Since the publication of a new strategy for the changing world of health and social care (CQC, 2021), CQC has been developing its new approach to regulation (CQC, 2022). It has been working with providers, stakeholders and members of the public to co-create, test and pilot aspects of that new approach, and in November 2023 it formally launched its new single assessment framework (CQC, 2023).
The new framework, which is designed to apply to providers, systems and local authorities, promises a more granular and transparent assessment, greater focus on what matters to people using services, and more scope for providers to benchmark themselves against others and to follow their own progress within a rating category. Under CQC's new approach, a set of new quality statements and the evidence categories that underpin them will be scored to arrive at an overall rating for each key question, service and location (CQC, 2023).
Thanks to an improved provider portal (CQC, 2024) and increased reliance on data and technology, CQC has suggested it will be better able to review new evidence, and will be able to update provider ratings more quickly, without the need to wait for a full-scale re-inspection.
The promise of greater objectivity and a more 'live' picture of quality is encouraging, as it speaks directly to the right-touch regulation principles of transparency and accountability, and could enhance CQC's ability to be more agile and targeted in its decision-making and activity.
While the shift to the new single assessment framework was seen as an improvement, trust leaders were unsure whether it would lead to an improvement in the re-inspection and re-rating of services. They welcomed the ability to compare themselves to others and to see their progress within a rating category, but they also feared that, with the added CQC remit of system and local authority assessments, an even more stretched regulator would be even less able to prioritise providers considered lower risk.
Recommendation 8:
We recommend that: CQC fully delivers on the potential of its new single assessment framework, which promises to provide greater objectivity and a more 'live' picture of quality. Ratings, particularly for providers considered lower risk, should reflect this.
CQC's new powers to review and assess integrated care systems (ICSs) and local authorities, under the Health and Care Act 2022, became effective in April 2023. Since then, the regulator has carried out five pilot assessments and produced guidance for local authority assessments. It is also currently piloting its approach to ICS assessments and has produced interim guidance for these assessments (CQC, 2023).
Trust leaders were generally positive about CQC's new role in system assessments. They felt this could enable the regulator to capture the challenges and achievements of providers, provider collaboratives and place-based partnerships within systems. They thought it presented opportunities for CQC to be more agile and to identify issues earlier, or even to anticipate them. By 'joining the dots' between different system players, the regulator could better enable them to integrate and improve services. Trust leaders also highlighted that, as it assesses systems, CQC would be well-placed to look at entire patient pathways and to better understand the patient journey and experience. The regulator could do this by speaking to staff and leaders, as well as to other stakeholders in the system, and by holding patient focus groups to hear directly about their experience of health and care.
Recommendation 9:
We recommend that: CQC takes the opportunity to explore entire patient pathways, rather than only assessing individual care settings. CQC's new role in assessing integrated care systems and local authorities could make it possible to build a system-wide picture of the challenges that impact on services, and how these might be tackled.