Louie Werth is the founder and director of Care Research, an independent research group that exclusively supports the care sector. Care Research support services by running independent CQC Feedback surveys for people receiving care, families, staff and partners as well as proving training to support services to understand and implement the CQC Single Assessment Framework.
As we begin the New Year, lots of care services are wondering ‘What’s going on with CQC?’ and ‘How can we prepare for an inspection in 2025?’. At Care Research we’ve been training providers around the Single Assessment Framework, providing free webinars and doing everything we can to help services understand and prepare. This article outlines what has happened in 2024, the changes coming through 2025 and what you can do to be ready for your next CQC inspection.
The Single Assessment Framework in 2024…
The CQC’s Single Assessment was rolled out across England through Dec 2023 into the first months of 2024. As reminder, some the key features of the framework are:
34 Quality Statements- These are the areas of care that are assessed which replace the KLOE prompts.
6 evidence categories- People’s Experience, Feedback from staff and leaders, Feedback from Partners, Processes, Observations and Outcomes (Outcomes evidence category is not in place for residential services and both observations and outcomes evidence categories are not in place for Homecare services).
1-4 scoring process for evidence categories that then generates scores for each Quality Statement which would then lead to the scores for each Key Question and (therefore) the service rating.
Remote inspectors and a much greater focus on collecting digital evidence remotely following the in-person part of the inspection.
Re-structured CQC reports with most services not being inspected against all 34 Quality Statements.
Use of previous CQC ratings information to inform the scores of any Quality Statements not initially assessed.
The promise of a digital portal that would make evidence collection and sharing much easier and give better communication pathways between services and CQC.
However, 2024 has not been smooth sailing. Though there is much that could be critiqued about the roll out, communication, and (of course) the online portal that never properly materialised for thousands of services, a key central issue CQC found in 2024 was that they simply weren’t able to inspect nearly enough services.
To illustrate this, between July 2024 and late Dec 2024 a total of 698 residential service reports and 315 Homecare service reports have been published. There are circa 10,000 residential services in England and around 12,000 homecare services. At this rate, it would take 16 years to assess all the residential services in England and 15.9 years to assess all the Homecare services- and that just assessing each one once!
As a result, CQC are making changes to ensure they can assess more services in 2025.
Changes to the Single Assessment Framework in 2025…
As we start 2025, there are some key changes CQC are making to their assessment process to speed things up:
Removing evidence category scoring and returning to ‘professional judgement’
Throughout 2024, CQC would score every evidence category for every Quality Statement individually. All in, a full assessment of 34 Quality statements would result in over 97 individual evidence category scores for homecare services and 107 for residential services! This was simply too time consuming. So, from December 2nd 2024 CQC inspectors no longer score at Evidence category level and CQC inspectors are instead reviewing all evidence and using professional judgement to create a 1-4 score for each Quality Statement.
A change to CQC reports
CQC are also changing their CQC reports to be more succinct. Throughout 2024, reports often included a few short paragraphs per Quality Statement (often built around each individual evidence category). This resulted in very long reports and a lot for inspectors to write. The new reports that have been used in recent CQC trials with providers are much more succinct with a simple sentence or 2 for each Quality Statement alongside the 1-4 score.
More guidance for providers
CQC initially did not want to burden services with lengthy additional information and guidance, hoping that the Quality Statements and Evidence Categories would suffice in supporting services to prepare. However, many in the sector felt more help was needed. On October 31st CQC released a draft ‘Key Questions and Quality Statements Ratings Characteristics’ document. This outlines what Outstanding, Good, Requires Improvement and Inadequate look like for each Key Question and each individual Quality Statement. CQC have confirmed that more work is being done to consolidate and complete this document and a new provider guidance handbook is also in the works too.
No more using old CQC reports to create new Quality Statement scores
One of the most unpopular aspects of the framework was the decision to use previous CQC ratings to score relevant Quality Statements that were not considered at inspection. For example, if a service was assessed against 18 Quality Statements, the remaining 16 would be ‘filled in’ using the previous rating. For example, if you previously had a ‘Good’ in SAFE, any non-assessed SAFE Quality Statements would receive a ‘3’ score (there were some slight variations as some Quality Statements were in Key Questions that didn’t correspond to the old approaches). This is no longer in place.
How many Quality Statements will CQC assess each time?
The move away from using old scores for non-assessed Quality Statements also raises the issue of how many Quality Statements CQC will assess at one time. Over the course of this year, we’ve seen reports with just 2 Quality Statements assessed all the way up to the full 34 with everything in between. One of the flagship aspects of the framework was CQC being able to assess services in more targeted ways as opposed to the ‘floor to board- all or nothing’ approach of the previous framework. CQC have stated they are now ‘Developing ways to produce an accurate rating while using a select number of Quality Statements’. There is clearly a continued commitment to assess services in targeted ways but (with the use of old scores being stopped) we will have to see quite what this will look like. CQC have stated more information on this approach will be shared early in 2025.
A return to a closer relationship management approach
A big issue providers had with the new framework was that many services felt they lost their designated CQC contact as they moved to a broader management approach based around both geographies and sector expertise. CQC have openly stated their approach to relationship management did not work and pilots have been conducted to develop closer named relationships between services and inspectors. It appears that move back towards the relationship management approach that what was in place prior to the new framework is being worked out and considered. Again, we should hear more information on this as plans are firmed up in the early part of 2025.
What can providers do?
Though nothing ‘on the ground’ has changed for providers and the framework, there are a few things you can do to prepare for your next inspection. Here are my top 3 tips:
- Focus on Feedback
Over 60% of the evidence CQC will collect is feedback evidence. Ensure you are collecting amazing feedback that is tied to the Quality Statements and capturing the views of people you support and families (People’s Experience evidence) staff (Feedback from staff and leaders) and professional partners (Feedback from partners evidence). If you’re unsure where to start, we can help. We supported over 400 care services in 2024 with our CQC Feedback Evidence Surveys.
- Organise your evidence
CQC have not scrapped or changed the Quality Statements or the Evidence Categories, so use these as structures to organise your evidence. Think about the type of evidence it is and which Quality Statement(s) it best fits and use a shared drive or label, store and organise your evidence.
- Prepare your care staff
Feedback from staff and leaders is an evidence category for every single Quality Statement. CQC are very keen and pro-active in speaking to care staff. Our clients have informed us of staff experiencing hour long phone calls with CQC as well as emails with over 20 questions. We need our care staff to be supported and prepared to speak with CQC and we need to give them the space to practice answering the sorts of questions CQC may ask. At Care Research, we have developed our Care Staff Confidence: How to speak to a CQC Inspector video course so that care services have the resources they need to support and encourage staff to engage with CQC.
2025 is a pivotal year for CQC. The new framework has some great strengths that will benefit people receiving care, their families and social care providers. But the rollout and other challenges have limited its impact and the good it could do. This year, CQC will be making tweaks and changes to ensure more services can be assessed and supported. We must continue to prepare whilst simultaneously holding the CQC to account- what the sector wants is clear: a robust regulator who fairly and effectively assesses and supports care services. My hope is that, this year, we see this more fully materialise.
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