Legal Director, Sarah Knight, and Principal Associate, Nythan Smith, analyse the consultation response showing the direction of travel of CQC in its approach to assessing providers.
CQC has announced its intention return to sector specific frameworks later this year acknowledging flaws in the Single Assessment Framework it introduced in July 2022. The CQC’s intention had been to simplify the process of assessing providers and providing transparency in their decision making and scoring. For those working in the sector it is clear that unfortunately the new process made things more difficult, both for CQC in terms of systems and for providers to understand. It is proposed that the revised framework will now be divided into four key areas: Adult social care, Mental health care, Primary care and community services and Hospitals.
The announcement marks a return largely to the way that CQC assessed providers, prior to its change, under the Single Assessment Framework. The five key questions remain: is the service “Safe, Effective, Responsive, Caring and Well Led?” and Key Lines of Enquiry, which are questions for inspectors to ask under each key question, return in a more streamlined version than previously. Whilst Quality Statements remain, there will not be the same level of detail as within the Single Assessment Framework and the old KLOE will dominate. There will be a move back to ratings characteristics which will be the descriptors of what each rating, from outstanding to inadequate, should look like. There is little distinction in what an Inadequate or Requires Improvement services should look like and the ultimate decision on where a provider sits will continue to lie with the professional judgement of those awarding the ratings. As mentioned, the Quality Statements remain in the ‘I’ statements that are in place currently, but the number of those statements have been pared down. Numbered scorings will be scrapped – so there will be less transparency as to how each element has been calculated. Ratings will remain, albeit only at key question level and not on the topic areas that underly each key question as was formerly the case.
CQC has sought to collaborate with partners in the sector in order to co-develop the way that providers are assessed. The shared goal of both CQC and those that it regulates is that CQC is fit for purpose to conduct assessments in a timely manner and that the findings from those assessments are proportionate to what has been identified at assessment. This is clearly subsequent to several years’ criticism of CQC and unsuccessful changes to its management structure.
Absent from CQC’s more recent update, but as was recently shared by the Chief Inspector of Adult Social Care, is that there will be a drive to make reports shorter, thus enabling them to be turned around more quickly which should, in turn, allow assessments to be conducted more frequently than has previously been the case. Hopefully, this will not mean a lack of sufficient scrutiny and detail in its reports. There is a welcome suggestion that if an issue is identified at assessment but can be readily rectified, that concern may either removed entirely or credit given to a provider, so as not to impact the ultimate rating.
It may be that a shorter report will be more accessible to lay people reading it but there is a danger, we would have thought, of potentially losing context or sufficient detail. The previous “new” reports covered both issues by having a summary and, for those who wanted a “deeper dive”, there was a detailed report that could be accessed online. It is always difficult to strike the balance in providing sufficient information to inform a judgement whilst at the same time not overwhelming the reader with data and information. On the other hand, without sufficient detail, how is a provider to understand the areas it needs to challenge - in a Factual Accuracy Challenge, for example.
The efficacy or otherwise of any framework will be determined by the engagement of the regulator and regulated – hopefully in a collaborative manner. Whilst more clarity is welcomed in the manner that assessments are to be conducted, the real litmus test is whether providers feel empowered to challenge assessments that they may disagree with. Providers can, in our experience, be reluctant to challenge CQC action because they do not feel that CQC will give sufficient credibility to challenges or - importantly - that the cost in engaging with CQC may outweigh the potential merits. Where providers consider that assessments contain disproportionate negative findings, they should review the frameworks alongside evidence which challenges those findings. Most providers will be conducting internal audits and applying these frameworks to assess adherence to the regulations and quality in the provision of care in any event. It is important that they can set up algorithms based on the new proposed regime.
The CQC remains committed to taking enforcement action where it deems it to be necessary. This is tied largely to assessments, as it is from assessments that the evidence to bring enforcement action is derived. CQC’s ambition is to return to conducting assessments more frequently than it has for some time which may lead to a spike in enforcement action being taken against providers. When enforcement action is taken, it has always been the case that much more information is provided to enable providers to respond in a meaningful manner than what appears in the public space. It is against this more complete set of information that challenges can more naturally be developed. Challenges to CQC will always be more effective if providers engage with alleged concerns raised by CQC with enhanced scrutiny, detailed, targeted and consistent evidence.
The consultation response shows the direction of travel of CQC in its approach to assessing providers, which will largely be resigning the past few years to history and returning to previous manner of assessment and ratings. CQC has not provided a concrete roll- out date for this new-old approach but best estimates are that it will come into effect in the latter part of 2026. Those who CQC regulates will likely welcome this approach, certainly if it leads to a reduction in the time between assessments, especially when concerns have been identified. Interpretation and professional judgement play as important a role in its new approach as before and providers should read and familiarise themselves with the frameworks prior to them coming into effect.
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