How we will assess quality and update ratings from August 2021

Page last updated: 12 May 2022

Published: 11 August 2021

Updated: 22 November 2021

We're starting to introduce some changes to how we will regulate from August 2021. This follows our consultation on changes for flexible and responsive regulation and our response to the feedback.

The changes enable us to be more flexible in how we assess and rate providers, and recognise the ongoing challenges that many providers face as we move into the next stage of the pandemic. They will help us work towards our ambition to be a more dynamic, proportionate and flexible regulator in line with our new strategy from 2021.

This update supports our latest published information in relation to our regulatory approach, which includes:

  • existing guidance for providers for each sector
  • information about our monitoring approach to improve how we prioritise our regulatory activity
  • our Chief Inspectors' statement of 24 March 2021, setting out priorities for the year for each sector.

We'll keep you updated as we develop our approach.

What this means for providers of health and social care

Our purpose has not changed – we make sure health and social care services provide people with safe, effective, compassionate and high-quality care, and we encourage services to improve. However, we need to make some changes to help us do this.

We will no longer set a maximum interval, based on previous ratings, between inspections.

Previously, we have always needed to carry out a site visit to give a rating. Going forward, we'll start to use a wider range of regulatory approaches to assess quality and rate. Initially, these will be in a limited number of circumstances as we continue to develop the regulatory approach outlined in our strategy. We'll use our professional judgement to determine when this is appropriate, and be clear about our methods when we inspect your services.

We'll provide further information about when we'll rate a service as we implement our strategy.

We'll use a different regulatory approach for example when:

  • making more use of technology to support how we gather evidence in all services
  • updating a rating without a site visit:
    • where we have gathered evidence of a deterioration in quality or taken enforcement action – we're less likely to do this in some settings such as residential settings, where it's necessary to observe care or the environment
    • where we ask a provider to show that they have addressed the concerns that affected their rating in a previous inspection

We won't always carry out site visits to rate homecare services, following the successful pilots we carried out in 2020.

We'll continue to assess whether services are safe, effective, caring, responsive and well-led using our assessment frameworks for healthcare and adult social care. We'll also carry on using inspections where we focus our assessments on specific areas.

Adult social care providers and GP providers: We will continue to use inspections that are more focused to update ratings for these providers in line with our published guidance. A more flexible approach to assessing and rating other primary care services will also be developing further.

Domiciliary adult social care (home care) providers: In some cases, we'll use phone and online methods to help us carry out our inspections. This means we will not always need to visit in person. In every other way, we will continue to follow our existing practices for inspecting, rating and enforcement.

We piloted this approach with domiciliary care services and extra care housing services in 2020. To begin with, we will continue using it to assess these types of provider.

Our use of the word 'inspection' in this context

For the time being we will continue to refer to these as 'inspections'. However, they are actually 'performance reviews' as set out in our duties under s46 of the Health and Social Care Act 2008 (the Act). In addition to the duties under s46, we have a power to inspect under s60 of the Act. This power specifically relates to the use of site visits, so 'inspection' legally means using a site visit to gather evidence. We think 'inspection' makes more sense to the public than 'reviews' and will retain this language for now.

NHS trusts: Our consultation response sets out changes to how we will rate NHS trusts from Spring 2022. For this year, we'll also carry out some well-led plus core service inspections and rate at NHS trust level. Using information from monitoring, we will be proportionate when deciding which core services to include in the inspection. We'll use our ratings principles in a more flexible way and use our professional judgement to depart from these where appropriate, either in response to concerns or where there has been improvement.

When we publish ratings for non-specialist acute trusts, this normally includes a rating for the trust's use of resources. The Use of Resources assessment is carried out by NHS England and NHS Improvement (NHSEI). NHSEI paused these assessments in response to the pandemic. They are currently re-evaluating and refreshing them to make sure they are fit for purpose.

On that basis, any inspections cannot include a Use of Resources assessment until we are advised by NHSEI. This means that when we inspect non-specialist acute trusts, we cannot update the trust’s Use of Resources rating or its combined rating. If you have any queries about use of resources assessments, you should contact the NHSEI regional team.

Key things these changes do not affect

  • We'll carry on using our assessment frameworks and ratings characteristics.
  • Inspection teams will still use the five key questions and key lines of enquiry (KLOEs) to structure their assessments.
  • We'll continue to gather the valuable views of people who use services, and staff, to inform our assessments and ratings.
  • Health and social care services will still be rated as either: outstanding, good, requires improvement or inadequate.
  • We'll continue to use our ratings principles.
  • We'll still publish reports about the services we inspect.
  • Our reporting and factual accuracy process is unchanged.
  • Our process to request a rating review still applies.
  • Our enforcement policy is unchanged.
  • We will continue to carry out Mental Health Act (MHA) monitoring visits to protect the rights of vulnerable people.

As we develop our approach to assessing and rating we'll update this information. This includes other changes proposed in the consultation – specifically removing ratings for population groups in our inspections of GP practices and changes to NHS trust level ratings.