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Levels of ratings: NHS trusts
We provide ratings at different levels, depending on the type of trust.
NHS acute trusts
Service and location level ratings
For each acute hospital location we inspect, we rate the quality of care at four levels:
- Level 1: A rating for each of our five key quality questions of: safe, effective, caring, responsive and well-led in every service that we have inspected (a core service or additional service).
- Level 2: An aggregated rating for each service that we have inspected
- Level 3: A rating for each key question in each location in the trust (hospitals and other services)
These ratings are normally based on the aggregation of the ratings for that key question in each service in the location. For NHS acute trusts with one location (hospital), the rating for well-led in that hospital location will be determined by the trust-level assessment of the well-led key question (see level 5 below).
- Level 4: An aggregated overall rating for the location as a whole.
For NHS acute trusts with one location (hospital), this will be the same as the overall quality rating for the trust as a whole (see level 6 below).
Note: the the aggregation of the well-led key question to Level 3 above does not apply in all trusts, for example trusts with one location (hospital).
We also award ratings at the level of the overall trust:
Level 5: A rating for each of the key questions overall for the trust.
For trusts with multiple sites (hospitals and other services), this is informed by our ratings in each location for safe, effective, caring and responsive, while the rating for well-led is determined by the assessment of well-led at trust level. The rating for use of resources (where applicable) is based on a trust-level assessment conducted by NHS Improvement.
For a trust with only a single site, the trust-level ratings for each key question are the same as the location-level key question ratings (level 3 above).
Level 6: A rating for the trust as a whole.
This includes a rating of the trust’s overall quality, based on our findings at trust level (level 5) under the five key quality questions that CQC inspects (safe, effective, caring, responsive and well-led).
For a single-site trust, the overall quality rating for the trust will be the same as the overall rating for the hospital location (level 4 above).
Where applicable, we will also award a combined rating at the trust level, based on the findings of the five trust-level quality ratings plus a use of resources rating.
Aggregated ratings are determined by using our ratings principles and the professional judgement of inspection teams to balance them. We don’t aggregate the rating for the well-led key question at overall trust level. We award this rating based on our separate assessment of this key question at trust level.
Mental health, ambulance and community health service trusts
Mental health, ambulance and community health services are frequently delivered from multiple locations. Therefore, we don’t give a rating at location level. The levels of ratings for these trusts are:
- Level 1: A rating for every core service against every key question
- Level 2: An aggregated rating for each core service
- Level 3: An aggregated rating for each key question
- Level 4: An aggregated overall rating for the provider as a whole.
When we would not rate
For all types of trust, sometimes we won’t be able to award a rating after an inspection. This could be because:
- the service is new
- we don’t have enough evidence
- the service has recently been reconfigured, such as being taken over by a new provider.
In these cases we will use the term ‘inspected but not rated’.
We may suspend a rating if we identify significant concerns that lead us to re-consider our previous rating. The rating will be suspended until we have investigated the concerns and/or re-inspected the service.
- Last updated:
- 23 July 2019