How the CQC will score practices under its new regulatory approach

My colleague, Gemma Nicholas, recently wrote an article outlining the CQC's new strategy and regulatory approach and what this might mean for practices.

The CQC has released further detail on how it intends to assess providers within its new regulatory model; including its ‘evidence categories’ and ‘scoring system'. A review of this material reinforces that the CQC is taking steps to move away from a reliance on on-site inspections and towards more assessment of providers ‘off-site’.

When determining whether to undertake an on-site inspection, the CQC will review newly introduced ‘evidence categories’ against a quality statement and the nature of the service.

Evidence categories

The CQC has determined six categories of evidence which it suggests will bring 'structure and consistency' to its assessment of providers. These are:

• People’s experience of health and care services. This is defined as 'a person’s needs, expectations, lived experience and satisfaction with their care, support and treatment'.
• Feedback from staff and leaders. This includes 'evidence from people who work in a service, and staff groups who provide care to people. It also includes evidence from leaders or services'.
• Feedback from partners. This is 'evidence from people representing organisations that interact with the service that is being assessed'.
• Observation. This means observing the quality of care either off-site, on-site, or a combination of both (see below for more on this).
• Processes, which is defined as the series of steps, or activities that are carried out to deliver care that is safe and meets people’s needs'.       
• Outcomes or the impact of care processes on individuals.

In terms of observations, off-site observations include interviews with staff and professionals who work in the service; information from Healthwatch and other partners; feedback from experts by experience (telephone calls with people using the services, families, carers and engaging the community).

On-site observations occur in the form of inspections and will include: observing care, the environment (equipment and premises) and speaking to those who use the service (including staff).

How will the CQC use the evidence categories?

While the CQC has taken time to outline and define six evidence categories, the information published suggests that not all categories will be used when assessing a provider. Instead, this will be a discretionary determination by the CQC based on the service type/model of the provider, the level of assessment required and whether this is for an existing service or the registration of a service.

In short, the new strategy continues to give power to the CQC to determine the relevant evidence, rather than working cooperatively with the provider.

Further, in order to 'reach out to people, families and carers and engage with community whose voices are seldom heard', the CQC intends to work with third party organisations. In practice, this could mean that an ‘off-site’ observation is occurring without any knowledge, or interaction with, the provider.

It is the evidence collected within these ‘evidence categories’ which will assist the CQC in determining an overall rating for a provider. This overall rating is achieved through use of a new scoring system.

Scoring system

The CQC intends to continue to describe the quality of care through the use of its four ratings: outstanding, good, requires improvement, or inadequate.

In a move intended to make its processes more transparent and consistent the CQC have generated a number-based scoring system:

• 4: exceptional standard of care;
• 3: good standard of care;
• 2: shortfalls in the standard of care;
• 1: significant shortfalls in the standard of care.

The following steps will be followed to produce an overall rating for the provider:

• Review evidence types within the required evidence categories against each quality statement.
• Apply a score to each of these evidence categories.
• Combine these required evidence category scores to give a score for the related quality statement.
• Combine the quality statement scores to give a total score for the relevant key question.
• This score generates a rating for each key question.
• Aggregate the key questions rating to give the overall rating.

The CQC says that it will weight each evidence category and quality statement equally. This will be accompanied by the use of professional judgment and a quality assurance process.

While this appears to be a well-intentioned approach, it is concerning to note that the majority of the ‘evidence categories’ rely on the opinions of individuals – service users, staff, family members, third party organisations – all of whom have their own agenda, grievance or bias. Currently, on the information disclosed, there does not appear to be a mechanism in place for the provider to counter the commentary from these individuals.

We still need more detail on this new regulatory approach and proposed strategy, in particular the presentation of this information, whether providers will be actively involved in ‘off-site’ observations and how providers can challenge the CQC’s assessment of its practice within this new framework. Unfortunately, there still remains more questions than answers.

The full CQC publication and a working example of the scoring system process can be found here.

• Samantha Guest is a lawyer at Ridouts, who qualified in New Zealand.
• If you require assistance or advice in relation to any issues with the CQC, please contact Ridouts Professional Services Ltd at info@ridout-law.com or by calling 020 7317 0340.