CQC �Single Assessment Framework

Date: 2025

Why we’re changing?

• To have a greater focus on care across local areas or systems
• To use our new regulatory powers effectively to improve people’s care
• To make our regulation less complex and more efficient
• To regulate in a smarter way
• To work better with the sector �as it changes and recovers

How we are changing:�Our strategy 

Regulating across systems and �tackling health inequalities

• People and communities
• Smarter regulation
• Safety through learning
• Accelerated improvement

What will not change

We will still be assessing against the five Key Questions

Is the service Safe

Is the service Effective

Is the service Caring

Is the service Responsive

Is the service Well-led

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We will still be rating

Outstanding

Good

Requires Improvement

Inadequate

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What will change?

Our new approach will fall into four main areas:

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• New technology – we’ll be able to harness what we hear from people using services through new data and insight skills and technology

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• New policy – we’ll use a single quality assessment framework for all service types and at all levels

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• New ways of organising – we’ll be working in multidisciplinary teams to make sure we can look at quality better across an area

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• New responsibilities – we’ll build on our previous activity looking at how services work together across a local area with new powers to look at Integrated Care Systems and local authorities

Our new online portal

We’ve created a new online portal for providers to interact with us in a simple and intuitive way.

Some examples of what this new portal will allow providers to do:

• Easily share information with the CQC, �including submitting notifications
• Register or apply to make changes to their �registration
• Manage their user accounts and easily �access information about their activity

Some providers have now been invited to login and start using its functionality.

Under each of the Key QUESTIONS will sit QUALITY STATEMENTS

What are quality statements?

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Quality statements are 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-centred care.

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The quality statements show how services and providers need to work together to plan and deliver high quality care. They directly relate to the regulations.

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When they refer to ‘people’ we mean people who use services, their families, friends and unpaid carers.

https://www.cqc.org.uk/assessment/quality-statements

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They are six categories that we have grouped into different types of evidence that we will look at.

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Evidence categories help us to do a few things;

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• Tailor how we assess quality statements depending on the level or sector we’re focusing on
• Collect and store evidence in a structured way
• Be more targeted in what we spend our time looking at
• Guide how we’ll look at different evidence; supporting colleagues and providers to have a better understanding on the methods we’d use to collect said evidence

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We will make clear what we look at in our assessments by setting out the key evidence categories we’ll focus on for each quality statement.

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Under each of the QUALITITY STATEMENTS will sit EVIDENCE CATEGORIES.

What are evidence categories?

https://www.cqc.org.uk/assessment/evidence-categories

This is all types of evidence from people who have experience relating to a specific health or care service, or a pathway across services. It also includes evidence from families, carers and advocates for people who use services.

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We define people’s experiences as:

“a person’s needs, expectations, lived experience and satisfaction with their care, support and treatment. This includes access to and transfers between services”.

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Find out about the importance of people’s experience in our assessments

Evidence Category

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People’s experience of health and care services

https://www.cqc.org.uk/assessment/evidence-categories

This is evidence from people who work in a service, local authority or integrated care system, and groups of staff involved in providing care to people.

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It also includes evidence from those in leadership positions.

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This includes, for example:

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• results from staff surveys and feedback from staff to their employer
• individual interviews or focus groups with staff
• interviews with leaders
• feedback from people working in a service sent through our Give �feedback on care service
• whistleblowing

Evidence category

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Feedback from staff and leaders

https://www.cqc.org.uk/assessment/evidence-categories

This is evidence from people representing organisations that interact with the service or organisation that is being assessed.

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We may gather evidence through interviews and engagement events.

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The organisations include, for example:

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• commissioners
• other local providers
• professional regulators
• accreditation bodies
• royal colleges
• multi-agency bodies.

Evidence category

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Feedback from partners

https://www.cqc.org.uk/assessment/evidence-categories

Observing care and the care environment will remain an important way to assess quality.

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Most observation will be carried out on the premises by CQC inspectors and Specialist Professional Advisors (SpAs).

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External bodies may also carry out observations of care and provide evidence, for example, Local Healthwatch. Where the evidence from organisations such as Healthwatch is specifically about observation of the care environment, we will include it in this category, and not in the people’s experiences category.

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We will not use the observation category for local authority assessments. It �does not apply to a local authority context.

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All observation is carried out on site.

Evidence category

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Observation

https://www.cqc.org.uk/assessment/evidence-categories

Processes are any series of steps, arrangements or activities that are carried out to enable a provider or organisation to deliver its objectives.

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Our assessments focus on how effective policies and procedures are. To do this, we will look at information and data sources that measure the outcomes from processes. For example, we may consider processes to:

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• measure and respond to information from audits
• look at learning from incidents or notifications
• review people's care and clinical records.

Evidence category

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Processes

https://www.cqc.org.uk/assessment/evidence-categories

Outcomes are focused on the impact of care processes on individuals. They cover how care has affected people’s physical, functional or psychological status.

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We consider outcomes measures in context of the service and the specifics of the measure.

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Some examples of outcome measures are:

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• mortality rates
• emergency admissions and re-admission rates to hospital
• infection control rates
• vaccination and prescribing data.

Outcomes

https://www.cqc.org.uk/assessment/evidence-categories

• To assess for a particular quality statement, we collect and assess evidence within each �of the relevant categories. This will be built into the regulatory platform.
• For the first assessment of the quality statement, we assess all the evidence categories �that are set for that topic.
• For subsequent assessments we may choose not to assess all categories when we review the topic. We can update the quality statement score by scoring one or more of the evidence category scores.
• We will use our professional judgement to decide if new evidence is necessary.
• We can use existing evidence alongside new evidence to reach our scoring decision.
• To support consistent scoring of evidence categories we have the following scale:

4 Evidence shows an exceptional standard of care

3 Evidence shows a good standard of care

2 Evidence shows some shortfalls in the standard of care

1 Evidence shows significant shortfalls in the standard of care

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Scoring evidence categories

https://www.cqc.org.uk/assessment/evidence-categories

• The quality statement scores will be used to produce key question scores and ratings.
• There are rules within the key question rating calculation that prevent poor quality being masked
• If the key question score is within the good range, but one or more of the quality statement scores is 1, the rating is limited to requires improvement.
• If the key question score is within the outstanding range, but one or more of the quality statement scores is 1 or 2, the rating is limited to good.
• The key question score will tell us where within the range of a rating quality is – eg, Good but nearly Outstanding
• Key question ratings will aggregate to give an overall rating – there is no score for overall service

Key question scores and ratings

Scoring scale

4. Evidence shows an exceptional standard of care

3. Evidence shows a good standard of care

2. Evidence shows some shortfalls in the standard of care

1. Evidence shows significant shortfalls in the standard of care

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Required categories:

• People’s experience
• Feedback from staff and leaders
• Observation
• Feedback from partners
• Processes
• Outcomes

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Scores given:

Peoples experience 3

Feedback from staff and leaders 3

Observation 3

Processes 2

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Total of 11 (out of a possible 16)

69%

Quality statement score

3

All categories have equal weight

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Example: QS – involving people to manage risk

Example: continued

Remember… 8 is the minimum score (not zero)

Key question ratings then determine the overall rating

Questions?