CQC Single Assessment Framework: A Complete Guide & Latest Updates

The Care Quality Commission (CQC) helps maintain and enhance the quality of England’s health and social care services. It ensures that care services are safe, effective, and compassionate while seeking to improve. In 2024, the CQC introduced a new single assessment framework that applies to all health and social care services. 

This article will explore the major changes introduced with the new CQC single assessment framework, what remained the same, and some latest updates after its phased rollout.

Understanding the CQC Single Assessment Framework

The new CQC framework is constructed around five key questions, maintaining the well-known rating system. However, a significant change was introduced by replacing KLOEs with quality statements. 

The rollout of this new framework began with an introductory phase in November 2023 and extended across England by March 2024. 

The CQC moved to a single assessment framework (SAF) to evaluate health and social care services in England. 

It’s centred on five key questions:

• Safe: Are services protecting people from harm?
• Effective: Does care, treatment, and support achieve good outcomes?
• Caring: Do staff involve and treat people with compassion, kindness, dignity, and respect?
• Responsive: Are services organised to meet people’s needs?
• Well-led: Does leadership ensure high-quality care and continuous improvement?

Each key question is made up of a set of 34 Quality Statements that define how care is delivered and what good care looks like. 

The CQC new single assessment framework was applicable to care providers, local authorities, and integrated care systems. 

It was designed to simplify the regulatory process, moving away from separate frameworks for different types of health and social care services to a single, unified set of expectations.

Why Was the CQC Single Assessment Framework Introduced?

There are three main reasons why the CQC single assessment framework was introduced.

• To make things simpler so care providers can focus on what really matters to people.
• To better reflect how care is actually delivered by different types of service as well as across a local area.
• To create a framework that connects registration activity to assessments of quality.

What Changed With the CQC Single Assessment Framework?

Quality Statements

The CQC retained its five key questions central to its assessment approach, focusing on whether services are safe, effective, caring, responsive, and well-led. 

However, a major change was the replacement of the previous key lines of enquiry (KLOEs) and 300+ prompts with 34 quality statements. 

These quality statements were expected to reduce duplication and focus more specifically on topic areas under each key question, linking directly to the relevant regulations. 

The shift to quality statements, referred to as ‘we statements’ from a provider’s perspective, aimed to clarify expectations and simplify the assessment process​​.

Six Evidence Categories in the New CQC Framework

The CQC grouped the different types of evidence they looked at into 6 categories. Each category would help them understand the quality of care being provided and the performance against each quality statement. It would focus on relevant evidence categories when assessing particular quality statements.

However, the number of evidence categories it considers and their sources depends on the following factors:

• The model or type of service
• The level of assessment, such as local authority, provider, service, or integrated care systems
• Whether the assessment is for an existing care service or at registration

Evidence could be information the CQC already has or is actively looking for, gathered through both on-site and off-site activities. The CQC can visit a site to collect evidence without prior notice, especially in response to a specific concern.

These 6 evidence categories are:

1. People’s Experiences: Focusing on how people experience care and services firsthand.
2. Feedback from Staff and Leaders: Evaluating insights from those who deliver and oversee care.
3. Observations of Care: Direct observation of care practices and interactions.
4. Feedback from Partners: Gathering perspectives from other organisations and entities involved in care delivery.
5. Processes: Looking at the systems and procedures in place to deliver care.
6. Outcomes of Care: Assessing the results and impacts of the care provided​​.

Here’s how the CQC scored evidence categories:

4	Exceptional standard
3	Good standard
2	Some shortfalls
1	Significant shortfalls

The CQC does not publish evidence category scores but shares them with care providers. 

The New Scoring System

Under the CQC single assessment framework, the methodology for determining the four traditional ratings (Outstanding, Good, Requires Improvement, and Inadequate) has been changed. 

The CQC introduced a scoring system into its assessments. When evaluating evidence, the CQC would assign scores to evidence categories related to each quality statement. These scores will then contribute to the overall rating. 

Some care services listed on the CQC website will not have ratings. It’s because:

• It does not have the legal power to rate some services like dental practices.
• Some care services may not have been assessed yet, though they might be registered with the CQC.
• Some old reports were published even before ratings were introduced.

The CQC gives percentages as well as ratings in its new assessment reports. 

The scores for each rating are:

Ratings	Score
Outstanding	88% – 100%
Good	63% – 87%
Requires improvement	39% – 62%
Inadequate	38% or lower

The CQC follows a three-step process to give a rating to a service.

• Review the evidence for each quality statement
• Assign scores to the relevant evidence categories
• Combine these scores to generate a score for the quality statement

After this, the scores for all quality statements are combined to produce an overall score for each key question. The ratings for key questions are aggregated to produce an overall rating. 

Scores are calculated individually for quality statements and key questions. While all evidence categories are usually weighted equally, there are some exceptions. For example, if a warning notice is issued for a particular area, it may affect the score for that quality statement.

What Wasn’t Changed in the New CQC Single Assessment Framework?

Here are the key elements that have not changed in the new CQC inspection framework:

The Rating System

The well-known CQC rating system, which classifies care services as Outstanding, Good, Requiring improvement, or Inadequate, continues to be a central aspect of the assessment process. The CQC awards an overall rating for a care service based on a set of aggregation rules taking into account the 5 key questions. 

When combining scores to produce an overall rating, the CQC applies the following principles:

• The five key questions are equally weighted.
• For an overall outstanding rating, at least two key questions must be outstanding and three good.
• If two or more key questions require improvement, the overall rating will be ‘requires improvement’.
• If two or more key questions are inadequate, the overall rating will be inadequate.

The 5 Key Questions

The framework retains the five key questions that assess the core aspects of care services:

• Safe: Are people protected from harm and abuse?
• Effective: Does the care, treatment, and support achieve good outcomes and promote a good quality of life?
• Caring: Do staff involve and treat people with compassion, kindness, dignity, and respect?
• Responsive: Are services organised to meet people’s needs?
• Well-led: Does the leadership, management, and governance of the organisation assure the delivery of high-quality care?

CQC Single Assessment Framework 2024: Rollout Challenges & Latest Updates

An interim report of an independent review of the CQC by Dr Penny Dash was published in July 2024, while a full report was published in October 2024. It has revealed significant failings in the internal workings and operational effectiveness of the CQC. 

The report highlighted its inability to identify poor performance and support better quality care at care homes, hospitals, and general practices, which has led to a substantial loss of credibility within the sector. In response, the CQC has been implementing significant changes in the last few months.

In particular, the 2024 rollout of the CQC single assessment framework has faced major challenges, complicating its goal of streamlining care quality assessments:

• Complexity and Inflexibility

The CQC aimed to simplify the assessment process by creating a single assessment framework for all sectors it regulates. However, the CQC new single assessment framework failed to account for the significant differences between services, such as hospitals, adult social care, and primary care. A ‘one-size-fits-all’ approach was impractical, leading to confusion among inspectors and service providers. 

• Lack of Clinical Expertise

Another major issue was the loss of clinical leadership and oversight in inspection processes. Previously, chief inspectors had a direct role in their sectors’ inspections, but under the new CQC single assessment framework, their involvement diminished. This reduced the quality of support for frontline inspectors and contributed to a decline in clinical input in assessments, essential for the healthcare sector.

• Inefficiencies in Inspection and Reporting

Since 2019, there has been a substantial reduction in CQC inspection activities, coupled with delays in the registration process and follow-up inspections. 

The CQC single assessment framework involved scoring across multiple evidence categories for each quality statement. This process increased delays in the number of inspections conducted and the publication of inspection reports. The time required to collect and score evidence, especially using the new regulatory platform, was burdensome. Additionally, the scoring system was criticised as ‘pseudoscience’ because it precluded professional judgment, making it harder to accurately reflect service quality. 

These delays impact the efficiency and reliability of the framework, leaving gaps in oversight and hindering service improvements.

• Rating System Flaws

The SAF’s insistence on scoring each evidence category for every quality statement was found to be impractical. Inspectors found this method overly rigid. It limited their ability to apply professional judgment in assessing the overall quality of care. The scoring system also led to unfair ratings, particularly in cases where minor improvements could have changed the rating.

The scoring system allowed services to receive positive ratings even when they were in breach of fundamental standards. This caused confusion, as a ‘good’ rating might mask serious regulatory breaches unless the full report was taken into consideration. Combining new ratings with older assessments also made it difficult to determine the current quality of care, undermining the credibility of the rating system.

This has affected the trustworthiness of ratings and overall sector confidence in the SAF.

• Technical Issues with the Regulatory Platform

The provider portal started in July 2023 and the regulatory platform in November 2023 has been plagued with technical difficulties. Providers report losing time due to inefficiencies, including the inability to easily upload documents, taking several hours to reset a password, etc. It hampered the seamless implementation of the CQC single assessment framework, causing frustration among care providers. 

• Lack of Patient Trust and Confidence

The complex methodology and rigid scoring system of the CQC single assessment framework led to inconsistent ratings that did not reflect the actual quality of care. This affected public trust in CQC’s ratings, as it failed to deliver on its promise of simplifying and improving the assessment process.

• Insufficient Training and Staff Demoralisation

CQC staff were demoralised by the changes introduced under the SAF. They felt that their concerns were ignored by senior leadership, leading to high turnover. The lack of adequate training for new hires and insufficient testing before implementing the CQC single assessment framework. It strained CQC’s capacity to carry out timely and effective CQC inspections.

A second review of the CQC single assessment framework analysing the wider landscape for quality of care, with an initial focus on safety, will be published in early 2025.

Prepare for CQC Inspections with the GoAudits audit app

Preparing for CQC inspections can be a demanding task. It requires meticulous planning, comprehensive record-keeping, and compliance with expected CQC standards. The GoAudits care audit app makes it easy to prepare for CQC inspections. Here’s how:

• Save time and go paperless with a user-friendly mobile app
• Easily produce evidence of good governance, in line with Regulation 17
• Implement continuous improvement with well-tracked corrective actions, show evidence of an effective ‘improvement loop’ to inspectors
• Use regular internal audits as a training tool to upskill your team on CQC fundamental standards

Some of the features of the GoAudits self-audit app for care homes include:

• User-friendly mobile app for inspections on the go, even offline.
• Generate and share professional, branded audit reports with one click.
• Assign tasks during inspections, track progress, and ensure timely completion of corrective actions.
• Identify trends, non-compliance areas, and recurring issues to proactively address risks and improve performance ahead of CQC inspections.
• Access a wide range of pre-built checklists for CQC inspections, customise them anytime, or create your own checklists.

Free & Customisable Checklists for Care Providers

With GoAudits, you get access to an extensive library of healthcare checklists. You can use the checklists below to ensure compliance and improve the quality of care.

• CQC Inspection Audit Checklist
• CQC Dental Inspection Checklist
• CQC Registered Manager Checklist
• MAR/EMAR Audit Checklist
• Care Home Audit Checklist
• Patient Care Checklist
• Care Home General Observation
• Daily Care Home Audit
• Care Home Cleaning Checklist – Daily
• Care Home Internal Audit Checklist
• Dignity in Care Audit