Summary
The aim of this short-term review is to support CQC in addressing the concerns relating to the single assessment framework and its implementation identified in the interim report by Dr Penny Dash (July 2024).
Work will initially focus on the NHS and independent healthcare, with preliminary findings informing the approach to reviewing the single assessment framework and implementation in other areas.
The review has been commissioned by CQC. The report will be addressed to the Chief Executive and Board of CQC and is to be treated as confidential to CQC but on the understanding it will be shared by CQC with the Department of Health and Social Care including ministers.
Areas of focus
- Assessing whether the single assessment framework is fit for purpose in both design and implementation including the transition from previous approaches. If not, making recommendations on changes that may be needed.
- Addressing specific concerns raised by Dr Penny Dash in relation to the single assessment framework and implementation including:
- the lack of clear definitions of what ‘outstanding’, ‘good’, ‘requires improvement’ and ‘inadequate’ look like for each evidence category (as per previous key lines of enquiry)
- the rationale for prioritising certain quality statements in different sectors
- the lack of emphasis on outcome measures
- the absence of focus on use of resources or efficient delivery of care
- the quality of documentation on the CQC website
- the lack of focus on innovation within the quality statements
- Making recommendations on CQC’s approach to implementation of the single assessment framework, in relation to the expertise and credibility of staff at all levels, to ensure credibility of the assessment and inspection process. This should include consideration of the amount of evidence collected to form a judgement.
- Making recommendations on the approach to ratings derived from assessment of the 5 key questions, 34 quality statements, 6 evidence categories and 4 scoring levels. This should include consideration of the flexibility of the single assessment framework and if priority quality statements need to be used.
Process
Professor Sir Mike Richards will work closely with CQC staff on this review and will be supported by a small team from CQC. The following steps are envisaged:
- Review of documentation regarding the single assessment framework and examples of assessments made using it.
- Review of organisational structure and staffing levels/expertise.
- Review of data currently used by CQC to inform assessments.
- Interviews with senior CQC staff who have been involved in the development and roll out of the single assessment framework.
- Interviews/focus groups with frontline operational staff and operational managers.
- Interviews and roundtables with leaders of organisations in different sectors that have been inspected using the single assessment framework.
Scope
Although the single assessment framework is designed to be used across all sectors regulated by CQC, this review will initially primarily focus on its use in the NHS and independent healthcare (including primary and secondary care, mental health, community and ambulance).
The findings from the initial phase of this review will be used to inform the approach of reviewing single assessment framework and its implementation in other sectors.
The following areas are not in scope for this review:
- Reviewing and making recommendations on operational performance and IT systems (including the provider portal).
- Reviewing the role of CQC within the wider regulatory ecosystem. This is being undertaken as part 2 of the Dash review.
Timescale
- Key findings to be reported as the work progresses where possible.
- Aim for final report to be delivered in autumn.
Reporting
- There will be high level interim findings and a full report to follow.
- Both will be sent to the Chief Executive, who will share with the executive team and the Board.
- CQC will share the reports (interim and full) with the Department of Health and Social Care.
- CQC wishes to be transparent and will commit to making the findings from the review public on a timely basis, in a form to be agreed with Professor Sir Mike Richards.