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CQC Commissioner Assessment Update

The Care Quality Commission (CQC) has a statutory responsibility to carry out reviews of councils and primary care trusts (PCTs), as commissioners of care. CQC is required to make assessments of each PCT and Adult Social Care (ASC) department in councils in England, to see how well they have commissioned services for people in their area.

CQC has therefore produced a guide that sets out its approach to the assessments of the quality of health and adult social care commissioners for 200910.[ 1] Although the guide is mainly intended for use and reference by Commissioner PCTs and ASC departments, CQC believes that providers may also be interested in the guide, as it will explain how their commissioners are being assessed by CQC. The guide gives an overall description of the assessment process, followed by sections containing detailed guidance and information.

CQC states that its assessments will allow people to have:

  • Information about how well commissioners put people first, meet their needs and ensure the right outcomes; l Assurances about the safety and quality of services;
  • Assurances that where there is poor practice it will be highlighted; 
  • Assurances that commissioners are achieving value for money 

Assessments of ASC departments

CQC will produce an aggregated grade for each council, based on the outcomes for people who use their services. It will be calculated from the seven grades in the existing performance framework, based on outcome areas in “Our Health, Our Care, Our Say”.[2] CQC will also report on two additional domains covering leadership, and commissioning and use of resources. CQC will introduce a new process of qualified self-declaration by councils against the outcomes which will, in prescribed circumstances, replace the submission of full self assessment evidence by councils and completion of a full assessment by CQC.

Qualified self-declaration – an overview of the approach:

  • All councils will still be required to complete a full self-assessment for the dignity and respect outcome – no self declarations will be allowed as this is where most of CQC’s evidence on council safeguarding appears.
  • The 32 councils judged as performing “excellently” in 200809 will have the opportunity to self-declare on their performing “well” and “excellently” outcomes – the self-declaration will only be challenged if any specified adverse indicators of performance come to light.
  • The councils performing “well” last year will have the opportunity to self declare on their performing “well” and “excellently” outcomes. Again, the self-declaration will only be challenged if there is evidence of adverse indicators of performance. 
  • Up to 1 in 4 self-declaring “well” councils will be required to complete a full self-assessment. These will be picked on a part risk/part random basis. 
  • CQC will have a power to override the whole self declaration process if something really serious comes to light. However, this power will be used sparingly. CQC will specify the types of adverse indicator that could trigger the override, e.g. a new serious case review or a recent poor service inspection. For 2009-10, CQC will score each council’s performance in relation to the quality of regulated services that they purchase. This is a helpful stepping stone to the introduction of a National Indicator in this area, which is in the Department of Health led programme for indicator development. 

Plans for 2010/2011

CQC has recently announced that in 2010/2011 it will streamline its approach to assessing councils as commissioners by focusing on three outcomes (rather than seven) that cover particularly important issues in adult social care.

The three outcome areas for 2010/11 will be:

– Improved health and wellbeing
– Increased choice and control
– Maintaining personal dignity and respect

CQC will pay particular attention to the way in which safeguarding, putting people first and value for money have been the key drivers for effective delivery of these outcomes. CQC will publish detailed guidance on the 2010/11 assessment of councils this autumn.

The current programme of service inspections will conclude in September 2010. CQC therefore proposes to develop and implement a revised method by spring 2011.

Assessment of PCTs

From 2005/06 to 2008/09, CQC carried out an “Annual Health Check” on NHS Trusts. This included PCTs in 2008/09. CQC looked at three key areas:

1. Whether trusts were getting the basics of healthcare right – i.e. were they meeting the Government’s core standards and existing commitments?
2. Whether trusts were making and sustaining improvements in priority areas – i.e. were they performing well against the Government’s national priorities?
3. Whether trusts were managing their finances effectively – this assessment was based on work carried out by the Audit Commission and Monitor, the regulator of NHS foundation trusts.

However, in June 2010, the government published revisions to the NHS Operating Framework for 2010/11.[3] CQC have been discussing the implications of the revisions with the Department of Health. The result is that ministers have agreed that further work should halt on periodic review assessments (i.e. the “Annual Health Check”) of NHS organisations for 2009/10, and do not require CQC to publish 2009/10 performance against indicators that have been taken out for 2010/11.

CQC will publish benchmarking data for 2009/10 for the indicators in the NHS Operating Framework as Existing Commitments, and Vital Signs tiers 1 and 2. This data will be published in the autumn. CQC will not publish aggregated scores for trusts. It will also not be publishing data relating to financial performance or World Class Commissioning.

Plans for 2010/2011

CQC has recently announced that it will not be assessing PCTs as commissioners in 2010/2011. These services will be monitored by the proposed new NHS Commissioning Board, who CQC will be working closely with.

To view CQC’s Commissioner Assessment Guide in full, please visit their website.[4] In light of recent changes, CQC have said that the guide will remain under review and that further information will be published as soon as it is available.


[1] CQC, “Introduction and overview of the assessment process for Health and Adult Social Care Commissioners 2009/10”
[2] Department of Health, “Our Health, Our Care, Our Say” (2006)
[3] Department of Health, “Revision to The Operating Framework for the NHS in England 2010/11” (2010)
[4] nhstrusts/annualassessments/ commissionerassessment.cfm


This briefing is for guidance purposes only. RadcliffesLeBrasseur LLP accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.

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