The consultation will build on earlier engagement, including the five external roadshows and a series of meetings and workshops held with a wide range of stakeholders. The insight provided through these events and other stakeholder meetings have helped to shape and co-design the proposals being put forward. In particular, these aim to address the concerns raised in external reviews of the CQC’s current ways of working from Dr Penny Dash, Professor Sir Mike Richards and the Care Provider Alliance. The changes will aim to create a clearer, simpler and more trusted framework, built through engagement, collaboration and co‑design with those who deliver and use services.
What will change?
Proposed changes fall into two main areas: developing frameworks and guidance for assessing providers and improving how providers are assessed and rated.
Developing frameworks and guidance:
• Re-introducing rating characteristics. These are clear descriptions of what each rating level (such as good or requires improvement) looks like in practice. They will help to provide a better understanding of what each rating means.
• Replacing quality statements with assessment questions. These questions will be similar to the previous key lines of enquiry (KLOEs) and will support the rating characteristics by guiding how we assess quality.
• Developing sector-specific frameworks. These will include detailed content and guidance tailored to a specific health or care sector, so providers can better understand CQC expectations for their sector, as well as consistent core content that would be included across all frameworks.
• Simplifying the content of the frameworks. Duplicate or overlapping content will be removed and the language made clearer and easier to apply in practice.
Improving assessment and rating:
• Making judgements at the key question level. CQC is proposing that judgements will be made directly at the key question level with reference to the rating characteristics. Lower level scores will no longer be awarded to drive key question ratings.
• Potential changes to how NHS Trusts are rated. Specifically, CQC is asking for feedback on: Re-introducing an overall quality rating for each NHS Trust; introducing Trust-level ratings for all five key questions; and whether to remove location-level ratings.
Have your say
Alongside this public consultation, CQC is also engaging on proposed changes to the current assessment framework. The aim is to simplify and streamline the framework to be more specific and relevant to the health and care sectors that it regulates.
The consultation is open to everyone, including providers, professionals, partner organisations, people who use services and members of the public. The quickest and easiest way to respond is through the online form, by 5pm on December 11, 2025.
Targeted consultation
Alongside the public consultation, CQC is also holding focused engagement sessions to hear the voices of people with lived experience and those working across the sectors it regulates. This activity will be focused on developing sector-specific frameworks and informing ratings characteristics.
The feedback received throughout the targeted consultation will be included in shaping decisions and will complement the public consultation by adding depth and practical insight.
People working at all levels in health and social care services, people who use services, carers, CQC staff and national stakeholders are invited to contribute, with opportunities to take part detailed in its bulletins.
Feedback will be analysed and a response published to explain how it helped to shape decisions.
