Ready for the CQC’s new single assessment framework

In the first of a two-part response to the CQC’s new approach to assessment, GGI principal consultant David Holden sets the scene for the changes and argues that NHS organisations would do well to stay ahead of them.

(Click here to read part two of this blog, by Joanna Watson, published on 30 September)

The Care Quality Commission (CQC) has launched a new single assessment framework (SAF) to regulate health and social care in England. This framework will apply from January 2023 to all care providers, local authorities and integrated care systems.

We’ll explore the changes in detail next week but broadly speaking they will result in a greater focus on workforce, on partnership working, and on environmental and organisational sustainability.

These are focus areas that were clearly signalled in the draft code of governance for NHS provider trusts, published in May, and which our CEO Andrew Corbett-Nolan advised at the time should be carefully considered by NHS boards.

The CQC announcement could well trigger some NHS leaders, who might struggle to see beyond the challenge of finding the time to build an understanding of the new framework and then organise their activities around it.

But we would invite them to ‘flip the script’ on this view, if I may borrow a phrase from GGI’s 2021 Festival of Governance. Rather than seeing the changes as the starting point for lots of work at an uncommonly busy time, perhaps they could be seen as an opportunity to get ahead of the game on changes that will be happening anyway. Perhaps they are a good thing.

On a practical note, NHS boards are required to show performance over time and January 2023, when the new arrangements come into force, will come around very quickly. If you are not already attending to these changes and gathering the data you will need, you are in danger of falling behind the curve.

The case for change

Introducing the changes, the CQC outlined three reasons for them:

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

Here at GGI, we believe the changes make sense because they seem well suited to help address a number of key issues facing the NHS:

• With the advent of integrated care systems there is a greater expectation of collaboration and much less on competition between system partners.
• The NHS faces a workforce crisis, particularly around recruitment and retention.
• There is a greater emphasis than ever across the NHS on sustainability, and this will only grow.

The CQC says the new single assessment framework will form the basis of quality assessments in all types of services and at all levels. The ultimate aim, they say, is to reduce health inequalities and to drive improvements for service users.

To help clarify its process and build the new framework, the CQC has collated information over the last 8 to 12 months from providers, people who use the services and other stakeholders such as local government and the third sector.

In its research, the CQC found that the language used in its current assessment frameworks was too complex. To address this, it has established 34 topic areas covering the five key questions: are services safe, effective, caring, responsive and well-led?

Beyond tick-box compliance

Measuring up to CQC expectations is sometimes seen as a compliance necessity – perhaps even something of an unwanted distraction at a time when NHS leaders have rarely felt more stretched. But this perception should be reframed.

Even if you feel that you and your colleagues are barely keeping your head above water, it makes sense to carve out the time it takes to understand the new assessment framework and then ensure that your organisation meets its requirements.

On a purely practical note, this immediate time investment will pay rich dividends in terms of the work it saves later.

For now, it’s important to be aware of the quality statements under each of the five key questions and to ensure that your organisation meets the statement requirements to establish good quality care and good governance.

Now is also the time to become familiar with the six new categories of evidence, and to begin compiling examples. We’ll explore in more detail exactly what these are in a follow-up blog.

Meanwhile, GGI is here to help you prepare for inspections, whether under the current arrangements or in the new regulatory landscape. Our rapid CQC preparation offer takes into account the new framework and the draft code of governance.

We would also be happy to run board workshops or briefing sessions to help your organisation prepare for the new regulatory landscape.

To find out more about how GGI can help, please email me or my colleague Janice Smith.