- CQC evaluates each quality statement under a key question by requesting specific evidence from care providers and using existing information.
- CQC assigns a score to each category of evidence based on how well the provider meets the requirements of the quality statements.
- Ratings for each quality statement under a key question are combined to determine the rating for that key question.
- The ratings for each key question are combined to provide an overall rating for the care provider.

The new rating system guarantees that the CQC will be consistent and transparent in how it rates care providers. This will enable care providers to identify and focus on areas for further improvement and help individuals make informed decisions regarding care services.

Ongoing Assessment and Dynamic Ratings

As it moves away from assessing at a single point, CQC intends to continuously monitor different categories of evidence, quality statements, and key questions, depending on where a service or organisation needs to improve. This means that scores can be updated at any time, which could affect quality statement scores and even overall ratings. Reports will also be kept current, providing an incredibly up-to-date perspective on quality. The CQC hopes to update all the information on a particular service across all quality statements within two years. This information will be available not just on a local level but on a national level so that care providers across England can learn from best practices.

A New Provider Portal

The CQC has also launched a new provider portal to simplify and streamline communications with care providers. The portal will allow providers to review their ratings and submit further evidence. A select group of providers had the opportunity to test the platform in August 2023. As per its summer update, the new portal will be rolled out to all users in phases starting in September 2023. Care providers will be invited to use the portal and given login details and guidance.

How can your Organisation Prepare?

Here are a few things you can do:

1. Stay up-to-date with the Latest CQC News

The new CQC framework is being rolled out in phases, so it is vital to stay updated with the latest announcements from the CQC. You can do this by subscribing to their email newsletter, reading their news bulletin, and following them on social media.

2. Keep your Contact Information Updated

If you still need to be invited to join the user portal, you can start by updating your contact information so the CQC can reach you when it is time to join.

3. Familiarise yourself with the New Framework

The new CQC framework will be implemented in November 2023, starting with providers in the South of England. You can get familiar with the quality statements and categories of evidence to prepare for how assessments will happen in the future.

4. Identify Areas for Improvement

To identify areas for development, you can compare your current quality of care to the new quality statements. They have a much different emphasis than the old KLOEs, focusing on learning culture, safety systems, pathways and transitions, sustainability, and other areas. You may have yet to establish practices to meet some of the requirements of the new quality statements, but this is an ideal opportunity to start implementing them.

Here are some specific things you can do to identify areas to improve:

- Gather feedback from those who receive your care, their families, staff, and other stakeholders.
- Audit patient care records, policies, and other documents.
- Review staff training and development records to ensure that staff are adequately trained to provide high-quality care.
- Compare how your service has performed to other services using public information provided by the CQC and other relevant organisations.

5. Start Collecting Evidence

Evidence is essential under the new inspection framework. Now that you know what types of evidence the CQC expects, you can start collecting and sorting evidence of your best practices that can support any of the quality statements. The CQC will provide more specific guidance on the categories of evidence needed to assess each quality statement in time, but commencing the process early is a good idea.

6. Communicate with your Team

Inspections can be a stressful time for everyone, especially if there are changes involved, so discussing the new CQC framework with your team will be essential. You can explain how it will differ from past inspections, highlighting the quality statements and categories of evidence while emphasising that the five key questions and the overall goal to deliver high-quality person-centred care will remain.

The Bottom-Line

The CQC's updated inspection framework brings a refreshing simplicity to providing and receiving exceptional care. For care providers, the new framework simplifies what it means to provide outstanding care. Focusing on continuous assessment, the new categories of evidence and scoring systems will make it easier for care providers to understand what the CQC is looking for and demonstrate their commitment to continuous development. By providing more transparency into the inspection process, the CQC will help care providers identify areas to improve and learn from best practices. The new framework update is significant for those receiving care because it allows them to make informed and meaningful decisions about care services.

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