This set of frequently asked questions (FAQs) has been developed by QCS to help you understand more about how the Care Quality Commission (CQC) is planning to deliver their new way of inspecting, assessing and rating services under their new single assessment framework (SAF).
The questions have been developed from what people have asked us, what our connections are telling us and from questions raised by attendees at CQC webinars, the latest of which took place on 2 August 2023.
The answers we have included are based on the most recent information made available by CQC and our interpretation of what the information means in practical terms for people working in care services. However, the environment is fast moving, and things can change when CQC provide more detail. So, keep an eye on all communications from us to keep up to date and get familiar with the CQC website and their information channels. You can do this by visiting the CQC Information Hub on the QCS website and follow us on social media.
- When is the new single assessment framework going to be rolled out?
The date has changed numerous times and was originally meant to be in January 2023 for all services, this then slipped to an undefined time of ‘later in the year’, but at last we seem to be receiving some clarity. CQC is now committed to start using the new framework from the beginning of November 2023 for all registered services in the South of England. This includes Gloucestershire, Oxfordshire and Buckinghamshire and all counties south of them, but excludes London.
There will then be a ‘phased approach’ to rolling out the new framework to the Midlands, East (including London) and the North. The specific timings have not yet been shared but the expectation from CQC is that by the end of March 2024 all registered services, wherever they are located, will be subject to the new single assessment framework.
Despite this firm commitment from CQC it still possible that the dates may change as there is still a lot of work that CQC need to do to make sure that any transition is smooth for providers.
- I have heard about the ‘provider portal’, what is it and when will I be able to use it?
CQC has a vision that providers will be able to easily share information with them, and that providers will be able to see in real time what CQC know and think about them. The tool they are developing to do this is called the ‘provider portal’. Each service will have its own private area where information can be uploaded electronically.
CQC is currently working on the functionality of the portal and during August will be inviting 230 providers to join to test how it supports the submission of notifications, then over time more providers will be invited to join. It is planned that by March 2024 all providers will be using the portal.
The information about specific aspects of the portal and the practical ways in which the portal will be used by providers is currently very limited. We understand that this is concerning especially considering it will be so central to the relationship between you and CQC.
It is advised that you continue to read all emails, updates and other communications from us, because as soon as we hear any more, we will share it with you.
- What is the new staffing structure of CQC, and will I still have a named inspector?
CQC has undertaken a massive change in structure to support the single assessment framework. They are merging the staff from all the different sectors together as they will be using the same framework, and CQC believe that this is beneficial.
There will be four geographic areas: South, East (including London), Midlands and North. Across the country there will be between 110 and 115 teams with about 12 staff in each team. In these teams will be a mix of inspectors, assessors, co-ordinators and officers.
The input into any individual service will be a team approach by CQC. Some people will be focused on assessing evidence, others will be undertaking site visits and others providing a co-ordinating function.
CQC has not stated whether services will continue to have the same named inspector, but it is felt that it will be unlikely, as teams become more generic, with the focus on assessing evidence and any associated risk.
- I know ratings are staying, but how and when will my rating be reviewed?
It does look like ratings will become much more fluid under the new framework, with the frequent and ongoing assessment of evidence being the main driver, rather than the systematic and planned schedule of assessment visits to services that were based on the existing rating.
The specific detail of how evidence will be scored, and what the criteria are for a rating change still hasn’t been defined by CQC, but with more remote assessment it does seem likely that ratings may be changed down, or possibly even up without a site visit.
However, the CQC has stated that if the evidence does indicate a high risk, then an assessment visit is likely, and as currently, any report may change the rating.
- Will the new single assessment framework be more consistent when judging services?
Consistency has always been a concern, and I’m sure it will continue to be. However, with all services being assessed by the same quality statements and evidence categories then there is a possibility that things may improve.
For the first time it is going to be the evidence that is going to be scored, and then this will be aggregated to come to a score for a quality statement, key question and ultimately a service rating. This process should promote consistency as in theory it is a transparent as a way of reaching a judgement, and it should be the same criteria for each evidence source.
CQC has also stated that providers will ‘always know what we know’, which indicates that judgements should be more transparent, and providers should be able to see how judgements have been made. So, it is hoped that judgements will be less subject to an inspector’s personal view and be more consistent.
- When will I know the specific evidence that I will need to provide for CQC, and how will I be able to share it with them?
CQC has stated that ‘in the next few weeks’ they will be sharing the evidence that providers will need to share to show that they are meeting the quality statements. This evidence will be ‘sector specific’, so a care home will not be asked to provide the same evidence as a dentist or a GP practice.
The longer-term vision is that all the required evidence will be shared through the provider portal, CQC will be providing more detail on the routes to be used with more to come on this.
- When could I expect an inspector to visit my service?
CQC will be doing less visits to services in the future under the new assessment framework. They have stated that they will be operating an ‘always on’ process and regularly reviewing the evidence that they have received and will be providing updates on their judgements without a site visit.
Timescales for visits will no longer be tied to the rating, and the expectation from CQC is that they will be more dynamic and targeted in their approach to site visits.
In summary, it is understood that site visits may only be undertaken when the evidence indicates that the service is a ‘high risk’, or that concerns about a theme are raised in a geographic area.
- I am worried that the evidence will focus on negative elements of the service e.g., notifications, complaints and safeguarding. How can I ensure that good practice is recognised by CQC?
This is a genuine concern that we all share, and the only way negative evidence can be mitigated is by providing good quality evidence of positive practice, and this could even be how you have positively addressed issues.
At QCS we are developing tools, such as the QCS Audit Centre launching in September 2023, to facilitate the gathering of good quality evidence based on the quality statements. This evidence can then be shared with CQC to provide a positive view of your service and ensure that CQC has a more rounded and complete picture of what you do.
- I have heard about ‘Priority Statements’, what are they?
CQC has stated that priority statements are going to be a subset of the quality statements. They are the areas that CQC feel are most important in the provision of your service. They are going to be developed for each sector and will be shared with providers in ‘the next few weeks’. There is little information about how they will be used by CQC, or what the impact on providers will be, but the feeling is they will identify specific quality statements that are core to the provision of the service, and that evidence must be robust to provide assurance.
- Is the Provider Information Return (PIR) still going to be used?
As we know, CQC under the new framework are going to be focused on requesting and receiving evidence about services from a wider range of sources. CQC has also committed to simplifying the regulatory process and making it easier for providers.
However, at the current time CQC has not stated that the PIR will cease, but they have made statements that they will not ask for information that has been provided to other organisations, and that they don’t want to rely on excel spreadsheets as a way for information to be shared. So, reading between the lines it does appear that under the new framework the PIR may go, or at a minimum be revised.
- Will the CQC focus be on risk or quality improvement?
CQC is a regulator whose primary duty is to ensure services are safe, effective, compassionate and of a high quality. So, they are naturally focused on risk, and having systems in place that identify and address risk.
But they also have a commitment to encourage services to improve. One way they are proposing to support this is by ‘benchmarking’ evidence they have received, so over time by reviewing evidence from a wide range of services it will be possible to identify best practice in a particular area. They will then share that evidence and be able to compare the evidence provided by individual services, to provide a ‘benchmark’ and hopefully encourage improvement.
Again, this appears to be a vision for CQC and there will be many ‘bumps in the road’ before this becomes a reality for providers.
- Will CQC still write and publish reports and what will they look like?
The idea of a timeline of reports based on the results of site visits will no longer be relevant under the new framework. CQC has stated that the primary audience for the information is the public, and they want reports to be short, simple, clear, up-to-date and accessible.
Reports will still be produced, and these will be completed when the evidence shows that it is necessary. Some reports will be written after a site visit, but it will become normal for a report to be completed and published without a visit to the service and just based on what information CQC currently holds about a service. We don’t know exactly what the reports will look like, but CQC has stated that as a minimum they will contain a summary of the evidence they have used to come to a judgement, how the evidence has been scored and how these scores have resulted in the rating.
CQC has also stated that they will still have a factual accuracy process for you to challenge as you do now, but how this will work in practical terms when there has been no site visit is unclear.
- How do I keep up to date with the changes, and what they mean for me?
We understand that as the implementation of the new framework gets closer there will be more changes and at QCS we want to make it as easy as possible for you to keep up to date. We will share information with you by email, send updates through your management system, release blogs, webinars and provide as many channels as possible to ensure you have the right information at the right time.
We are also working very hard to ensure that the transition is as seamless as possible for you and that all our tools are aligned with CQC’s expectations.
You should also ensure that you sign up for updates directly from CQC, join their webinars, explore their website and get involved in their ‘citizen lab’, which is a way you can share you views on new ways of working and influence future practice.
QCS have also been busy preparing for the new changes which you can explore on our system through the dedicated single assessment framework section within our Resource Centre. All policies have also been mapped to the new quality statements.
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