The Evolution of CQC’s Regulatory Approach: A Deeper Look

In the near future, the Care Quality Commission (CQC) is set to embark on a full-scale implementation of its innovative single assessment framework, marking the culmination of the early adopter phase this year. In this comprehensive article, we will delve into the significant changes that care providers should acquaint themselves with.

The CQC is gearing up to commence assessments under the new framework, accompanied by the introduction of integrated assessment teams. Prior to this rollout, the CQC has pledged to furnish more detailed insights into what constitutes “good” under the new framework, what types of evidence will hold precedence, and how providers will engage with the newly formed integrated assessment teams. These teams will soon initiate contact with providers and local stakeholders in the months ahead.

Additionally, the CQC is poised to launch its improved provider portal starting this summer, which is expected to expedite the submission of crucial information, such as statutory notifications. Providers will be individually notified when they can register on this portal.

Furthermore, efforts are already underway to apply the new regulatory approach to assess local authorities and Integrated Care Systems (ICSs).

Key Highlights of the Changes

Shift in Assessment Timing: The new single assessment framework, detailed in the online guidance “How We Will Regulate” on the CQC website, signifies a departure from using a service’s existing ratings as the primary determinant for the timing of the next assessment. Instead, assessments can now be triggered at any time based on evidence provided or collected, making it a more continuous process.

Expanded Use of Information: The CQC is set to rely more heavily on information, including service users’ experiences, which will not be limited to on-site inspections. In the future, evidence gathered during on-site visits will complement information collected in various ways at different times to inform the CQC’s assessments.

Structured and Transparent Assessments: The regulator will consider a multitude of Quality Statements when conducting assessments, drawing from a broader array of sources of evidence. This will lead to more structured and transparent assessments organized around six new evidence categories.

Concise and Timely Reports: The resulting reports will be shorter and more straightforward, offering the most up-to-date assessment findings.

The Five Key Questions and Ratings

The CQC’s ratings will continue to revolve around five key questions that assess whether a service is safe, effective, caring, responsive, and well-led. These questions will be evaluated on a four-point rating scale, encompassing “Outstanding,” “Good,” “Requires Improvement,” and “Inadequate.”

Quality Statements

Beneath each key question, a set of new Quality Statements will replace the Key Lines of Enquiry (KLOE). These Statements articulate clear expectations for providers concerning the delivery of high-quality and person-centred care based on service users’ experiences and expected standards. These statements also elucidate how services and providers should collaborate to plan and provide high-quality care.

For example, under the key question of “safe,” which examines the safety and protection of service users from various forms of harm and discrimination, there are now eight Quality Statements, starting with “Learning Culture.” Each Quality Statement follows a similar structure, with a “we” statement provided for each one.

The Six Evidence Categories

The number of evidence categories and the required sources of evidence may vary depending on the type of service, whether it’s an existing service assessment, a new service registration, or the level of assessment for a service, provider, local authority, or Integrated Care System. This ongoing evidence collection allows for flexible updates to ratings by the CQC.

The six new evidence categories are as follows:

1. People’s Experience of Health and Care Services: This category encompasses individuals’ needs, expectations, lived experiences, and satisfaction with their care, support, and treatment.

2. Feedback from Staff and Leaders: Evidence will be gathered from service employees, staff groups, and service leadership, including results from staff surveys, focus groups, and interviews.

3. Feedback from Partners: This category involves evidence from organizations interacting with the service, including commissioners and local providers.

4. Observation: Evidence can be collected through on-site and off-site observations, as well as interviews with staff and professionals.

5. Processes: Assessments will scrutinize the effectiveness of policies and procedures, considering information from data sources that measure processes, such as infection prevention control data and reviews of care records.

6. Outcomes: This category focuses on the impact of care processes on individuals, including infection control rates, mortality rates, and quality of life assessments.


The single assessment framework will undergo refinements and enhancements as the CQC initiates testing and implementation with providers later in the year. The initial assessment activity, integrated into an ongoing process, will revolve around a provider’s registration, aligning closely with this framework’s principles and standards.

In summary, the CQC’s new single assessment framework represents a significant shift in the way healthcare providers are assessed and regulated, placing greater emphasis on continuous improvement, transparency, and the experiences of service users and staff alike. As these changes take shape, providers should prepare for a more dynamic and collaborative approach to ensuring the delivery of high-quality care.

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