The New CQC Single Assessment Framework: How it’s going?

Amidst the Care Quality Commission's (CQC) transition to a new Single Assessment Framework (SAF), like the rest of the care sector, Care 4 Quality has been following closely the CQC's operations, inspection processes, and published information.

Review of Published reports

In Mid-April, Care 4 Quality conducted an analysis of 296 recently published reports on the CQC website. This exploration revealed crucial insights into the evolving nature of CQC assessments.

Out of the 296 reports, only 60 were conducted under the SAF, with Adult Social Care (ASC) comprising a significant 72% of the total assessments.

As we know, for any quality statements that are reviewed, the CQC are rating as follows:

• 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’.

For quality statements that have not been reviewed, the scores will be based on previous inspection reports. For instance, a ‘Good’ rating in safety would correspond to all 3’s in any quality statements that were not checked.

The published reports under the new framework demonstrated a huge variation across the number of quality statements reviewed, while there were a few that had over 30 quality statements looked at, others examined showed an average of seven statements. Reports showcased inconsistencies in the number of quality statements reviewed, impacting overall ratings. This variability challenges the fairness and equity of the assessment process.

It appears CQC heard the outcry of inconsistency, and it was advised that “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.” This does remain to be seen as providers who are being visited still report that only a handful of quality statements are being reviewed, even if they are currently sitting in Requires improvement in one or more Kay Questions.

On further analysis of another 80 published reports in May 2024, Care 4 Quality still found an average of 10 quality statements being reviewed across adult social care services and minimal health care services being inspected.

Although it is reported by providers, with very recent inspections, that CQC do appear to be advising that they are reviewing an increased number of Quality Statements (an average of 11-12).  

While many services previously held 'good' ratings, some still haven't undergone inspections since 2017 or 2018, whilst many services have been sat in requires improvement for over 18 months, unable to evidence to the sector the improvements they may have made in that time.  In turn this can have a detrimental impact upon the sustainability of the care business, raising concerns about governance and quality assurance over time.

The CQC have assured on 9 April 2024 that future assessment will be either planned or responsive based on concerns, stating “Once the new frequencies are decided, we will publish a more detailed schedule for planned assessments. This will include a date by when we will have updated ratings for all providers. This will signal the end to our transition period. We expect to publish this information at the start of July 2024”.

Care 4 Quality also found there were surprises when it came to scoring concerns such as issues in processes in medication management and infection control.  Scores of 3’s were still awarded, presumably because people’s experiences and feedback was good. This raises the question of whether ensuring the safe administration of medication process is paramount, more so than the feedback from stakeholders regarding it? The unclear weighting of evidence categories further complicates assessment accuracy of ratings.

Review durations varied significantly, with inconsistencies in onsite visits and desktop reviews, some being merely a day or two, others spanning over a month. However, transition to remote assessments has been praised as it does offer the care service time to provide the evidence requested and allows the onsite visits to be less intensive and intrusive.

There is a lot of support for the new assessment approach as it is clear it would promote transparency on focus on areas for concern, however clarity on assessment frequency and dedicated relationship holders within the CQC is essential.

Provider portal

The CQC has encountered notable technical challenges during the implementation of the new provider portal. Technical issues have required ongoing refinement for improved usability, with users not being able to access the portal fully. To date users continue to have problems loading and using it with a lack of email or phone support for queries.  

The CQC have assured people as recently as 16 May 2024 that the provider portal is being continuously improved based on feedback, with a focus on addressing enrolment issues in particular. They have also advised that they have made some recent improvements to ensure that providers can log in to the portal, including the ability for Nominated Individuals to delegate access to others in their organisation so they can complete notifications.

My colleagues at Care 4 Quality supporting registration submission report that in many instances, to register a new service, it is taking over 7 months from application submission for the CQC to confirm approval status.  

CQC and DHSE Review:

The Department of Health and Social Care announced their review of the CQC's new inspection process. The review will focus on assessing the effectiveness of the CQC's single assessment framework and its application. Although this is a pre-planned assessment which is part of the Cabinet Office Public Bodies Review Programme, it has come at a time of need, when it is reported that vacancies and sickness within the CQC itself is at an all-time high. The CQC’s internal People Survey showed that of colleagues surveyed within the CQC only 15% agreed that “changes are effectively implemented in our organisation” and only 57% of people said they’d “like to be working here in 12 months” time.

 The reviews are intended to identify areas in need of improvement and provide tangible recommendations for addressing them.

Conclusion

Providers and stakeholders are apprehensive about the high number of quality statements used in assessments, with a concern that this could lead to reliance on outdated evidence, translating to inaccurate assessment scores.

The CQC has stated it is committing to prioritise the assessment of services not recently inspected or currently rated inadequate or requires improvement, with a view to ensuring the service is reviewed appropriately and there are timely rating changes for such providers. The CQC maintains that the new approach will reduce the amount of work needed for the assessment of each key question rating.

It is too early to say if the adjusted approach will be effective, we hope it will and here at Care 4 Quality we will be keeping in close contact with providers who are being inspected, reviewing published reports continuously until we can see a clearer picture continuing to keep those we support up to date with the latest changes. 

As the CQC continues refining its assessment framework, collaboration and ongoing feedback are paramount. Care 4 Quality remains dedicated to supporting care organisations in navigating these changes and enhancing quality outcomes across health and social care services.