As healthcare providers you will be aware of the importance of the Care Quality Commission (CQC) as an independent regulator for health and social care standards in England, working to ensure people receive safe, effective and compassionate care. However the CQC can refer to a few key sets of differing terminology that can be confusing at first.
For example, what are the 5 CQC standards, what are key questions, how do Quality Statements (replacing KLOEs), Topic Areas and I Statements help to assess those key questions, and how does all this connect to the Fundamental Standards?
While these terms are distinct, they work together to ensure the CQC meets their ultimate goal of driving improvement within the healthcare sector and promoting a high standard of care across the board.
Verita has a wealth of experience working with health and social care organisations, helping them to improve the quality of care by conducting a comprehensive review in relation to the wide-ranging CQC standards. In this article we explore the differing terminology by explaining the difference between each one and their relationship with each other under the new Single Assessment Framework.
What are the 5 CQC standards?
The Single Assessment Framework
The Care Quality Commission (CQC) uses a robust framework to assess health and social care services in England. This framework centres on five key questions to assess the quality of health and social care providers. So, when people ask ‘what are the 5 CQC care standards?’ it is actually these key questions which are being referred to.
Previously the CQC would break the key questions down into a further set of questions called ‘key lines of enquiry’ (KLOEs), but as of May 2024, services are now being assessed using ‘quality statements’ (or “we” statements). The CQC collects evidence from a range of areas, including people’s experiences, staff and leader feedback, and observation which set the overall expectations for delivering high-quality, person-centred care.
These statements are further supported by ‘I statements’, which reflect what care receivers have said matter to them highlighting the individual accountability of staff in upholding these standards.
Finally, the framework breaks down these broad areas into Topic Areas, providing specific areas of focus for inspectors during their evaluations. By examining documentation, observing practices, and conducting interviews, inspectors build a comprehensive understanding of what constitutes good care, while holding both services and staff members responsible for achieving it.
What are the 5 CQC key questions?
The five key questions that aid inspectors in their evaluation of how well a service is meeting the needs of patients and residents are:
- Are they safe? This question ensures that services prioritise the safety and well-being of patients and residents. It focuses on minimising risks of avoidable harm, by having robust policies and procedures in place to ensure:
- Safeguarding from abuse: Measures are in place to protect patients from physical, emotional and financial abuse.
- Safe environment: The physical environment is maintained to prevent accidents and injuries.
- Safe medication management: Medications are prescribed, stored and administered correctly.
- Qualified and competent staff: Staff are properly trained and experienced to deliver safe care.
- Are they effective? This question emphasises that care and treatment are based on best practices and deliver positive outcomes for patients. Inspectors look for:
- Evidence-based care: Treatments are based on current medical knowledge and research.
- Individual needs: Care plans are tailored to each patient’s specific needs and conditions.
- Effectiveness monitoring: The service monitors the effectiveness of treatments and makes adjustments as needed.
- Patient involvement: Patients are involved in decisions about their care.
- Are they caring: Compassion, respect and dignity are central to answering this question. It ensures that services treat patients and residents as individuals. Services that meet this standard will ensure:
- Respectful communication: Staff communicate with patients in a respectful and sensitive manner.
- Individual preferences: The service considers patients’ cultural and religious backgrounds, as well as their personal preferences.
- Emotional well-being: Staff are attentive to the emotional needs of patients and provide comfort and support.
- Privacy and confidentiality: Patients’ privacy and confidentiality are respected.
- Are they responsive to people’s needs? This question focuses on ensuring care is tailored to individual needs and preferences. A responsive service will maintain:
- Individual assessments: Needs assessments are conducted to understand each patient’s unique situation and preferences.
- Flexibility: The service can adapt care plans to accommodate changing needs.
- Communication: There are effective communication channels for patients to express their needs and preferences.
- Complaints process: A clear and accessible process is available for handling concerns and complaints.
- Are they well-led? This question ensures the care service is well-managed with a strong leadership team committed to continuous improvement. This includes:
- Clear vision and values: The service has a clear vision for providing high-quality care and promotes strong ethical values.
- Effective leadership: Leaders are accountable for the quality of care and provide clear direction to staff.
- Staff development: Staff are supported in their professional development.
- Performance monitoring: The service monitors its performance and identifies areas for improvement.
CQC fundamental standards
While the 5 CQC key questions provide a broad framework, the CQC also has a set of fundamental standards that are the minimum standards below which care must never fall. These standards ensure basic rights for patients, such as dignity, respect and consent.
Here’s a breakdown of each fundamental standard:
Person-centred care: This standard emphasises that care should be tailored to the individual needs and preferences of each patient or resident. Services must involve them in their care decisions and respect their choices.
Visiting and accompanying: Residents in care homes and hospitals, as well as hospice patients, should have the right to receive visitors, go on outings and have a companion during appointments.
Dignity and respect: Everyone receiving care has the right to be treated with dignity and respect at all times. This includes respecting their privacy, cultural needs and emotional well-being.
Consent: Care providers must obtain informed consent before providing any care or treatment. This means patients or residents must understand the proposed care, its potential risks and benefits and have the freedom to choose whether or not to proceed.
Safety: This standard ensures services prioritise the safety and well-being of those receiving care. It covers minimising risks of avoidable harm from medication errors, falls, infections and inadequate staffing.
Safeguarding from abuse: Services must have robust measures in place to protect patients and residents from all forms of abuse and neglect. This includes having clear safeguarding policies and procedures and staff trained to identify and report potential abuse.
Food and drink: People receiving care have the right to access enough nutritious food and drink to maintain their health. Services must cater to individual dietary needs and preferences.
Premises and equipment: The care environment, including buildings and equipment, must be clean, suitable and well-maintained to ensure the safety and comfort of patients and residents.
Complaints: Services must have a clear and accessible complaints procedure to allow people receiving care, or their representatives, to raise concerns. Service providers must properly record, thoroughly investigate and take action to address any identified issues highlighted within those complaints.
Good governance: This standard emphasises the importance of strong leadership and effective management within the care service. It ensures there are clear lines of accountability, robust risk management procedures and a commitment to continuous improvement.
Staffing: Services must have an adequate number of suitably qualified, skilled and experienced staff to meet the needs of patients and residents safely and effectively.
Fit and proper staff: Only staff deemed “fit and proper” can work in health and social care settings. This ensures staff have the necessary character to provide safe and appropriate care. This is achieved through a strong recruitment process including background checks, a DBS, criminal record check and work history check.
Duty of candour: Care providers and managers have a legal duty to be open and honest with the person being cared for and regulatory bodies like the CQC about any incidents or concerns that may put people at risk.
Display of ratings: Care services are rated by the CQC as Outstanding, Good, Requires Improvement, or Inadequate. This rating must be clearly displayed so that people using the service can make informed choices.
By adhering to these fundamental standards, care services can help ensure a safe, dignified and positive experience for patients and residents.
CQC Inspections
The CQC inspects health and social care providers in England to ensure services are providing care that’s safe, caring, effective, responsive to people’s needs and well-led. This is achieved through:
- Comprehensive Inspections: Looking at those five key questions, Quality Statements, Topic Areas, I Statements and evidence of good practice.
- Focused Investigations: Investigating a concern picked up on a comprehensive investigation or a change in the care provider’s circumstances, for example takeover or merger.
Healthcare providers can increase their chances of securing a good rating by analysing their services and prioritising all five CQC key questions:
- Safety: Implement robust measures to minimise risks, ensuring proper medication management, infection control and safe equipment. Strong safeguarding procedures are crucial.
- Effectiveness: Invest in qualified staff with up-to-date skills and knowledge. Provide evidence-based, personalised care plans and regularly monitor their effectiveness.
- Caring: Treat patients and residents with dignity, respect and compassion. Actively involve them in care decisions and foster a caring environment that addresses emotional needs.
- Responsiveness: Be adaptable and responsive to individual needs and preferences. Ensure clear communication with patients, families and staff, and adjust care plans as circumstances change.
- Well-led: Demonstrate strong leadership with a clear vision and effective governance. Promote a culture of continuous improvement and invest in staff development.
When it comes to inspections, CQC look for organisations which are outward looking, responsive and open which means there may be a particular focus on leadership. So the organisation will need to provide evidence of this, which is, of course, vital for all organisations, not just the healthcare sector.
To help with this, Verita has developed a comprehensive framework for assessing the effectiveness of an organisation’s leadership as well as reviewing other aspects such as culture, systems and procedures, all of which helps to improve CQC compliance.
Conclusion
The CQC Single Assessment Framework and Fundamental Standards are designed to ensure a high bar for quality and safety in health and social care services across England. Understanding the different terminology used by the CQC, such as the five key questions, Topic Areas, Quality Statements and I Statements, can be crucial for service providers.
By familiarising yourself with these terms and what the CQC looks for during inspections, services can proactively address areas for improvement and demonstrate their commitment to delivering exceptional care.
Here at Verita, we have extensive experience in supporting healthcare providers throughout the CQC inspection process. We can help you navigate the CQC standards, identify areas for improvement, and develop strategies to achieve a positive rating. With our guidance, you can ensure your service is well-prepared to demonstrate its dedication to providing the best possible care to patients and residents.
If you’d like to find out more about the 5 CQC standards and the support we can offer, please book a free consultation or contact Ed Marsden on 020 7494 5670 or [email protected].
