Introduction
In July 2022, CQC published its new single assessment framework for regulating health and care providers. The regulator’s published aims were to make things simpler, to better reflect the differences in care delivery for different types of service, and to create one single framework connecting both registration and quality assessments.
Not everything is changing - CQC’s four quality ratings (outstanding good, requires improvement and inadequate) and its five key questions (safe, effective, caring, responsive and well-led) will remain at the centre of the framework.
However, the previous key lines of enquiry (KLOEs) and prompts are being replaced by new ‘quality statements’ (also known as ‘I statements’ and ‘we statements’). ‘I statements’ are written from the service users’ perspective expressing what the service user seeks from a quality provider and ‘We statements’ from the provider’s perspective describing how a typical quality provider delivers its services.
The quality statements will prove a valuable source of guidance for providers in self-assessing the quality of their service and in preparing for future inspections under the new framework.
In addition, CQC has created six evidence categories for the evidence they collect: people’s experiences, feedback from staff and leaders, feedback from partners , observations of care, processes, and outcomes of care. CQC will state which evidence is required for each quality statement - this evidence depends on both the type of service and the level of assessment.
This article outlines and explains key questions, quality statements, and evidence categories under the new system, to assist you in quickly understanding how you will be affected as a social care provider.
When will this come into effect?
- CQC expect all providers to sign up, during Summer 2023,to the new CQC Portal for use in all communications with CQC
- The full roll-out of the new framework has been delayed from January 2023, with inspections under the new framework expected to start in Autumn 2023
Action to take now:
- Prepare to sign up for and set up your access to CQC’s new Provider Portal
- Familiarise leaders with the new quality statements and evidence categories
- Consider conducting a self-assessment against the new quality statements
- Schedule training for all staff on the framework, in particular the quality statements
- Consider strengthening your own systems for obtaining feedback, as feedback will form an increasingly important aspect of the new framework
Key questions and quality statements
- Quality statements are the commitments that the service you provide should live up to. They show what is needed to deliver high-quality, person-centred care, and relate directly to CQC regulations. For each key question, quality statements fall under specific topic areas, of which there are a total of 34
Key question: safe
- Safety must be a priority for everyone, and your service must always protect people from bullying, harassment, avoidable harm, neglect, abuse and discrimination
- Quality statements for safety will fall under the following 8 topic areas: learning culture; safe systems, pathways and transitions; safeguarding; involving people to manage risks; safe environments; safe and effective staffing; infection prevention and control; and medicines optimisation
Key question: effective
- Your service must give people and communities the best possible outcomes, and must work in harmony, with people at the centre of it's care
- Quality statements for effectiveness will fall under the following 6 topic areas: assessing needs; delivering evidence-based care and treatment; how staff, teams and services work together; supporting people to live healthier lives; monitoring and improving outcomes; and consent to care and treatment
Key question: caring
- Your service must always treat people with kindness, empathy and compassion, and their privacy and dignity must always be respected
- Quality statements for care will fall under the following 5 topic areas: kindness, compassion and dignity; treating people as individuals; independence, choice and control; responding to people’s immediate needs; and workforce wellbeing
Key question: responsive
- People and communities must always be at the centre of how care is planned and delivered by your service, and your service must encourage feedback, act on it, and deliver the relevant improvements
- Quality statements for responsiveness will fall under the following 7 topic areas: person-centred care; care provision, integration and continuity; providing information; listening to and involving people; equity in access; equity in experiences and outcomes; and planning for the future
Key question: well-led
- Your service must foster an inclusive and positive culture of continuous learning and improvement and must have effective governance and management systems
- Quality statements for good leadership will fall under the following 8 topic areas: shared direction and culture; capable, compassionate and inclusive leaders; freedom to speak up; workforce equality, diversity and inclusion; governance, management and sustainability; partnerships and communities; learning, improvement and innovation; and environmental sustainability
Evidence categories
What are evidence categories?
- As well as quality statements, six evidence categories have been created as part of this framework. They exist to bring structure and consistency to CQC’s assessments, by outlining the types of evidence it uses to assess the quality of care being delivered
- The evidence categories required to assess each quality statement are called ‘required evidence’
- The number of categories and sources of evidence required depends on: service type/model, level of assessment, and whether the assessment is for an existing service or at registration
The six categories are explained below
People’s experience of health and care services
- CQC defines people’s experiences as ‘a person’s needs, expectations, lived experience and satisfaction with their care, support and treatment. This includes access to and transfers between services’
- People using your service, their families, friends and advocates are the best sources of evidence about lived experiences of care
- CQC considers the context and impact of people’s experiences, and values people’s experiences as highly as other sources of evidence, weighting them equally with other evidence categories.
Feedback from staff and leaders
- This is evidence from people who work in your service, staff groups who provide care, and leaders of services
- This may include: results from staff surveys, trainee surveys, interviews, focus groups, your service’s own self-assessments, and compliments and concerns raised with CQC
Feedback from partners
- This is evidence from people representing organisations that interact with your service
- Evidence may be gathered through interviews and engagement events and from commissioners, professional regulators, accreditation bodies, royal colleges, and multi-agency bodies
Observation
- CQC can observe quality of care either off-site, on-site, or with a combination of both
- Evidence from off-site observations includes: interviews with those who work in your service, Healthwatch and other partners, and Experts by Experience support (telephone and video calls with service users, families and carers, and engagement with underrepresented communities)
- During on-site observations(inspections), inspectors will observe care, observe the care environment(including equipment and premises), speak to service users and staff, and understand the culture and staff interaction
Processes
- This is the series of steps or activities carried out to deliver safe care that meets people’s needs
- CQC will focus on effectiveness of policies and procedures, looking at both information provided by you and data sources that measure processes
- This may include: data from national clinical audits, indicators from patient level data sets, waiting times, infection prevention control, reported incidents/notifications, and reviews of care records
Outcomes
- This is the impact of care processes on individuals, covering how care has affected their physical, functional or psychological status
- Outcome measures may include: mortality rates, readmissions rates, emergency readmission rates, patient reported outcome measures, infection control rates, and quality of life assessments
- The information will be sourced from: patient level data sets, national clinical audits, and initiatives such as the patient reported outcome measures (PROMs) programme
Final thoughts
These changes will impact the way your service is assessed and regulated by CQC and viewed by stakeholders within your local area. Now is the time to focus on preparing leaders and staff for the new framework. More detail on example quality statements, the relevant regulations can be found on the CQC's website.
For further guidance, please visit the Scott-Moncrieff& Associates website, or contact me through my bio.
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