Understanding the Full Review of CQC's Single Assessment Framework

The Care Quality Commission (CQC) yesterday released a comprehensive review of its single assessment framework and its implementation. This review, conducted by Professor Sir Mike Richards, provides insights into the framework's effectiveness and offers key recommendations for improvement.?

In this blog, I delve into the findings and understand what this means for the future of health and social care regulation in the UK.

Before we dive into this subject, if you have not already, please join over 9,400 people and subscribe here so that you receive future newsletters straight to your email inbox ??

Background of the Single Assessment Framework

The single assessment framework was introduced as part of the Care Quality Commission new strategy in 2021. It aimed to streamline the assessment process across all sectors regulated by CQC, including hospitals, mental health services, ambulances, primary and community care services and adult social care. The framework was designed to ensure a unified approach to quality assessment, making it easier to compare and improve services.

Key Findings of the Review

The review highlights several critical issues with the single assessment framework and its implementation:

1. Complexity and Inconsistency

The framework is deemed too complex and does not account for the vast differences in the size, complexity and functions of the services regulated by CQC. This one-size-fits-all approach has led to confusion among both inspectors and providers. The complexity has also made it challenging to apply the framework consistently across different service types, leading to variability in inspection outcomes.

?

2. Operational Challenges

The introduction of the framework, along with a major organisational restructure and a new IT system, has not delivered the intended benefits. Instead, it has resulted in fewer inspections, delayed reports and demoralised staff.?

The operational challenges have been exacerbated by the simultaneous implementation of multiple significant changes, which has stretched resources and impacted the quality of inspections.

?

3. Impact on Staff and Providers

Staff morale is within the CQC is low, with many feeling that their concerns have not been addressed. Providers have also expressed frustration with the inspection process and the quality of reports, leading to a loss of confidence in CQC. The disconnect between the framework's intended outcomes and the reality experienced by staff and providers has created a sense of disillusionment and disengagement.

?

4. Loss of Clinical Leadership

The structural reorganisation has separated policy development from operational delivery, leading to a disconnect between strategy and practice. The loss of clinical leadership and oversight has further compounded these issues. Clinical input is crucial for ensuring that assessments are grounded in practical, real-world healthcare experience, and its absence has been keenly felt.

?Recommendations for Improvement

The review makes several key recommendations to address these challenges and improve the effectiveness of the single assessment framework:

?

1. The framework should be simplified to better reflect the diversity of services regulated by CQC. This includes reducing the number of quality statements and focusing more on outcomes rather than process measures. Simplification will help make the framework more user-friendly and easier to apply consistently across different service types.

?

2. Adequate training and support should be provided to inspection staff to ensure they are well-equipped to carry out their duties. This includes improving induction processes and providing ongoing professional development. Enhanced training will help inspectors feel more confident and competent in their roles, leading to more effective and reliable assessments.

?

3. CQC should work to rebuild trust and partnership with providers. This involves clear communication, timely feedback, and a more collaborative approach to regulation. Building stronger relationships with providers will help create a more cooperative and constructive regulatory environment.

?

4. Processes to ensure consistency and adequacy of evidence should be reinstated. This includes bringing back rating characteristics and improving the quality assurance of reports to ensure that inspection outcomes are fair, reliable and based on robust evidence.

?

5. The regulatory IT platform needs significant improvements to reduce the burden on both CQC staff and providers. This includes making the provider portal more user-friendly and resolving technical issues promptly. Improving the IT system will help streamline the inspection process and reduce administrative burdens.

Final Thoughts

The review of CQC's single assessment framework and its implementation provides a comprehensive look at the challenges faced by the regulator and offers a clear path forward. I do not think it tells us anything we did not know, and I think as a sector we could have written this. To be honest, the failings in CQC stem from not reading the room, not following up on people's social media posts etc. The insight was there from the start, but they chose to ignore it!

I do remain sceptical about the potential for real change. Many in the leadership team and on the board were in their roles when the regulator faced significant challenges and failed its staff and thousands of providers.?I have mentioned how they chose to ignore the thoughts and feedback, and I doubt this is something that will change.

Without substantial changes at the top, it is difficult to see how the organisation can truly move forward and avoid repeating past mistakes.?

Ensuring accountability and bringing in fresh perspectives at the leadership level I feel is crucial for driving the change that is needed.

For more detailed information, you can read the full review on the CQC website by clicking here:?https://www.cqc.org.uk/publications/review-cqcs-single-assessment-framework-and-its-implementation/6-single-assessment-framework

If you enjoyed this article, join over 9,400 people and subscribe here so that you receive future newsletters straight to your email inbox ???