Scores, aggregates, and ratings. Three words that many of us associate with sport; I could be writing about rugby but alas, that isn’t the feature of this blog. As Brian O’Driscoll once said, “rugby takes its toll”, and the same can be said for the CQC. How many changes are we going to have to tackle before we fully understand the new rules?

Wouldn’t it be great if we were to be advised that the way the CQC does business is changing and be given a full brief as to what is changing, why it is changing and when it is changing BEFORE kick off? Furthermore, wouldn’t it make sense if the information we need to understand those changes was given in one instalment rather than in monthly instalments.

This protracted rollout phase is something which intrigues me. I’m not talking about the regional rollout of the new single assessment framework, but the rollout of information about what these changes mean for us working in primary care.

It’s as if the CQC are taking the stance that knowledge is power. What they need to realise is that information is liberating! We’re happy to share our knowledge, and we’ll be delivering an online session giving an update on the new CQC single assessment framework in October. Listen out for our podcast too.

A scrum in rugby is a means of restarting play. So, we’re now at a point where the regulator wants to restart its approach. So, let’s kick doubt into touch as we focus on scores, aggregates, and ratings. Good news first, ratings are here to stay; providers will be given one of the following ratings: Outstanding, Good, Requires Improvement or Inadequate.

However, what is being introduced is a four-tiered scoring system which the CQC believes will offer a reliable and clear view of quality and to determine a service provider’s rating. This system is called the evidence scoring framework (not to be confused with the single assessment framework). There are six evidence categories: People’s experience of health and care services; Feedback from staff and leaders; Feedback from partners; Observation; Process; Outcomes.

The evidence findings will determine the score for each quality statement:

4 = Evidence shows an exceptional standard of care

3 = Evidence shows a good standard of care

2 = Evidence shows shortfalls in the standard of care

1 = Evidence shows significant shortfalls in the standard of care

Each quality statement can have multiple evidence categories. Therefore, the CQC will have to combine the scores from each evidence category to gain an overall score. If a quality statement has four evidence categories, the score from each would be added together to give a total, let’s say 12.

So, what the CQC needs to do next is to convert this into a percentage. To do so, it divides the total by the highest possible score (number of evidence categories x highest score for each category). That’s 4 x 4 = 16. 16/12 = 75%. That percentage is then converted back to a score, in this instance 3.

That’s the score for just one quality statement. For the caring key question, there are five quality statements, each needs to be multiplied by 4, giving a maximum score of 20. If the provider achieved a total score of 14, this would equate to a percentage score for the caring key question of 70%.

But for key questions, the score is then converted into a rating, in this example that is ‘good’ as scores between 63 – 87% are rated good.

Next up is another conversion (what a match, so many conversions!). This time the CQC aggregates the scores for each key question to achieve a total percentage that enables it to give an overall rating.

This score is converted into a percentage 94/136 x 100 = 69.18%. Therefore, the overall rating using this example would be ‘good’ (by just over 6%).

Despite this complex scoring system being introduced, providers scores won’t be published by the CQC just yet. This will happen at some point in the future – another case of knowledge is power – so all you will see on your provider page on the CQC website is your rating.

While you might not be a fan, I hope you now understand scores, ratings, and aggregates. But there’s still more to come. The game isn’t won, join me again next time for an update on quality statements and types of evidence.

Phil.