Care Quality Commission
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Our new assessment approach: Assessing the well-led key question for NHS trusts

As a part of introducing our new approach, we plan to start work on well-led assessments for NHS trusts which have been developed in collaboration with NHS England.

What is happening and when?

We will use our new assessment framework to align with our broader work and use the quality statements under the well-led key question.

Alongside this we are also introducing changes to how we rate NHS trusts which were part of a 2021 consultation. This set out proposals to simplify ratings for NHS trusts by publishing a single rating at the overall trust level. This would focus on the culture and leadership of an organisation, as well as the services where people receive care.

For NHS Trusts, our initial focus will be on service-level assessments. Quality at core service level is important to inform a holistic view of quality at trust level. Updating our service-level view of quality will allow us to focus on risks to patients and enable us to reflect a broad and up-to-date overall view of quality in our trust-level assessment and rating.

We anticipate trust-level assessments will begin in the coming months. We will update the guidance for trusts on our website shortly.

How we will assess and rate the well-led key question at trust level for NHS trusts

We are simplifying ratings for NHS trusts by publishing a single trust-level rating, rather than multiple levels of complex, aggregated trust-level ratings. Using the 8 quality statements under the well-led key question to will ensure our assessments have a strong focus on:

  • leadership
  • culture
  • governance.

We are not making changes to how we rate at service level (or location level for acute trusts).

Scope of the first NHS trust-level assessments

The first trust-level assessments under the single assessment framework will be based on an assessment of the 8 quality statements under the well-led key question.

We are taking this approach because:

  • it will give us a starting point and enable us to issue a first rating based on a full assessment at the trust level.
  • when we award our first new ratings under the new approach we will be confident that:
  • they are the right judgements
  • we have considered the full scope of the assessment of both leadership and wider organisational performance.
  • this approach reflects previous challenges over several years in updating overall trust ratings.
  • we can address the complexity of assessing organisational leadership, culture and management by using the new quality statements under the well-led key question.


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