A guide to CQC ratings and the new scoring system

While Care Quality Commission (CQC) ratings remain unchanged, the introduction of the new single assessment framework brings with it a new scoring system. We say goodbye to the old rating characteristics and hello to new dynamic scoring.

The CQC ratings system under the new single assessment framework will see the introduction of numerical scoring and provide clearer detail of where providers are excelling and where they are failing.

What are the four CQC ratings?

The CQC gives health and social care services they inspect one of four ratings:

• Outstanding: The highest rating achievable. In this case, the service is performing exceptionally well.
• Good: Most services receive this rating, meaning they perform well and meet the CQC’s expectations.
• Requires improvement: The service is not performing as expected. With this score, the CQC will give recommendations on how to improve.
• Inadequate: The service performs poorly and the CQC will take action against the person or organisation running it.

New CQC scoring system

A new CQC scoring system has been introduced to give the commission the ability to provide more transparency in the ratings they assign to health and care providers. It consists of a 4-point scale:

• 1 = significant shortfalls
• 2 = some shortfalls
• 3 = good standard
• 4 = exceptional standard

The benefit of the CQC’s new scoring system is that it will provide a better understanding of how an overall service rating is reached. For example, if a health or care provider receives a ‘Requires improvement’ rating, they will now be able to better see whether they are performing just below ‘Good’ or nearing ‘Inadequate’ for a key question.

Five key questions

The CQC uses five key questions to score health and care providers and give them their overall rating.

The five key questions are:

1. Safe – Are they safe?
2. Effective – Are they effective?
3. Caring – Are they caring?
4. Responsive- Are they responsive to people’s needs?
5. Well-led – Are they well-led?

Each key question is broken down into a set of quality statements to better assess the quality of care. Each individual quality statement gets a score. These scores are then converted into percentages to give each key question a rating:

• Inadequate: 25 to 38%
• Requires improvement: 39 to 62%
• Good: 63 to 87%
• Outstanding: over 87%

The key question ratings are then aggregated using rating principles for health or care services to determine the overall service rating.

Quality statements

The quality statements used to assess each key question are ‘We statements’ set out by the CQC. They demonstrate what standard is expected of a service.

For example, here is a quality statement for the key question ‘Are they caring?’ addressing kindness, compassion and dignity:

‘We always treat people with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect.’ The CQC uses evidence to score a health or care provider for each quality statement.

Gathering evidence

At this time, providers are not required to submit evidence proactively. The CQC will either request specific information from a health or care provider or collect evidence independently.

Evidence gathered by the CQC includes:

• On-site evidence including observing how staff interact with people, speaking to people using the service, and observing the equipment and premises
• Feedback collected through local and national programmes including the CQC’s National Customer Service Centre, NHS Patient Survey Programme, and Healthwatch
• Care and health provider data including reviews of clinical record
• Information from national bodies including prescribing datasets, waiting times, and NHS staff surveys

More transparency with the new CQC rating and scoring system

The pursuit of ‘outstanding’ is no walk in the park with the new CQC scoring system.

To achieve a ‘good’ or ‘outstanding’ for any key question, providers must excel across all quality statements – no hiding allowed. If you fail to evidence a good standard in just one, it will compromise your overall key question rating. A single low score in any quality statement can downgrade an otherwise ‘outstanding’ key question to ‘good’.

The CQC will initially publish ratings only, but the commission intends to reveal the scores behind each service provider rating in the future. Transparency is at the forefront of this ratings system.

As CQC ushers in this new chapter, it’s not just a shift in scoring. It’s a promise of a more transparent evaluation, steering healthcare quality assessment towards a brighter future.

Find out more about the CQC’s new single assessment framework on our blog.

Learn more about the CQC rating scale and scores in our webinars

Want to know more about how the scoring system will work? Join one of our upcoming CQC webinars, to learn more about the rating scale and other areas of the CQC assessments process.

You can also view a preview of one of our previous webinars about the intricacies of the new CQC scoring system below: