Care Quality Commission's new approach to regulation

Following publication of its Strategy in 2021, the regulator consulted on changes, and in October 2022, confirmed it would be taking a new approach to regulation, adopting a Single Assessment Framework for all services it regulates. 

To facilitate the way CQC will approach assessment, changes have been made to the operational and management structures within CQC.

The Homecare Association has contributed the views of homecare providers at each stage of the development process and continues to liaise closely with CQC on the transformation.

While CQC was developing its new approach, it continued to use existing systems to monitor, assess and rate providers, outlined here.

The Homecare Association’s primary resource on regulation is our Inspection Guidance for England (available for members to download) which this online resource supplements.

Update 18 November 2024

The CQC has published a new webpage entitled ‘Improving how we work’ to provide updates on changes following reviews by Dr Penny Dash and Professor Sir Mike Richards. The intention is to update these pages regularly as the work progresses.  

Improvements listed on 14 November were as follows.  

Leadership

CQC’s new Chief Executive, Sir Julian Hartley, starts on 2 December. The regulator will soon be starting recruitment for 4 permanent Chief Inspectors. 

Assessment

CQC will be working to align assessment teams under the Chief Inspectors and around areas of sector expertise. It has invested £2 million to support resourcing the assessment workforce and increase inspection activity and is piloting approaches to ensure assessments are led by people with sector specific expertise.

CQC is reviewing the assessment framework and:

•    discontinuing scoring at evidence category level
•    discontinuing the use of previous ratings to produce scores
•    reviewing how it uses quality statements for each assessment
•    reviewing how it uses professional judgement when producing a final rating.

CQC is also working with Professor Sir Mike Richards and the Care Provider Alliance to provide recommendations on the future of regulatory assessment. 

Relationship management

CQC is piloting approaches to improve relationship management across all sectors and will evaluate these in early 2025.

Improved tools for providers

CQC is working to identify improvements for the provider portal and introducing improved customer support. The registration functionality has been removed: More information.
CQC is co-designing a clear and accessible provider handbook.

Inspection reports

CQC is experiencing technical issues, resulting in delays to uploading inspection reports and sharing draft reports with providers to check factual accuracy. CQC apologise and are working to fix this.  In the meantime, reports are being uploaded manually. The regulator's operations team will inform providers when their report is going to be published.

Engagement

There is more about CQC’s engagement on assessments and ratings in a blog from Director of Engagement, Chris Day and recordings of engagement sessions on its work developing  new ratings characteristics under the four ratings: outstanding, good, requires improvement and inadequate:
 
•    Recording of an engagement session held on 23 October
•    Recording of an engagement section held on 5 November

Further engagement opportunities will be added to CQC's new webpage. 
 

Update 4 November 2024

The Care Quality Commission is making changes to the way providers register, to resolve issues faced by providers signing up and using the new provider portal. 

Changes to registration process

From 18 November, CQC will no longer be accepting any type of registration applications from the provider portal, other than cancellation applications. Instead, applications must be made using the application form on CQC’s website.

CQC’s guidance for providers is:

• If you have already submitted an application using the provider portal and it has been validated and accepted by the Registration team, you do not need to resubmit it. Your application is now in the queue to be assessed.
• If you have submitted an application using the provider portal, but you have not yet received confirmation from the Registration team, CQC will be contacting you within the next few weeks to confirm that your application has been forwarded for assessment. If there is a problem with your application, CQC will contact you with instructions on how to resubmit it. You won’t be put to the back of the queue.
• If you have only completed part of your application on the provider portal, you will need to complete and submit this by 5pm on 18 November. This includes both provider and manager parts of the application, if this applies to you.

Applications will still be approved or refused based on the outcome of the registration assessment as usual, and CQC will continue to assess applications in date order, so this won’t have an impact on timeframes. If you would like an update on the status of your application, please contact CQC in the normal way.

From 18 November, the provider portal can still be used to submit some notifications and submit registration cancellations. To see what activity can be completed on the portal, please see the provider portal pages on CQC’s website.

Improving CQC’s registration process 

CQC say, on delays to registration:

“We know that you may have concerns around the backlog of registration applications. We are working hard to proactively manage the backlog of registration applications and are now making good progress in reducing both the overall number of applications still to process and the average time they have been with us.

We are tackling the backlog from several angles. This includes a large active recruitment drive for additional registration inspectors, streamlining internal registration processes, a strategy that targets specific sectors, and continuing to use the prioritisation process, which is described on our website.”

Source: CQC’s update on registration, 4 November 2024.
 

Update 28 October 2024

We have seen the publication of Professor Sir Mike Richards’ review of CQC. It covers three key changes following the 2021 strategy: an organisational restructure, introduction of the single assessment framework, and development of a new IT system. Professor Richards concluded that, despite initial provider support, all three initiatives failed to achieve their intended benefits. As a result, he said the CQC has been unable “to ensure health and care services provide people with safe, effective, compassionate high-quality care and to encourage these services to improve.” The Homecare Association worked with members and Professor Richards on his review. We continue to advocate on our member’s behalf to ensure our system of regulation is fit for purpose. Click here to read more from our CEO about the review and the final Dash report.  

Following the recent reviews of CQC, they are asking for provider feedback to help improve their regulatory approach. Deputy Director of Regulatory Model and Governance, Dave James, will lead the sessions and we encourage members to sign up and attend. As there are limited places, we encourage you to book attendance early. Please note there is only one place allowed per organisation. Booking details are available here. 

CQC has also commissioned the Institute of Employment Studies (IES), in partnership with IFF Research, to conduct a survey on workforce inequalities. This research will help CQC better understand what helps to tackle workplace inequalities most effectively and identify how, as a regulator, CQC can best help. Click here to take part. 

Update and recap 8 October 2024

There have been several developments concerning the Care Quality Commission since the Independent Review of the CQC by Dr Penny Dash, published interim findings which identified specific concerns about the regulator’s performance.

The CQC issued a response to the Dash review’s interim findings in which Kate Terroni, Interim Chief Executive, accepted the findings in full and said CQC is working at pace and in consultation with stakeholders to rebuild trust and become a strong, credible, and effective regulator. This was followed by various announcements on its plans for improvements, culminating in the recovery plan below.

The Homecare Association published a report highlighting serious failings in regulation in England. This showed 60% of homecare providers either have no rating or a rating which is 4-8 years out of date.

The CQC published a recovery plan Re-building a trusted approach to our regulation which includes proposals to appoint three new Chief Inspectors; review the single assessment framework; increase assessment frequency; and improve registration processes, but omits concrete timelines, specific targets and accountable individuals, or details of how it will fix the lack of expertise and training or the backlog of registration applications and inspections.

The CQC announced that the Care Provider Alliance (CPA), chaired by Professor Vic Rayner OBE, will work with Professor Sir Mike Richards on his review of the Single Assessment Framework (SAF) and its implementation.

Providers are asked to complete a survey giving their experiences of the Single Assessment Framework (SAF), regardless of whether they have had an inspection under the SAF. The survey will close at 5pm on Sunday, 20 October. This is an important piece of work, as it will inform the second stage of the review project, which will focus on what people want for the future.

Sir Julian Hartley will be appointed as the new Chief Executive of the Care Quality Commission. He has extensive experience in healthcare leadership and improving complex organisations. We welcomed the appointment and set out our expectations.

We invite Homecare Association members to share their general views about the CQC by completing our Autumn 2024 CQC Pulse Survey.
 

Update 2 August 2024

CQC’s response to Dash Review and updates

There have been a number of developments concerning the interim report by Dr Penny Dash on the effectiveness of the Care Quality Commission, which was published on 26 July 2024.

Government acts after report highlights failings at regulator - GOV.UK (www.gov.uk). Government measures include:

• the appointment by CQC of Professor Sir Mike Richards to review CQC assessment frameworks. Sir Mike was a hospital physician for more than 20 years and became CQC’s first Chief Inspector of Hospitals in 2013, retiring from this role in 2017
• improving transparency in terms of how CQC determines its ratings for health and social care providers
• increased government oversight of CQC, with CQC regularly updating the department on progress, to ensure that the recommendations in Dr Dash’s final review are implemented
• asking Dr Dash to review the effectiveness of all patient safety organisations.

The Homecare Association has issued a response: Homecare Association demands urgent action on CQC failings.

The Care Quality Commission has issued an apology by Interim Chief Executive Kate Terroni, which she repeated at a round table with the Care Provider Alliance, currently chaired by Dr Jane Townson, CEO of the Homecare Association. 

The regulator has also made a series of commitments to improve its service in Kate Terroni's message. Providers can comment on this message via a short survey.

The Care Quality Commission's update published on 1 August 2024 contained plans for the regulator to develop a new CQC Handbook for providers, to explain what they can expect from an inspection and customer services standards, and how CQC can reach a shared understanding of what ‘good’ looks like for different service types. CQC say there will be more detail soon, including how providers can get involved.

CQC are also intending to publish an interim statement in August about how frequently they plan to assess each type of service, with more information in September. This replaces CQC’s original commitment (made pre Dash Review report) to publish information in July.

In other news, CQC have reminded providers that they may need to submit a notification under Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 if the recent IT outage meant they were unable to continue to deliver regulated services safely (but not if their contingency arrangements meant a notifiable incident had not occurred).

CQC has also announced sites for testing the integrated care systems (ICS) engagement and inequalities improvement framework. These are Black Country ICS, Gloucestershire ICS, Hampshire and Isle of Wight ICS and Nottingham and Nottinghamshire ICS.
 

Update 25 June 2024

Chief Executive of the Care Quality Commission (CQC), Ian Trenholm, has announced he will step down from the role and as Board member at the end of June 2024. Ian has held the position for six years. Deputy Chief Executive Kate Terroni will hold the position in the interim. More information can be found here.
 

Update 21 June 2024

The Care Quality Commission’s latest update on 20 June 2024 includes a new masterclass video on how scoring features in the new assessment model.

There is further information on scoring in CQC’s guidance on the new assessment approach.

CQC also describes, in the update, what you can do in the new provider portal, including notifications and registration activities.

CQC says providers can now contact them directly about financial matters by emailing their contact centre.  This is part of their improvements to internal finance systems.

The care regulator is asking for feedback from providers, by way of short surveys, on:

• Assessment frequency
• Relationship management
• How well providers understand the new approach

Given both assessment frequency and relationship management are issues which have caused problems for providers, members may wish to consider providing feedback to CQC, if they are able.

Update 18 June 2024

Tim Coolican, Head of Regulatory, Anthony Collins, gives an update on the Care Quality Commission's new approach and advises providers on their best chance of a positive outcome to assessment, in an article for June 2024 Homecare magazine: 

CQC’s single assessment framework – light at the end of the tunnel? (homecareassociation.org.uk).

Member log-in required.
 

Update 7 June 2024

CQC says it’s business as usual in election period

The Care Quality Commission says the pre-election period will not affect the activities it classes as ‘business as usual’ - these are permitted to continue under Cabinet Office guidance. So CQC will continue:

• Carrying out inspections of health and adult social care services across England, including planned and follow-up inspections, and those in response to concerns.
• Taking enforcement action against providers that are not delivering the care that CQC expects.
• Publishing findings and judgements of health and care services in inspection reports, including giving ratings.

CQC won’t be publishing any new national reports, but is expected to publish a series of reports on NHS trusts, in the pre-election period.

More from What does a general election mean for CQC? - Care Quality Commission.
 

Regulator publishes how it will calculate first scores using new approach

The Care Quality Commission has published how it will carry out its first assessment of services using the new approach, including new services which have not yet been inspected.

Where services have an existing rating or findings about compliance, CQC will select which quality statements to look at, determined by national priorities, set by the type of service, and consideration of information held about a service.

For each of the quality statements selected, CQC will collect evidence and give a score for all the relevant evidence categories, based on the new assessment.

For the remaining quality statements, scores will be based on CQC’s previous findings using current, published ratings. Scoring will be:

• 4 for each quality statement where the key question is rated as outstanding
• 3 for each quality statement where the key question is rated as good
• 2 for each quality statement where the key question is rated as requires improvement
• 1 for each quality statement where the key question is rated as inadequate

The date of previous assessment will be stated.

There will be some exceptions, described here, where topics have been moved from one key question to another or are new to the assessment framework.

Where services have not previously been inspected, CQC will be unable to use this method of scoring, and so will normally collect evidence for all the quality statements within the first year.

The Homecare Association has raised with CQC the possibility that scoring could be based on old and out of date data, for example, where services have not been rated for five years. We have also pointed out that this system may make it difficult for services to upgrade their rating, in the short-term, and that new services are effectively being treated differently from existing services, in terms of the number of quality statements being scored.

Separately, CQC has issued an update on Integrated care system assessments and the first local authority assessment reports (for Hertfordshire County Council, London Borough of Hounslow and West Berkshire Council – all rated good).

The regulator has also issued new guidance on how it will assess services that do not receive a rating.

CQC make portal improvements and invite people to sign up

CQC has apologised in its recent update (3 June) for issues with the new provider portal. Improvements have been made and providers are invited to sign up if they haven't been able to do so. Any issues about signing up should be referred to the support team at [email protected]. There is more about what can be done in the portal, in CQC’s update, which also describes improvements to CQC’s internal finance systems.
 

Update 10 May 2024

Review expected of effectiveness of CQC’s new assessment methodology

The Health Service Journal has reported that the government is reviewing the Care Quality Commission's new inspection process (the single assessment framework). Dr Penny Dash, Chair of the North West London Integrated Care Board, is leading the review. CQC responded to those who receive provider engagement communications:

‘You may have seen reports that the Department of Health and Social Care (DHSC) has commissioned a review that will focus on the effectiveness of our new assessment methodology and how we apply it. DHSC has appointed Dr Penny Dash to lead the review.  

This is a pre-planned assessment which is part of the Cabinet Office Public Bodies Review Programme, which aims to periodically review the governance, accountability, efficacy, and efficiency of existing arm’s-length bodies, including in response to significant changes in approach. The reviews are intended to identify areas in need of improvement and provide tangible recommendations for addressing them. There are over 30 Cabinet Office reviews of public bodies planned for 2024/25. We have been told by DHSC that the Cabinet Office do not publish terms of reference for the Public Bodies Review Programme.

We welcome this review and look forward to working with the appointed team. We recognise how important scrutiny of regulation is to give the public and our stakeholders assurance that the effectiveness of our approach has been independently assessed.’
 

Update 8 May 2024

Skills for Care tools and seminars on CQC’s Single Assessment Framework

Skills for Care has created a range of tools, resources and seminars to assist providers with the Care Quality Commission’s new Single Assessment Framework.

Tools and guidance include a GO Online: Inspection toolkit and GO Guide: Single Assessment Framework Edition. More from: Supporting you with the new CQC Single Assessment Framework, 7 May 2024.

In addition, there is a series of three seminars to help providers understand what’s needed to meet or exceed CQC expectations shaped around the CQC Single Assessment Framework.

The topics are: Being prepared for CQC inspection - understand the basics, Delivering outstanding care - strive to be the best, and Improving your CQC rating - recover your rating. Each seminar costs £120 +VAT per person and a 10% discount is available for ASC-WDS account holders. 

Skills for Care has also published two blogs on the new approach, which share initial feedback from some of the first assessments and set out what providers can do to prepare.  See: CQC assessment: first impressions and tools to help and First impressions of the Single Assessment Framework.

Update 3 May 2024

CQC’s new engagement forum

CQC is setting up a CQC Regulatory Approach Advisory Group to meet at least 6 times a year, first meeting 21 May from 10-11am, for providers to give feedback on the new assessment approach. CQC would like as many people as possible to have the opportunity to join this group. Expression of interest form.

CQC has invited our Policy Specialist, Terry Donohoe, to join the new Engagement Form and so we will continue to represent members’ interests there.  If members have any issues they would like us to take up, please email [email protected].
 

Changes CQC has made following feedback on new approach

CQC’s latest update (2 May 2024) refers to a blog by Chief Executive, Ian Trenholm, published on 26 March, which reflects feedback received around the new assessment approach and resulting changes.  Among the topics addressed are:

Quality statements

In response to feedback on the number of quality statements being used to assess services, and whether this means assessments, and therefore scores, are based on out-of-date evidence, the blog says ‘every service is different so the amount of work required to confirm or change a rating will vary depending on the starting position. When carrying out an assessment of a service that is either ‘inadequate’ or ‘requires improvement’ all quality statements under the key question that are rated ‘inadequate’ or ‘requires improvement’ will be reviewed.

Frequency of assessments

CQC will be using feedback and data gathered during the period of transition and aim to publish timelines in the summer.

Relationships with providers

Dedicated relationship holders have been replaced by a new assessment team structure. CQC say there will always be someone a provider can contact and speak to who has knowledge about their service. This might not always be the same person, but knowledge will be shared across the team. CQC are reviewing how this team structure is working and will explain more how to get in touch in the most effective way.

Clarity of guidance

CQC has created a new ‘guidance and regulation’ landing page,structured around registration, regulations, notifications, assessment, enforcement, and added an index page for assessment, with the facility for providers to download assessment content in pdf format.

Dates for the ‘last significant update’ have been added.

Provider portal

CQC is taking swift action to resolve initial issues following the launch and are working towards releasing more functionality and coming weeks in coming weeks.

In addition, in the update, CQC is calling for feedback on:

• Whether the above blog adequately reflects providers’ feedback, comments and concerns. Survey.
• Providers’ experiences of preparing for and the new assessment itself. Survey.
   

Update 12 April 2024

The Care Quality Commission has apologised to those who are experiencing issues with the new provider portal. CQC says that due to the volume of queries received its staff may not be able to respond to everyone individually, but they have recorded the issues and will communicate with all providers when they have been fixed (CQC email update, 9 April 2024). 

Those who have new accounts on the portal should continue to use them, and those who are unable to register should continue to use notification forms, as before, until the issues are resolved and CQC has issued a further update.
 

Update 15 March 2024

CQC’s long awaited portal has opened for registered providers. CQC have told us the portal should be accessible to the majority of people who hold a registered manager, nominated individual or partner role. The latest CQC bulletin has top tips on signing up. 
 

Update 27 February 2024

The Care Quality Commission has moved the launch date of its new provider portal from 27 February to 11 March 2024.

This means from 11 March, providers with a role registered with CQC can use their email address associated with their CQC registration to create an account on the new portal.

CQC say the portal will offer a better experience when submitting statutory notifications and completing some registration actions.

Until 11 March providers can continue using the existing provider portal and submitting notifications via email.

To get ready, providers should make sure all the contact details CQC holds for their organisation are correct, so they can use an email address associated with their registration. Video on the new portal.

CQC ask registered managers who are currently sharing an email address to change to a unique email address and notify CQC as soon as possible, by submitting a Changes to registered details: change contact details – notification form.

Also postponed to 11 March:

• CQC's existing provider portal becoming read-only.
• The new assessment framework for all registration activity.

 

Update 20 February 2024

The Care Quality Commission has announced that from 27 February all providers can sign up to their new provider portal. Until that date providers must wait for an invitation. Anyone invited to join the new portal should see the invitation email 'New CQC portal: sign up today'. This explains how to log in and use it.

The existing portal will become read-only on 27 February 2024, but providers can still access and download saved data until the end of March 2024.

Local authority assessment: CQC has issued an update on implementing our local authority assessments: January 2024
 

Update 26 January 2024

New Provider Portal

The Care Quality Commission’s recent update says all providers can sign up to the new portal from 27 February 2024. Until then, they must wait for an invitation. The existing portal becomes read-only on 27 February but providers can download saved data until 31 March 2024.
 

What lessons can the CQC learn from Ofsted’s changes to inspections?

Anthony Collins Solicitors have published a blog on the lessons CQC can learn from Ofsted's changes to inspections.  This contrasts the different approach to regulation of the two regulators, and how CQC’s new approach seems to be moving further away from addressing the core issues of improving communication and increasing the independence and consistency of the inspection process.
 

Update 9 January 2024

CQC has issued a further update on their new assessment approach: update January 2024 - Care Quality Commission (cqc.org.uk), which considers registering a new activity with CQC, the regulator's new digital offer for providers and local authority and integrated care system assessments.

From 9 January, assessments are due to start for all registered providers in CQC’s London and East of England region.

From 16 January the roll out extends to a small number of providers in CQC’s North region and Midlands region.

From 6 February, CQC says assessments start for all registered providers in their North region and Midlands region, Trust well-led assessments start in all regions and CQC will assess applications to register a new activity or service using the new approach.

The update suggests providers prepare by:

• Reading provider guidance on CQC’s new approach to assessment.
• Making sure their contact details are up to date, and the right people in their organisation are subscribed to CQC’s email newsletters.
• Watching CQC’s videos and webinar recordings. See Video on new approach.
• Signing up to attend CQC webinars when they advertise them.
• Joining CQC’s digital engagement platform to share feedback on the new approach.
• Subscribing to CQC’s WhatsApp channel for latest updates.

Update 4 January 2024

CQC has confirmed that its new assessment approach is now live across the South region, as part of a staged rollout over the next few months.  Further information on assessment start dates for other regions in England and preparation material can be found here.

CQC has also issued their latest guidance on: ‘Top tips for a good experience submitting notifications’. This refers to statutory requirements for regulated providers to notify CQC about certain changes, events and incidents that affect their service or the people who use it. To get getting notifications right, CQC’s advice to regulated providers is: 

1. If you have access to the provider portal (current or new), this is the easiest and quickest way for you to submit a notification
2. If you're using a Word form,  always download the latest version from CQC's website rather than using saved versions as CQC change our forms from time to time
3. Make sure the provider and location IDs and name of provider entered on the form are correct. It is important to remember this will have changed if you have made changes to your legal entity. You will find your provider ID and the location IDs on your latest certificate of registration. 
4. Make sure all the fields on the notification form are completed
5. Keep up to date with the latest guidance on submitting notifications
6. You should always receive a submission notification and a reference when you have correctly submitted a notification. If you do not receive this CQC may not have received your information.
    

Update 19 December 2023

CQC has published a new quick guide document, which is a summary of the regulator's assessment approach in a single document to gives providers a helpful overview.
 

Update 17 November 2023

The Care Quality Commission has published new guidance for regulated providers on their website:

1. How we will roll out our new assessments.
2. How we will calculate the first scores.
3. How we gather evidence.
4. Display your ratings: posters.

The Commission has also updated online information to include a list of all the evidence categories they will be using when assessing individual quality statements for different types of services, including homecare and shared lives services:

Evidence categories for sector groups

This update follows CQC’s various consultation exercises to obtain feedback from providers on their draft proposals.  There is an opportunity to share feedback on the above guidance via the usual Citizenlab surveys.

The timetable for roll-out of the new approach to regulation has now been confirmed as follows:

• From 21 November 2023 CQC will start using their new single assessment framework in the South region.
• Between 21 November and 4 December 2023 CQC will undertake a small number of planned assessments with 14 early adopter providers, whilst continuing to respond to risk. They will then expand our new assessment approach to all providers based on a risk-informed schedule. 
• From 5 December 2023 CQC will be using their new regulatory approach with all providers in our South region and with providers in the Bedford, Luton and Milton Keynes integrated care system area (ICS).
• From 8 January 2024 CQC will start using their new single assessment framework in the London and East of England region.
• From 23 January 2024 CQC will start using their new regulatory approach with a small number of providers in the North and Midlands regions.  
• From 6 February 2024 CQC will start using their new regulatory approach with all providers in the North and Midlands regions and will include NHS well-led assessments.

CQC say they will contact providers directly in each area, ahead of their rollout date with more information (source: CQC update, 17 November 2023).

Separately, CQC has started a WhatsApp Channel to share updates: WhatsApp Channel Invite.

CQC intends to invite small groups of providers to join their new Provider Portal from October.  The regulator asks that providers make sure their contact details are up to date. 

Update 10 November 2023

The Care Quality Commission have published provider guidance on how they will report under the new regulatory approach. 

CQC say once they have completed their assessment and the factual accuracy check process is over, they will publish a report of their findings. This information will be published in a different format from the inspection reports under the regulator's previous model. The biggest difference is that the information is all published on CQC's website rather than in a PDF document, though providers will still be able to download, print or share a copy of the report.
 

Update 19 October 2023

The Care Quality Commission have announced that they will, as expected, start using their new single assessment framework in their South region from 21 November. Between 21 November and 4 December CQC intends to undertake a small number of planned assessments with 14 early adopter providers, while continuing to respond to risk.

CQC will then expand their new assessment approach to all providers based on a risk-informed schedule.

CQC say they are sharing more information with providers in the South separately and will be in touch with providers in other areas of the country to confirm when they will start using their new approach shortly.

Regulatory update, 19 October 2023

The South region includes services registered in these counties: Berkshire, Buckinghamshire, Cornwall, Devon, Dorset, Gloucestershire, Hampshire, Kent, Oxfordshire, Somerset, Surrey, Sussex and Wiltshire.

CQC have also shared a recording of the second webinar in their 'CQC is changing' series, which took place on 12 October 2023, with speakers Amanda Hutchinson, Head of Policy, Regulatory Change and Dave James, Head of Adult Social Care Policy.

The full provider guidance referred to in the webinar, including evidence categories for homecare and supported living services (dated 2 October), is here. 

The deadline to complete CQC’s survey on the types of evidence they will look for as part of assessing each quality statement has been extended to 31 October.

Update 28 September 2023

CQC may ask providers for their green and environmental sustainability plan, one of the types of evidence listed in their draft guidance, when they assess services using the new approach to regulation. The regulator has indicated that these should include plans for medicine sustainability.

CQC started a new project in September 2023 on medicines sustainability with a view to producing a suite of products to support providers, They are asking providers to answer a short survey by 30 November 2023 on the sustainable use of medicines and decreasing their environmental impact.
 

Update 22 September 2023

The Care Quality Commission launched a call for views from regulated providers on the types of evidence it will use to assess quality statements, when the Single Assessment Framework is introduced.

The Commission issued a regulatory update on 22 September which contained the next part of guidance which groups different types of evidence under 6 evidence categories the regulator will look at to assess:

• The quality of care being delivered
• The performance against each quality statement.

The number of evidence categories needed, and the sources of evidence to be collected, will vary depending on:

• the type or model of service
• the level of assessment (service, provider, local authority or integrated care system)
• whether the assessment is for an existing service or at registration.

The draft guidance consists of a common section on Evidence categories, with further detail for each different type of service group.

The homecare and shared lives services evidence categories contain examples of the types of evidence the regulator will be looking for in those sectors.

Providers wishing to comment should read the draft guidance and complete the survey on CQC’s Citizenlab platform. Those who have not yet signed up, can do so here.

There is an evidence category grid at Project • Provider guidance feedback (citizenlab.co) which summarises the evidence categories under the headings of Safe, Effective, Caring, Responsive and Well-led.

On the timing of the roll-out of the new inspection regime, CQC say they intend to give providers a reasonable period of notice before they are directly affected, with the current estimate being about eight weeks between publication of the final guidance and starting the new assessment approach.

The intention is to start with a small group of providers in the South network in mid to late November.  These may get slightly less notice of the final guidance, but CQC say they will work to mitigate this.

CQC intend to continue to work with providers and provide further updates and guidance. 

Plans to test and launch the new provider portal are continuing and CQC held a webinar on introducing quality statements and evidence categories on 12 October 2023. (CQC is expected to put a recording on their YouTube channel).

Update 2 August 2023

CQC held a webinar on 2 August 2023 to update providers on the new regulatory approach and provider portal roll-out. 

The regulator has split England into four regions for regulation purposes, with a new staff structure that reflects this arrangement.

The South region will be the first to adopt the Single Assessment Framework in November 2023, with a roll-out to the rest of the regions by the end of March 2024.

Testing of a new provider portal will be carried out from August 2023, with a group of 230 providers invited to participate, mainly larger users of the notification system.

Providers are asked to ensure CQC have up to date contact details of their Nominated Individual, so they don’t miss email invitations or updates. Providers can sign up to receive CQC’s email bulletins.

CQC are planning further webinars and a communications programme. They have circulated the presentation and recording from this webinar. 

There is more about the roll-out here: Our transformation plan and new approach - summer update - Care Quality Commission.
 

Although the underlying legislation and fundamentals of regulation will remain the same, CQC will be changing how, and how often, it gathers information and how it rates services.

The most significant change is the move to a Single Assessment Framework, noted above, which will assess providers, local authorities and integrated care systems with a consistent set of key themes, from registration to ongoing assessment.

There is guidance about the Single Assessment Framework on CQC’s website, together with information on how CQC intends to assess quality and performance, with more guidance due soon.

Gathering evidence

CQC will continue to make use of a wider range of evidence. Evidence to support its judgements will be gathered through different routes and at different times, including through the provider portal. CQC’s focus will move away from on-site inspections as the main source of evidence about the performance of services.

CQC’s focus on risk and identified areas of concern will narrow the scope of inspections, which will still be called inspections, and it will be important that providers focus on evidence of a systematic approach to risk assessment and management. Evidence must be up to date and relevant to ensure that an inspector receives accurate information about your service.

If you are in any doubt about the particular lines of enquiry being followed by an inspector, it is appropriate for you to ask for clarification during the inspection. Most importantly, you must challenge inaccuracies during the Factual Accuracy process.

Guidance on how to get the best out of inspection is available on the CQC’s website.

Frequency of Assessments

CQC is moving away from a scheduled three-year cycle of inspections. Monitoring activity will, increasingly, be triggered by evidence collected or received by the Commission, including off-site evidence. Triggers for inspection activity could include concerns raised over staffing levels, missed or late calls or concerns about the recruitment, training or supervision of staff.

This shift in emphasis will allow CQC to decide where best to focus its activity, whether at sector or provider level and will see the Commission gather evidence in both planned and responsive ways.

Ratings limiters

A significant change under the new approach are the rating limiters, linked to scores under each quality statement, which limit the overall rating that can be achieved if a low score is awarded against a quality statement. 

The CQC's Assessing quality and performance document is available here. 

There is more information in the Ratings under the new Framework section below.

 

CQC’s more dynamic approach to assessment will mean that judgements about the quality or services will be more flexible and regular, rather than arising from a fixed point in time.

CQC will be collecting evidence off-site and working with third-party organisations to collect evidence:

The wider range of evidence collected will allow CQC to be more selective about how it weighs evidence. Assessments will be more structured and transparent, using evidence categories as part of the assessment framework.

The evidence categories are likely to be:

• People’s experience of health and care services
• Feedback from staff and leaders
• Feedback from partners
• Observations
• Processes
• Outcomes

Further information on evidence categories can be found here.

CQC are consulting on the different types of evidence used in each of the six categories, for different types/models of services.  See their draft guidance on types of evidence for the Homecare and Supported Living sectors.

There is a Microsoft Excel evidence category grid which summarises the evidence categories for each type of service under the headings of Safe, Effective, Caring, Responsive and Well-led.

The evidence categories will be scored individually, which should allow for easier ranking and benchmarking of services.
 

Planned activity

Each evidence category in the assessment framework will have an initial schedule for ongoing assessment. This will set out the length of time before CQC needs to collect evidence for that category in each service type.

CQC’s current ambition is that the information will be updated across all the evidence categories, relevant to a service, within two years, although there will be no ‘fixed point’ for this, as was the case with the Provider Information Return (PIR). Collection of evidence will not indicate imminent inspection activity.

The frequency of planned evidence collection may be varied depending on additional national priorities or whether CQC’s view of risk in an individual service, or area changes.
 

Responsive activity

Since the start of the COVID-19 pandemic and the development of its current Monitoring Approach, CQC has, increasingly, taken action on receipt of information that could indicate an immediate risk or marked change in quality within a service.

Typically, CQC has taken action in light of:

• Whistleblowing concerns
• Safeguarding reports
• Statutory notifications
• Concerns raised by people using services, their families or other stakeholders reported through CQC’s ‘Give feedback on care’ site.

CQC will work with other people and organisations such as local Healthwatch groups and Experts by Experience. These will help CQC engage more effectively with people, their families and carers, as well as with communities whose voices are less often heard.

Site inspection will remain an option where CQC has concerns about the transparency of the evidence it has received.

There are changes to the way that CQC calculate ratings. The guidance on scoring is here.
 

CQC will continue to use 4 ratings to describe the quality of care: Outstanding, Good, Requires Improvement and Inadequate. However, the regulator will use a new scoring system which will translate into one of the ratings for the Key Questions: Safe, Effective, Caring, Responsive and Well-Led. These scores will also form the basis for the overall view of quality at the service level.

CQC’s current Quality Statements are the commitments that providers, commissioners, and system leaders should live up to and describe the standards of care that people should expect in each of the sectors regulated by the Commission.

Evidence

For each sector CQC will set out the types of evidence that will be focused on under each evidence category when a quality statement is assessed. These will vary, depending on the type of service.  Draft guidance on this is being consulted on, and further information will be published by CQC as the new system develops.

CQC will make use of the evidence it already has or has actively sought, for example, through statutory notifications, or on-site inspection activity.

Depending on what CQC has found, a score will be given for each of the evidence eategories, relevant to a service.
 

Scoring evidence categories

The Commission has outlined the process it is likely to use to produce ratings for the key questions and overall.

Firstly, the Commission will combine the required evidence category scores to give a score for the quality statement the evidence relates to. All evidence categories and quality statements would be weighted equally. These categories could include people’s experiences, feedback, observation and processes.

Secondly, the evidence category scores will be combined to give a score for the relevant key questions for the service. All evidence categories and quality statements would be weighted equally.

Finally, the key question ratings would be aggregated to give an overall rating for each key question.

CQC has said a four-level scoring system will be used. Further information can be found here.

The new system will align with the current system, as follows:

4 = Evidence shows an exceptional standard of care

3 = Evidence shows a good standard of care

2 = Evidence shows shortfalls in the standard of care

1 = Evidence shows significant shortfalls in the standard of care

The table, below, shows how the scoring system might work, in practice:
 

The intention is that the percentage score will allow more detailed sharing of information and, in time, support benchmarking for providers. Thresholds have been proposed to allow conversion of a percentage to a score, for ease of understanding.

Suggested thresholds are:

25 – 39% = 1

39 – 62% = 2

63 – 87% = 3

Over 87% = 4

As outlined previously, the proposed scores map to the current quality ratings: Outstanding (4), Good (3), Requires Improvement (2), Inadequate (1).
 

Ratings limiters

One difference with the new system is the introduction of rating limiters linked to scores for the quality statements under each key question.

Here is an example of how scoring 1 for Medicines optimisation under Safe, would limit a rating to Requires Improvement, despite scoring 21 out of a possible 32, ie 65.6%, a score that would otherwise lead to a Good rating:

This means providers must be good at everything or risk having their rating limited.

We suggest the key areas homecare providers should focus on to prepare for the Single Assessment Framework, within the five key questions, include:

Safe, Effective and Caring

Responsive and Well-led

The Homecare Association has information and resources which may help providers with their compliance, both under the current regulatory system and the new approach.  See our Resources section below.

There is a range of information and guidance to help homecare providers adapt to CQC's Single Assessment Framework.
 

CQC's guidance on  new approach to assessment

• Our new approach to assessment - Care Quality Commission
• How we will regulate - Care Quality Commission
• Evidence categories - Care Quality Commission
• Assessing quality and performance - Care Quality Commission
• How we will reach a rating - Care Quality Commission
• Webinar in August recording and presentation - Care Quality Commission
• Evidence categories (draft guidance)

Homecare Association guidance, resources and services, including member only resources

• Inspection guidance for England - Homecare Association (this will be updated when CQC's final guidance is published)
• CQC - Proving compliance workshop - Homecare Association
• Workforce development fund training funding for providers - Homecare Association and Skills for Care
• Enhanced DBS check under £50 – Disclosure Service - Homecare Association

Information related to CQC’s five key questions

Safe

• Writing an adult safeguarding policy for homecare services in England - Homecare Association
• Safeguarding for homecare providers workshop - Homecare Association
• Risk assessment – what is it and how it is done? Factsheet and templates - Homecare Association
• Medication policy guidance and summary - Homecare Association
• Medication train the trainer pack and workshop - Homecare Association
• Infection control train the trainer pack - Homecare Association
• Food hygiene train the trainer pack - Homecare Association
• Fire safety for homecare providers: Questions and Answers - Homecare Association and London Fire Brigade
• Skin care creams and lotions – Guidance for homecare providers on fire safety - Homecare Association and London Fire Brigade

Effective

• Personalised care and care planning factsheet - Homecare Association
• Quality assurance and auditing workshop - Homecare Association

Caring

• Equality, Diversity and Inclusion - advice and guidance for homecare providers - Homecare Association
• Dementia Care train the trainer pack and workshop - Homecare Association
• What is wellbeing and why is it important? Webinar - Homecare Association and Talent for Care

Responsive

• Accessible Information Standards factsheet - Homecare Association
• PRSB Information Standards factsheet - Homecare Association
• Public engagement - Engaging more with people who draw on services – Care Quality Commission
• Specimen terms for homecare services and live in care – explanatory note – Anthony Collins Solicitors LLP and Homecare Association
• End of life care train the trainer pack - Homecare Association

Well-led

• Registered managers Being well-led workshop - Homecare Association
• Environmental sustainability - Skills for Care
   

For more information about:

• Our resources or train the trainer packs, contact 020 8661 8188, option 4.
• Our workshops, contact 020 8661 8188, option 5.
   

Homecare Association information and updates

The Homecare Association sends members a weekly round-up and single-issue email alerts to keep them updated with developments, including CQC’s roll-out of the new approach.

If you work for an organisation that is in membership, and would like to receive our alerts, please contact our Membership Team on 020 8661 8188, option 2.

The Homecare Association's helpline for members answers questions across a range of topics relevant to regulation and refers members to our specialist helplines for assistance in individual cases. Please call 020 8661 8188, option 4 for more information, or email [email protected].

To find out the benefits of membership and how to join the Homecare Association, click on the banner below:
 

Disclaimer

Whilst every effort has been made to ensure the accuracy of this information resource, it is a summary, rather than a definitive statement of the law; advice should be taken before action is implemented or refrained from in specific cases. No responsibility can be accepted for action taken or refrained from solely by reference to the contents of this information resource.