CQC consults on sector specific assessment framework for hospitals and specialist care

The Care Quality Commission has published a 64-page draft sector specific assessment framework for hospitals (secondary and specialist care) and opened a public consultation running until 12 June 2026.

The draft framework forms part of CQC’s response to its Better regulation, better care consultation and marks a further step away from the Single Assessment Framework towards a more tailored, sector based approach to regulation.

Why is CQC moving to sector specific frameworks?

CQC has said that feedback to its consultation showed overwhelming support for moving away from a single framework that applied across all regulated services, in favour of approaches that better reflect how different parts of the health and care system operate.

In response, CQC has developed four draft assessment frameworks covering:

• Adult social care
• Mental health care
• Primary care and community services
• Hospitals (secondary and specialist care)

Although presented as reform, the direction of travel will feel familiar to many providers, with a renewed emphasis on sector specific expectations and clearer descriptors of what good care looks like. In that context, the proposals represent a rework of CQC’s approach, rather than a complete redesign of the inspection model.

What stays the same?

The draft framework confirms that the five key questions remain central to all assessments:

• Is the service safe?
• Is it effective?
• Is it caring?
• Is it responsive?
• Is it well led?

For hospitals and specialist providers, this continuity mean that inspections will continue to be structured around familiar headings, even as the underlying assessment mechanics change.

What is changing under the draft hospital framework?

Supporting questions replace quality statements

• The draft framework proposes replacing existing quality statements with supporting key lines of enquiry, framed as structured questions.
• For hospitals, these supporting questions are intended to offer greater clarity about what inspectors will look for, while allowing flexibility to reflect the scale, complexity and risk profile of secondary and specialist care.

Rating characteristics become central to assessment

A key feature of the draft framework is the introduction of sector specific rating characteristics, setting out what outstanding, good, requires improvement and inadequate care looks like for hospitals under each of the five key questions.

For example, under “Safe” and then under “safeguarding” they state that good will include:

• The service has effective safeguarding systems, processes and practices, which protect people from abuse, neglect, harassment and potential breaches of their human rights.
• The service has a rigorous process for investigating any allegations against people employed in positions of trust.
• Where relevant to the service, there is a clear understanding of the Deprivation of Liberty Safeguards (DoLS). These are used appropriately, in line with legislation (the Mental Capacity Act and Mental Health Act), and only when it is in a person’s best interests.

For example, under “Safe” and then under “safe delivery of medicines and treatment” good will include:

• Where a person lacks capacity to make decisions about their medicines and treatments, formal processes (under the Mental Capacity Act 2005) and assessments are undertaken before administration. This includes exploring alternative ways to administer medicines.
• Where a person is given treatment without their consent (under the Mental Health Act 1983), review processes are followed in line with the code of practice.

For example, under “Effective” and then under “consent to care and treatment” good will mean:

• Decisions are made in line with the Mental Capacity Act 2005, involving carers or advocates, when needed.
• Where people are subject to the Mental Health Act 1983 (MHA), consent to care and treatment provisions, rights to access independent mental health advocates and the MHA Code of Practice are complied with. Any departure from the Code of Practice guidance is clearly justified.
• Advance care planning, including DNACPR and ReSPECT, is managed as a proactive and inclusive process.

For example, under “Responsive” and then under “listening and responding to feedback” outstanding will include:

• Investigations of incidents and complaints are comprehensive and the service uses innovative ways of looking into concerns, including the use of external professionals to make sure there is an independent and objective approach.

For example, under “Well Led” and then under “governance” outstanding will include:

• Governance of partnerships, joint working arrangements and shared services is rigorous and mature, with clear shared objectives, defined accountabilities, and joint risk management. The service plays a leading role in the wider health and care system by supporting collaboration that delivers improved health and care outcomes.
• Governance arrangements explicitly support the delivery of high-quality, safe and equitable care. They enable early identification of risks to quality, safety and equity, and timely, proportionate action to address them. Relevant quality frameworks and recognised standards are implemented effectively and used to reduce inequalities in experience and outcomes.

CQC describes these characteristics as central to future judgments. In practice, they will play a critical role in shaping inspection outcomes, particularly as services adapt to a more narrative led assessment approach.

Removal of scoring and increased emphasis on judgment

The draft framework confirms that CQC intends to remove numerical scoring from its assessment methodology altogether.

Instead, ratings will be made directly at key question level, informed by evidence and guided by the rating characteristics.

This change places greater reliance on professional judgment by inspectors, moving further away from cumulative scoring models. While this is intended to produce more holistic judgments, it also means that the clarity, consistency and application of rating characteristics will be particularly important for providers, especially in complex hospital environments.

What does this mean for hospital and specialist providers?

Taken together, the proposals suggest a shift towards a more narrative focused inspection experience. For NHS trusts and independent hospital providers, this may mean:

• Less emphasis on evidencing activity against scores.
• Greater focus on demonstrating how systems, governance and culture support quality and safety across the service.
• Increased importance of articulating a clear and coherent account of performance under each key question.

Although CQC positions the draft framework as improving transparency, its practical impact will depend on how consistently the new characteristics are applied in inspections and final ratings.

Have your say

CQC has emphasised that feedback on the draft frameworks will be used to refine the approach before wider implementation in late 2026. For hospital and specialist providers, the consultation represents an important opportunity to comment on whether:

• The supporting questions reflect operational realities.
• The rating characteristics are clear, proportionate and workable.
• The framework adequately captures the complexity of secondary and specialist care.

CQC are seeking views on this by 12 June and you can share your feedback here.

Hospital providers may wish to engage with the consultation to help shape how inspections are conducted and how quality is judged under the new model.

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