Review of CQC's single assessment framework and its implementation

In 2021, CQC published ‘A new strategy for the changing world of health and social care – our strategy for 2021’. [6] This confirmed CQC’s purpose “To ensure health and care services provide people with safe, effective, compassionate, high-quality care and to encourage those services to improve”. The new strategy set out ambitions under 4 themes:

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

With 2 core ambitions running through each of these themes:

• Assessing local systems
• Tackling inequalities in health and care

The strategy set out a large number of benefits that it was intended to deliver, but without clear (indeed any) statements on how each of these would be achieved. The strategy did, however, list 12 broad outcomes that CQC would achieve:

People and communities

1. Our activity is driven by people’s experiences of care.
2. We clearly define quality and safety in line with people’s changing needs and expectations. This definition is used consistently by all people and at all levels of the health and social care system.
3. Our ways of working meet people’s needs because they are developed in partnership with them.

Smarter regulation

4. We are an effective, proportionate, targeted and dynamic regulator.
5. We provide an up-to-date and accurate picture of quality.
6. It is easy for health and care services, the people who use them and stakeholders to exchange relevant information with us, and the information we provide is accessible, relevant and useful.

Safety through learning

7. There is improvement in safety cultures across health and care services and local systems that benefit people because of our contribution.
8. People receive safer care when using and moving between health and social care services because of our contribution.

Accelerating improvement

9. We have accelerated improvements in the quality of care.
10. We have encouraged and enabled safe innovation that benefits people or results in more effective and efficient services.

Core ambitions

11. We have contributed to an improvement in people receiving joined-up care.
12. We have influenced others to reduce inequalities in people’s access, experiences and outcomes when using health and social care services.

While these outcomes are aspirational, the strategy does not provide any indication of how its vision might be achieved. Nor are there any metrics against which progress towards the stated outcomes might be measured. The findings outlined in Penny Dash’s interim report suggest that limited or no progress has been made on the majority of these outcomes, despite the strategy being published 3 years ago.

Subsequent to the publication of the strategy, a transformation programme was initiated, with 3 key components:

• The development of a single assessment framework.
• Major changes to the structure of the organisation, with the establishment of an operations directorate separate from regulatory leadership.
• Major changes to the IT systems used by CQC, with a new regulatory platform and provider portal to replace the existing (and ageing) customer relationship management (CRM) system.

Note

[6] ‘A new strategy for the changing world of health and social care – our strategy for 2021’, Care Quality Commission, May 2021 https://www.cqc.org.uk/about-us/our-strategy-plans/new-strategy-changing-world-health-social-care-cqcs-strategy-2021