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Environmental Sustainability in Health and Social Care | Implementing the CQCs Guidelines

Single Assessment Framework: NEW CQC Updates

Published On:

1 December 2023

Published In:

On the 30th of November, the Care Quality Commission (CQC) released new information about the process and timing of their inspections under the new framework.

To ensure managers and providers stay informed, we are presenting the latest updates below with links to the sources.

When will I be visited?

Rollout of New Regulatory Approach – Key Dates:

The CQC has now released the intended rollout across the country for the next 6 months.

As we know, the CQC is currently inspecting the early adopters from 21st November to 5 December – these are planned assessments involving 14 providers in the South.

  • From 5 December: Assessments begin for providers in local authority areas including Bedford Borough, Central Bedfordshire, Luton, and Milton Keynes.

    Assessments also start for all registered providers in the South region.
  • From 9 January: Assessments begin for all registered providers in the London and East of England region.
  • From 16 January: Assessments begin for a select number of providers in the North and Midlands regions.
  • From 6 February: Assessments begin for all registered providers in the North and Midlands regions. Trust well-led assessments commence in all regions.

    CQC will assess applications to register a new activity or service using the new approach
Additional Points:

The CQC have expressed that continuous feedback from providers is encouraged. The approach may be adjusted based on feedback for optimal implementation. Updates will be provided as changes are made during this transition.



Provider Information Return (PIR) & Factual Accuracy Check (FAC) Processes

Despite all the recent changes, there are certain aspects have remained consistent.

For the FAC (Factual Accuracy Check), the CQC will still ask you to make sure that the information they use to make judgments is accurate and complete. This is a great chance to go through everything and add any extra evidence that you think is important. If you find something that’s wrong or incomplete, you can challenge it. CQC hasn’t said yet if this process will happen through the portal or by email.

For the PIR (Provider Information Return), the CQC is still going to use this method and ask providers for evidence to support their assessments. This could be via the portal or email or a mixture of both, using information that the provider already has. For adult social care services, CQC have advised they won’t specify a particular format for the information. They understand that different services are at different levels when it comes to using technology, so they’ll be flexible with how they collect data.


How CQC will calculate the first scores?

The CQC has introduced the plan to use scores to rate services and has released further information about what this will look like.

The first important thing to note is that the CQC advise: “When we carry out our first assessment of your service, we will select which Quality Statements to look at.”

This means when evaluating a service for the first time under the new approach, not all Quality Statements (QS) may be covered. CQC have advised they will select what QS to look at based on national priorities, set by the type of service, as well as a consideration of the information they hold about your service.

Evidence will be collected for each QS and scores assigned.

For any QS not looked at, they will base their scores on previous findings, using the published ratings for the previous KEY Question.

  • 4 for outstanding
  • 3 for good
  • 2 for requires improvement
  • 1 for inadequate

Certain topics have exceptions:

  • The Quality Statement “Workforce wellbeing and enablement”, which used to sit under Well-Led in the old framework, now sits under Caring in the new framework, but will initially still sit under Well-Led.
  • The CQC will not apply an initial score for the environmental sustainability quality statement for most services.

For adult social care only:

  • The Quality Statement “Care provision, integration, and continuity”, which now sits under Responsive in the new framework, will initially still sit under Well-Led.
  • The Quality Statement “Providing Information”, which now sits under Responsive in the new framework, will initially still be based on the Effective key question rating.

Some services (e.g., dental care, hyperbaric therapy) legally can’t receive ratings. While assessed using the new framework, scores for these services are not published.

Newly Registered Services

It is important to note, that if a service hasn’t been inspected under the new approach yet and will be inspected for the first time, initial scores are not applied. CQC have advised that evidence collection for all quality statements typically occurs within the first year.

Levels of Ratings:

New information has been provided on how the CQC will award ratings on different levels, based on different types of services under a specific location. For example at key question level, overall service rating level or rating of a location level.

We have summarised these details below but the full link can be found at the bottom of the page. CQC will evaluate healthcare services based on five key questions, assigning ratings at different levels:

Types of Services and Their Ratings:

Different services are rated at different levels:

  • Adult social care, GP services, independent doctors, and clinics: Levels 1 and 2.
  • Independent health services (single specialty): Levels 1 and 2.
  • Independent health hospitals: Levels 1, 2, 3, and 4.
  • Online primary care, urgent care: Levels 1 and 2.
  • Non-acute NHS trusts: Levels 1, 2, and 5.
  • Acute NHS trusts: Levels 1, 2, 3, 4, and 5.

Service Level Ratings

  • Level 1: Specific ratings for each key question related to a service (e.g. Safe, Effective, Caring, Responsive, Well Led)
  • Level 2: An overall rating for the entire service (like now – Good, Requires Improvement, Inadequate and Outstanding)

Location Level Ratings:

  • Level 3: Aggregated ratings for each key question at the location level (e.g., safety of a hospital).
  • Level 4: An overall rating for the entire location.
  • Level 5: An overall rating for an NHS trust, this is based on the trust-level assessment of the well-led quality statements and moderation.

Aggregating Ratings:

Changes in service providers prompt new assessments without using previous ratings.

If concerns arise during an assessment, CQC will use their professional judgement to decide whether to depart from applying the rating principles. Considerations include:

  • The extent of the concerns
  • The impact of the concerns on people who use services
  • The risk to quality and safety of services, taking into account the type of setting
  • Our confidence in the provider to address the concerns
  • Whether the provider has already taken action.

How different types of services will be rated:

Rating Principles for Adult Social Care:

  • Level 1 involves individual ratings for each key question.
  • Level 2 aggregates these ratings for an overall service rating.

All FIVE key questions will be equally weighted as opposed to previously.

Principles for overall ratings:

  • Outstanding: At least 2 key questions outstanding, others good.
  • Good: No inadequate key questions, at most 1 requires improvement.
  • Requires Improvement: 2 or more key questions require improvement.
  • Inadequate: 2 or more key questions inadequate.

Rating Principles for Health Services:

All FIVE key questions will be equally weighted as opposed to previously.

Aggregation principles are based on the number of outstanding, requires improvement, or inadequate ratings at the underlying level.

NHS Trust Level Rating:

Trust ratings are based on the 8 well-led quality statements, ensuring a strong focus on leadership, culture and governance. Factors considered include balance, evidence of quality and safety, and service-level ratings over time.

More information can be found here:

If you require support or any further guidance, please don’t hesitate to contact us at [email protected] or 01579 324787.

Further information can be found at:

Summary Keep up to date with the rollout dates for the new SAF here How the new assessments will be rolled out Information regarding the Key Questions and Quality Statements How the CQC will reach a rating Information regarding Factual Accuracy Check Information regarding the PIR Keep up to date with the digital health and social care plans


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