Following its consultation on the future of regulation, the Care Quality Commission (CQC) has recently published draft sector-specific assessment frameworks. However, although feedback from social care stakeholders has been incorporated into the development of these frameworks, the proposals currently lack sufficient detail on how providers should provide evidence their compliance with the new draft Key Lines of Enquiry (KLOEs).
Observation versus Documentation
One way would be to focus on observation rather than documents. The recent consultation highlights the desire of both providers and the public for an emphasis on evidencing outcomes rather than processes during CQC assessments. There was a prevailing sentiment among respondents that the quality of care experienced by individuals should be prioritised over the meticulous completion of documentation: respondents consistently argued that the care that people experienced should matter more than whether every document is perfectly completed.
Recent presentations by CQC leaders allude to this new approach being adopted, suggesting a shift towards observational assessments and away from checklists and documentation. The CQC appears to be searching for a more holistic approach to evaluating care standards.
A Changing Approach?
Therefore, as the CQC pilots and adopts its new methodology, can we expect to see a shift in how CQC inspections are conducted? Rather than relying heavily on policies, audits and documentary evidence, will inspectors place greater weight on what they see, hear and experience during a visit? The preferred direction of travel is clear: there should be less emphasis on paperwork and more focus on people’s lived experience.
For many providers and stakeholders, this would be a welcome change. For years, the sector has argued that outstanding care cannot be measured by the size of an evidence folder. High-quality care is reflected in relationships, compassion and culture. Those things are rarely captured fully in documents.
Risks of Observation as Evidence
However, it may be wise to temper the enthusiasm. Haven’t we been here before? A stronger focus on observation rather than documentation was one of the central ambitions of the Single Assessment Framework. The introduction of the ‘Observation’ evidence category promised a more meaningful assessment of care, with greater emphasis on people’s lived experiences. Yet, despite those aspirations, the reality fell short. Translating that vision into practice proved far more challenging than anticipated.
The independent review led by Dr Penny Dash identified significant problems. Providers experienced delays in inspections and reports, inconsistent ratings and increasing uncertainty about how the evidence categories were to be interpreted. Rather than reducing complexity, many felt the framework had increased it. The lesson is clear. Good intentions alone do not produce better regulation. The type of evidence and the way this is evaluated matters just as much as the framework itself.
What is clear is that observation can tell us things that paperwork never can, and we need a regulatory system that supports that. An inspector walking through a dining room can immediately see whether people are enjoying their meals, whether staff know individuals well and whether support is delivered with dignity and respect. They can observe whether people are offered choice, whether interactions are meaningful and person-centred and whether there is kindness in everyday interactions.
No policy alone can demonstrate culture. Even the most comprehensive audit can’t capture kindness. And do training records really tell us whether staff understand the nuances of mental capacity? There is little doubt that observation has an essential place within inspection. Yet, as an evidential tool, it also raises an important question: how reliable is observational evidence when regulatory decisions carry such significant consequences?
The Subjectivity of Observation
By its very nature, observation is subjective. Two experienced inspectors may watch the exact same interaction and interpret it completely differently. One may see confidence and familiarity; another may perceive complacency. A quiet lounge could suggest a calm environment or maybe this is, in fact, the result of a lack of stimulating activity? An efficient dining room could demonstrate efficient teamwork or institutional practice. Context matters, and context is not always immediately visible or interpreted uniformly.
This is not simply a speculative concern. One of the most frequent criticisms levelled at CQC over recent years has been inconsistency. The Dash Review highlighted concerns about unpredictable judgements and weakened quality assurance processes. Providers have frequently questioned why apparently similar services receive different ratings. Increasing reliance on observation, therefore, may very well risk amplifying those
concerns unless observation is supported by robust care plans, audits, risk assessments and training records.
CQC is not unaware of these challenges. Its Short Observational Framework for Inspection (SOFI) was developed to bring greater consistency to observations, providing structure and documentary evidence, particularly where people cannot easily communicate their experiences. The framework provides inspectors with a structured approach and undoubtedly strengthens observational practice.
Yet even a structured framework cannot eliminate subjectivity. Observation remains a snapshot. It captures a particular moment, involving particular staff, supporting particular people, on a particular day. Whether that moment accurately represents everyday practice is often impossible to determine from observation alone. And it is clear that the presence of an inspector can influence a natural course of events.
The Evidential Challenge
This creates an evidential challenge. Documentary evidence can be audited. Complaints can be investigated. Incident records can be reviewed over time. Observation, conversely, depends heavily upon professional, yet subjective, interpretation. That does not make it weak evidence, but it does make it different evidence. Like witness testimony in court, observational evidence becomes considerably more compelling when supported by corroborating information.
That distinction matters because inspection outcomes have profound consequences. Around 30% of adult social care services remain rated Requires Improvement or Inadequate according to CQC’s latest State of Care report, and the regulator continues to use enforcement powers where serious concerns are identified. Ratings influence occupancy, commissioning decisions, workforce morale
and organisational reputation. Given those severe consequences, every source of evidence must withstand careful scrutiny.
Perhaps it is better to recognise that neither observational nor documentary evidence tells the whole story. Excellent documentation cannot compensate for poor care but equally, one positive interaction cannot demonstrate consistently outstanding practice. The strongest regulatory judgements will always come from corroboration. Inspectors should consider what they observe alongside people’s feedback, staff interviews, governance systems, complaints, incidents and quality assurance information. When every source tells the same story, there is increased confidence in the judgement.
The Future
The draft assessment frameworks represent an exciting opportunity for CQC to rebuild confidence in regulation. This is a chance to acknowledge what the sector has argued for years: that the quality of care is experienced rather than documented. Observation reveals humanity in a way that paperwork never will.
However, if observation is to play a greater role in future inspections, CQC must also recognise its limitations. Inspectors will require excellent training and clear guidance on the evidential weight that observations should carry. There needs to be robust internal quality assurance processes to ensure consistency. Otherwise, the sector risks replacing one imperfect form of evidence with another.
Ultimately, observation should not replace documentary evidence but nor should documentation overshadow what people experience. The future of regulation lies in balancing both. The best
inspections will always combine professional judgement with objective evidence, ensuring that ratings are fair, consistent and truly reflect the lives of the people receiving care. This is the conversation the sector should now be having.