New and improved, or is it? – The CQC’s Single Assessment Framework

United Kingdom

The new Care Quality Commission (CQC) single assessment framework is now in force for health and social care providers across England. As background, the new framework aims to provide a single vision of quality for the whole health and care system – you can read more about the changes in our previous article titled “Out with the old, in with the new – what do healthcare and social care service providers need to know about the CQC’s new single assessment framework?” – (here)[1]. So now that the framework has been fully rolled out to providers, how is it going and what do providers think? And what of the somewhat controversial next phase of the roll out to Integrated Care Systems?

Areas of Feedback and CQC’s Response

The CQC reports that the first health and social care providers to be assessed under the new framework have expressed overall support for the new assessment approach, including the flexibility offered by the single assessment framework supported by quality statements. There is, however, still work to be done in refining the process and provider feedback has highlighted some key areas where improvements are required[2].

Quality Statements

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about the high number of quality statements used in assessments, with a concern that this could lead to reliance on outdated evidence, translating to inaccurate assessment scores.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 resources to prioritise the assessment of services not recently inspected or currently rated inadequate or requires improvement, with a view to ensuring 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.

Frequency of Assessments

Providers are, understandably, seeking clarity on assessment frequency. The CQC has provided an assurance that they are in the process of gathering data which will allow them to publish assessment timelines by summer 2024.

Relationships with Providers

Concerns have been raised by providers about the absence of dedicated relationship holders within the CQC. In response, the CQC has promised that, despite potential changes in contacts, a team structure will be in place to ensure that providers always have access to individuals with knowledge about their service. The CQC reports they are reviewing the assessment team structure based on feedback received and any updates resulting from this review will be communicated to providers by April 2024.

Clarity of Guidance

Providers have described the guidance section of the website as confusing and difficult to navigate. The CQC has stated they have introduced a clearer 'guidance and regulation' landing page along with an index page to aid navigation. To enhance transparency, 'last significant update' dates have been added for guidance sections to facilitate tracking changes effectively.

Provider Portal

It is widely-known that the CQC has experienced significant technical difficulty in the roll out of the new provider portal. Refinements to the provider portal are ongoing based on feedback, particularly addressing the enrolment issues.

The CQC states they are confident that as they continue to assess services against the new framework and as their technological changes mature and become embedded, the strategic aims behind their transformation will be realised. The aims are regulation driven by people's needs and experiences, smarter regulation, safety through learning, and accelerated improvement. We continue to monitor feedback and it remains to be seen how well the changes will fulfil these aims.

Introduction of CQC’s New Assessment of Integrated Care Systems (‘ICS’)

The introduction of the single assessment framework in respect of Integrated Care Systems (‘ICS’) is causing a stir amongst the care sector. The recent Health and Care Act 2022 bestows new responsibilities and powers on the CQC to assess whether ICS’ are meeting the needs of their local populations. The new approach is intended to enable the CQC to understand how ICS’ are working to tackle health inequalities and improve outcomes for people.[3]

Expected implementation date and recent developments

The CQC planned to start to review data and publish documentary evidence across all local authorities from 1 April 2024. However, following discussions with the Department of Health and Social Care they have agreed to a short delay to starting ICS assessments to allow for further refinements to their approach. A specific date is yet to be released [4]. Following the announcement to the delay in the assessments, it is understood that the plans for ICS’ to be given CQC ratings are still on hold and no ratings will be issued until summer 2024 at the earliest[5].

Potential limitations

Criticism and concerns regarding the new ICS assessments have emerged before the roll out has even begun[6]. The first area of contention has been who will pay for the assessments which the CQC has estimated will result in annual regulatory costs of £5.5 million.  In December 2023, the CQC concluded its consultation regarding the proposed introduction of an annual fee whereby it was envisaged that each Integrated Care Board (ICB) would pay the annual regulatory fee proportionate to its running cost allowance[7]. At a time when NHS budgets are tight and providers are asked to reduce expenditure in the face of rising demand, these costs are substantial and have, understandably, been met with resistance from ICS leaders[8]. The outcome of the consultation and the finalised fee scheme are yet to be published, pending the required government approval[9].

There is a question around the added value of the implementation of ICS assessments against a backdrop of existing inspection regimes. ICBs are already given “segmentation” ratings under NHSE’s oversight framework, based on performance and quality indicators, and NHSE’s judgements. The concern is that without such clarity, there is a risk of duplicating existing regulation and inflating both costs and the burden on providers without adding benefits for patients and taxpayers. Back in December 2023, the NHS Confederation’s ICS Network had already urged the CQC to reassess the ICS assessment process and explore the potential for developing a more collaborative approach that offers value to all stakeholders involved[10].

A further concern is that adding ICB regulation to the CQC’s remit could ultimately lower regulatory standards and result in a slower overall assessment process. The rationale is the significant additional responsibility for an already stretched regulatory body will increase resource pressures on the CQC who would, therefore, be less able to prioritise revisiting ratings in providers considered lower risk.

How can we help you?

We are regularly monitoring the progress and updates to the new CQC framework and assessments. If you are a health or social care provider and require advice or assistance, please contact us. Our team are on-hand to help with your CQC and other regulatory enquiries.

Article co-authored by Leia Hayes, Solicitor Apprentice at CMS

[1] "Out with the old, in with the new – what do healthcare and social care service providers need to know about the CQC’s new single assessment framework?" – CMS, Law-Now

[2] "Reflecting on your feedback supports our ongoing improvement" - Care Quality Commission, Medium

[3] "Our approach to assessing local authorities" - Care Quality Commission

[4] "Integrated care system assessments: update April 2024" - Care Quality Commission

[5] “CQC to inspect first ICSs this summer” – Health Service Journal

[6] Increased CQC fees for ICBs threaten drive to improve care" - NHS Confederation

[7] “Consultation: regulatory fees for integrated care system assessments” – Care Quality Commission

[8] See footnote 6 above.

[9] See footnote 4 above.

[10] See footnote 6 above.