An insight into the CQC single assessment framework

Following the investigation into the effectiveness of the Care Quality Commission (CQC), the government announced a review of CQC’s assessment framework to make it better fit for purpose. Therefore, it is more important than ever for providers to understand the purpose of the new Single Assessment Framework, the regulator’s ambition for this in assessing the quality of care delivered by health and social care providers and how providers can align quality assurance to the framework. Tendable’s CQC Readiness Dashboards provide organisations with real-time reporting on their performance against the framework’s key questions and quality statements and can help providers to rapidly understand and address areas for improvement.

The Single Assessment Framework

The new Single Assessment Framework is an update to the Care Quality Commission (CQC)’s regulatory tool for assessing the compliance of health and care providers to the relevant laws and regulations governing the provision of safe and appropriate quality of care.

Tendable aims to support health and care organisations across the country to understand how their performance will match up against the new quality statements. We can ensure that your organisation is inspection-ready at all times.

This framework supports CQC’s vision and journey to becoming a targeted regulator that can flex around the evolving models of care emerging in the sector. All this underpinned by CQC’s strategy relating to spotlighting people’s experience, safety culture and promoting improvement, innovation, learning and collaboration.

Multiple to one framework

The previous inspection framework saw CQC using multiple methodologies for inspecting adult social care, acute, primary care services and for registration activities. The Single Assessment Framework brings this all together with clear sets of expectations that clearly triangulates to regulations across all types of regulatory assessments including registration and enforcement activities.

This aims to provide regulatory consistency ensuring clarity on the standards and benchmarks of what good care looks like.

KLOEs to quality statements

The Single Assessment Framework see the Key Lines of Enquiry (KLOEs), and the associated prompts and characteristics of the old methodology replaced by 34 Quality Statements. These are products of an extensive review of the old methodologies and extensive co-production with a range of health and care partners and people who use health and care services.

Quality statements described the standards of care expected by providers, local authorities and Integrated Care Systems (ICS); the commitments that should demonstrate they deliver good, safe care that meets the needs of people who use their service. These are termed the ‘we statements’.

The quality statements also help the public understand how they should most likely experience good care. These are termed the ‘I statements’. This supports one of the ambitions of the Single Assessment framework which is to spotlight the experience of people who use health and care service and to amplify their voices through regulatory activities.

Quality statements or a sub-set of them are used for all service types including CQC’s regulation of local authorities and ICS. However, the evidence to assess quality will be specific to the type of service being assessed.

6 evidence categories

The 6 evidence categories in the most simplistic terms are the type of evidence CQC assess. They provide structure, transparency and consistency to how CQC makes regulatory judgements. They are:

• People’s experience – this includes feedback obtained in a variety of ways from people who use services, loved ones who support them, their advocates and representatives.
• Feedback from staff and leaders – this is evidence where the source is from staff and leaders of a service. This may include their self-assessment of their service’s performance.
• Feedback from partners – this is obtained from health and care stakeholders who work together with a service to deliver care and support.
• Observation – this is evidence CQC obtains from observations of care and care environments. This is predominately collected on-site. This may also include observations by Healthwatch and/or Patient Led assessments.
• Processes – these are obtained from the activities that enable the provider deliver good and safe care. The test for this is in the effectiveness of the ‘processes’.
• Outcomes – this is the ‘so what’ evidence category. They give evidence of the impact of care and support on people’s health and wellbeing status. Sources include national clinical audits, patient level data set, patient reported outcomes measures programme. Outcome measures are currently not available for some service types.

Rolling assessment of quality & risk

The flexible and granular model of the Single Assessment Framework replaces the rigidity of the old framework. This means that assessment could flex around particular areas of focus, at different periods of time rather than the old ‘all at once’ intense style of the old methodologies.

The different evidence category relevant a quality statement are scored and contributes to a quality statement score; quality statement scores then combine to form a rating for each key question and each key question rating contributes to the overall rating.

This flexibility allows CQC to review and (where relevant) change ratings frequently based on more frequent assessment of evidence and quality statements. The frequency of this will be both responsive (to risk and regulatory intelligence) and planned assessments based on a provider’s previous ratings and service type. This means that an assessment can become more of a rolling picture of quality as opposed to a snapshot of quality as at the day of an inspection.

In conclusion, when fully embedded the Single Assessment Framework will support CQC deliver a more up-to-date picture of quality at a provider level and system level. It is important to note that this framework remains mapped to the fundamental standards of care in line with the Health and Social Care Act and associated laws. Therefore, this supports clarity and consistency in demonstrating known expected standards of care. These standards of care can then be added into Tendable and work as your point of truth for your inspections and guide your front-line teams on the journey to outstanding.

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