CQC’s new inspection framework

The Care Quality Commission are making significant changes to the way they regulate and inspect health and care providers. The regulator’s new inspection framework will launch in January 2023 for most providers.

Certain elements of the framework are already in the process of being rolled out in a phased way with “early adopters” of the framework, which started in August 2022 and will continue until the end of October 2022. The regulator’s stated aim here is to “learn as we go”.

In this blog, we look at the current inspection framework and how it will change when the CQC’s new framework comes into force next year.

The current framework

The framework is largely based on in-person inspections whereby inspectors look at and judge a service at a single moment in time, using the well-known five key questions: is the service safe, effective, caring, responsive and well-led.  

The rating given after an inspection in large part determines when the next inspection is carried out, with those rated Inadequate being inspected more frequently than those rated Outstanding.

What’s changing

The CQC’s new inspection framework was announced as part of its new strategy published in May 2021, with the ambition of delivering a more dynamic, data-led method of assessment with a focus on people’s experiences, safety cultures and care integration.

The new inspection framework will be a single assessment framework which will assess quality in all service types at all levels (including local authorities and Integrated Care Systems). Unlike the old framework, the new framework will therefore extend to registration.

Exactly how this new framework will apply has not yet been made entirely clear, but the CQC has set out a number of important aspects:

1. The five key questions will remain central (safe, effective, caring, responsive and well-led).
2. The four ratings will remain (outstanding, good, requires improvement and inadequate).
3. Inspections will remain but a wider range of activities will be used to gather evidence to assess quality.  
4. Key Lines of Enquiry (KLOEs) are being replaced with new ‘quality statements’ (the CQC is calling these ‘we statements’) which will be linked to relevant Regulations.
5. When assessing quality statements, there will be six categories of evidence collected which will be used to understand the quality of care being delivered.
6. Ratings can be updated at any time.
7. Reports will be shorter and simpler, showing the most up-to-date assessment. This may include benchmarking against other providers.
8. The whole framework will be underpinned by best practice standards and national guidance.

Dynamic re-rating

Perhaps the biggest change is that the CQC has stated that whilst site visits will remain a vital tool to gather evidence and assess quality, evidence will be collected on an ongoing basis. This will mean that assessments will be ‘flexible and frequent’ so will not be tied to set dates or driven by previous ratings.

Indeed, the CQC has said ratings can be updated at any time under the new framework. The idea behind this being that ratings are more responsive to changes in risk and reflect the most up-to-date view of quality.

Overall, the CQC’s new approach to inspections is a positive one offering providers more clarity on how inspectors have reached their ratings and the steps needed to improve. Dynamic re-rating will be welcome news to those providers making real improvements. But much will depend on how these changes are implemented and work in practice.

Getting ready for new assessment framework

With the new assessment framework only months away, becoming familiar with the Quality Statements and the Categories of Evidence would be good preparation.