The weather has turned cold, Strictly is back on our screens and the countdown to Christmas is on. Alas, CQC’s purple present for providers it is not Quality Street but the eagerly awaited publication of guidance on its quality statements and evidence categories. This is the latest instalment in the fragmented roll-out of its guidance on the new single assessment framework.
The latest webinar from CQC on this topic left Providers wanting. This article attempts to shed some further light on the quality statements and evidence categories and some thoughts on how providers might prepare for these.
The New Approach Quality Statements, Evidence Categories & How to Prepare
Under the CQC’s new approach, the quality of a service will be reviewed more regularly. The latest guidance provides information about the types of evidence CQC will look for as part of assessing each quality statement in its new assessment framework.
The CQC describes quality statements as, “the commitments that providers, commissioners and system leaders should live up to. Expressed as ‘we statements’, they show what is needed to deliver high-quality, person-centered care.”
All providers, no matter what type of service they provide, will be assessed under the same single assessment framework which will link to the relevant regulations. The CQC website breaks down all of the quality statements and links them to the relevant regulations.
The quality statements replace the Key Lines of Enquiry (KLOE’S) but the five Key Questions (Safe Effective, Responsive, Caring and Well-led) remain. The Quality Statements identify the different areas considered under each Key Question and specific evidence will be sought for each quality statement across the five key questions. There are 34 Quality Statements.
The CQC is not prescriptive and therefore doesn’t specify precisely what must be done in order to meet their Quality Statements. Providers will therefore be able to evidence this in a number of ways. The CQC’s only steer on this is the different categories of evidence types that it will focus on when assessing a particular quality statement. There are 6 Evidence Categories:
- People’s Experiences
- Feedback from staff and leaders
- Feedback from partners
- Observation
- Processes
- Outcomes
Which evidence type goes with which Quality Statement depends on the service type and CQC have mapped this out in more detail on its website. However, all Providers, should note that a key shift in the evidence that CQC will gather and use to assess is feedback. At least three of the evidence categories set out above relate to feedback (people’s experiences, feedback from staff and leaders and feedback from Providers).
If the hype is to be believed Providers will be able to pro-actively supply evidence of good feedback through the new Provider Portal whenever it is rolled out. In the meantime however, a good way to prepare for good outcomes under the new framework would be for all Providers to seriously consider overhauling the way it gathers, records and shares feedback from all stakeholders. Think outside the box on this, gather feedback pro-actively and regularly and ensure you can present it in a meaningful way to CQC. Then, ensure you link that good feedback into another of the evidence categories – outcomes. Evidence how your care has produced good outcomes perhaps with mini case studies.
Ratings and Scoring
The CQC’s current four ratings of Outstanding, Good, Requires Improvement or Inadequate will remain in place but the CQC will use a scoring framework to determine the quality of the service on an ongoing basis. Depending on what the CQC finds, it will provide a score for each required evidence category 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
CQC will follow these initial 3 stages for all assessments:
- Review evidence within the evidence categories assessed for each quality statement.
- Apply a score to each of these evidence categories.
- Combine these evidence category scores to give a score for the related quality statement.
Initially the CQC will only publish ratings but in the future it intends to publish specific scores. The CQC’s rationale for using a scoring system as part of its assessments is that it will assist providers by giving an indication of how close the service is to another rating. For example, for a rating of Good the score will demonstrate whether the rating is closer to achieving Requires Improvement or Outstanding. This will also be helpful for people reading reports since, at the moment, a ‘Requires Improvement’ rating and the associated amber colouring, has negative connotations and people reading the report have no way of knowing whether that service is just below a ‘Good’ rating or whether it narrowly avoided an ‘Inadequate’. The scores will also help the CQC determine if quality is moving up or down within a rating.
What Happens Next?
The CQC is due to start rolling out the new framework from November 2023 by geographical network. The first network will be the South Network made up of services registered in these counties: Berkshire, Buckinghamshire, Cornwall, Devon, Dorset, Gloucestershire, Hampshire, Kent, Oxfordshire, Somerset, Surrey, Sussex and Wiltshire. During this time, in other regions, it will continue to use its existing assessment framework.
Provider’s should keep an eye on CQC’s website for updates and of course consider providing feedback on the new guidance. CQC has said that it is sharing the new guidance now, so that Providers have time to read and understand it, as well as provide feedback to them about “whether it works”. Providers have until the end of October to provide feedback. This does not leave much time for the CQC to start the roll out of the new framework in November 2023 as promised!
If providers would like help with or advice in relation to the CQC’s inspection process, Ridouts can help. Please contact our specialist team of solicitors on 0207 317 0340 or ask for a call back via our website.
