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 has been developing its new approach, it has 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 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.