What Is Changing and Why It Matters
The CQC introduced the Single Assessment Framework in 2023 as a unified approach to regulating all health and social care services. The idea was to simplify regulation, reduce duplication, and create one consistent model that worked across every sector. In practice, it did not land the way it was intended. Providers and inspectors found the numerical scoring model difficult to work with, and at times the results did not reflect the actual quality of a service. An independent review in 2024 confirmed those concerns and recommended significant changes.
Rather than trying to fix the existing framework, the CQC decided to replace it altogether. Four sector-specific assessment frameworks are now in development, each designed around the realities of a different part of the health and care landscape. For registered providers in England, this is the biggest shift in how regulation works since the five key questions were introduced.
If you have been preparing for inspection based on the SAF, building evidence against Quality Statements, tracking numerical scores, or training staff around that methodology, some of that work will need to be revisited. Not all of it, but the framework it was built around is moving.
The Four Sector-Specific Frameworks
The CQC is developing separate frameworks for:
- Adult social care, covering residential care homes, home care agencies, supported living, shared lives, and related services
- Mental health, covering inpatient mental health services, crisis resolution, community mental health, and specialist providers
- Primary and community care, covering GP practices, dental services, community health services, independent clinics, and urgent treatment centres
- Secondary and specialist hospital care, covering NHS trusts, independent hospitals, ambulance services, and specialist hospital provision
The thinking behind the split is straightforward. Inspectors working in adult social care face very different environments and risks compared to those working in acute hospitals. A framework designed specifically for each sector should produce assessments that are more meaningful and more consistent than a single model stretched across all of them.
The detail of each framework is still being finalised. Pilots are running through 2026, and the CQC has committed to publishing a full consultation response before any formal national roll-out.
What Stays the Same
For all the change that is coming, several things are staying put.
The five key questions. Every inspection will still be built around whether a service is Safe, Effective, Caring, Responsive, and Well-led. These have underpinned CQC regulation since 2014 and they are not going anywhere. Your service still needs to provide strong, specific evidence for each one, regardless of which framework is in play.
The rating scale. Outstanding, Good, Requires Improvement, and Inadequate are all staying. The CQC has been clear on that. What changes is how those ratings are reached, not the ratings themselves.
How inspectors gather evidence. Inspectors will still speak to people using services, observe care in practice, review documentation, and talk to staff at every level. The sources of evidence are not changing. What changes is how inspectors weigh and interpret what they find.
The focus on leadership. Governance and quality assurance remain firmly under the spotlight. In fact, the move to structured professional judgement arguably places even more weight on the inspector’s overall view of leadership culture, which means visible, embedded governance matters more than ever.
What Is Genuinely Different
Structured Professional Judgement Instead of Numerical Scoring
Under the SAF, evidence was scored numerically. Each piece of evidence contributed to a score against a Quality Statement, those scores were aggregated, and the result was a rating. The independent review found this model hard to apply consistently, and it sometimes produced outcomes that did not match the reality on the ground.
The new frameworks replace this with what the CQC calls “structured professional judgement.” Instead of adding up individual scores, inspectors will look at the evidence for each key question as a whole and use their professional expertise to reach a judgement. It is a less mechanical process and one that gives experienced inspectors more latitude.
For providers, the practical takeaway is this: building a coherent, well-evidenced picture of quality across each key question matters more now than trying to score well against individual criteria. The evidence itself still matters, but the way it gets evaluated is fundamentally different.
Quality Statements Replaced by Supporting Key Lines of Enquiry
The 34 “we statements” that providers have been working to evidence under the SAF are being removed. In their place, each sector-specific framework will use “supporting key lines of enquiry,” which are structured questions that inspectors use to explore each of the five key questions within the context of that specific sector.
If this sounds familiar, it is closer in spirit to the original KLOEs that came before the SAF, although the CQC has been clear this is not simply going back to the old model. The aim is for these key lines of enquiry to be more practically relevant to each sector, and for inspectors to treat them as a structured guide to professional judgement rather than a checklist.
The precise content of the supporting key lines of enquiry for each sector has not been published yet. That is still being developed through the pilot process. What we do know is that the five key questions provide the overarching structure, with sector-specific sub-questions sitting beneath them.
No More Ratings Below Key Question Level
Under the SAF, ratings were generated at Quality Statement level and then aggregated upward. Services effectively received sub-ratings for individual Quality Statements, which fed into the key question rating and then the overall service rating.
That cascade is going. Under the new approach, ratings will only be given at key question level (Safe, Effective, Caring, Responsive, Well-led) and at the overall service level. There will be no formal ratings below that point, which removes the scoring complexity that many providers found confusing and that the independent review identified as a source of inconsistency.
Rating Characteristics Are Coming Back
One of the main criticisms of the SAF was that it dropped the “rating characteristics” that used to describe what each rating level looked like in practice. Without them, providers found it harder to understand what they needed to demonstrate to achieve or maintain a particular rating.
The CQC is bringing rating characteristics back, tailored to each of the four sectors this time. Once finalised, these will give providers a sector-specific description of what Outstanding, Good, Requires Improvement, and Inadequate actually look like in their type of service. That should make it much easier to self-assess where you stand and work out what to focus on.
These are still being developed and piloted. Final versions have not been published for any sector yet.
What This Means for Your Inspection Preparation
The frameworks are changing, but inspections have not stopped. The CQC has not paused its inspection programme while the new approach is developed. Services are being assessed and rated right now, primarily using the existing methodology while pilots run alongside.
That creates a practical challenge: you need to be ready for inspection under the current system while also positioning yourself for what comes next.
Focus Your Evidence on the Five Key Questions
The five key questions are the constant through this entire transition. Providers who have built strong evidence against each key question are well placed regardless of which framework version applies to their inspection. Those who built their preparation narrowly around Quality Statement scoring may find that evidence harder to transfer across.
The most sensible preparation approach right now is to treat each key question as the primary unit of evidence. For every key question, consider:
- What does our practice actually look like in this area?
- Can we back that up with specific, recent examples?
- What do the people we support say about it?
- What does our governance and audit trail show?
- Would this evidence hold up if an inspector was not applying a scoring formula?
That last question is the important one given the shift to professional judgement. Strong, rounded evidence across each key question is worth more than evidence that was engineered to tick specific scoring criteria.
Strengthen Your Governance and Leadership Evidence
Without numerical scoring, the inspector’s professional judgement about leadership culture, governance quality, and whether improvement is genuinely embedded carries more weight. Well-led is often the key question that separates a Good from an Outstanding, and it is the one where services most commonly get caught out.
If your governance systems exist on paper but do not demonstrably drive change in practice, an experienced inspector using professional judgement will see that. Review your audit cycles, quality assurance documentation, improvement records, and leadership meeting notes. The question is not whether those documents exist, but whether they tell a coherent story about a service that understands its own quality and acts on what it finds.
Prepare for Sector-Specific Scrutiny
By their nature, the new sector-specific frameworks will require sector-specific evidence. An adult social care inspector will be looking at your service through a different lens to a primary care inspector, using key lines of enquiry that are designed around the particular risks and quality markers of your sector.
Your preparation should reflect that. Generic compliance work has limited value when the inspection framework itself is built to probe the specific challenges of your type of service.
Our consultants at Team Care Compliance work within specific sectors. We understand the quality markers that matter in adult social care, the governance expectations in mental health settings, and the particular pressures on primary care providers. Our mock inspections and audits reflect the scrutiny your service will actually face, not a one-size-fits-all version of it.
How to Use This Transition Period
The gap between now and full implementation of the new frameworks is not a waiting game. It is a window to get your house in order.
Stay informed. The CQC is publishing updates as the pilots progress. Keep an eye on the CQC website and subscribe to their provider updates. We track these developments closely and share our analysis with the providers we support, so you do not have to piece it together yourself.
Review your evidence base. Look at your existing evidence through the lens of the five key questions rather than individual Quality Statements. Where is it strong? Where is it thin, inconsistent, or too vague to withstand professional scrutiny? That review will serve you well regardless of which framework version you are inspected under.
Invest in your governance systems. The shift to structured professional judgement is partly a shift toward trusting experienced inspectors to evaluate quality holistically. Services that can demonstrate robust, visible governance and genuine quality improvement will be in a strong position. Services that have relied mainly on documentation to satisfy scoring criteria will need to go further.
Brief your team. If your staff have been trained around the specific language and structure of Quality Statements, they will need to understand that the framework is evolving. What has not changed is the expectation that staff can speak confidently and specifically about how they deliver safe, effective, caring, responsive care within a well-led organisation.
Get a mock inspection now. A mock inspection under the current approach is not wasted effort. It gives you a baseline assessment of where your service stands, identifies the gaps, and generates an improvement plan that will remain relevant as the new frameworks come into effect. If anything, the transition period is a good reason to get independent oversight sooner rather than later.
How We Can Help
Team Care Compliance has been working at the front line of regulatory change since before the Single Assessment Framework was introduced. We supported providers through the transition to the SAF, and we are already working with providers to prepare for what comes next.
Our approach is straightforward: we tell you what we actually see in your service, what the CQC is likely to focus on, and what needs to change. We do not deal in generic compliance advice. Everything we provide is specific to your sector, your service type, and your current evidence base.
During this transition, we offer:
- Sector-aligned mock inspections that reflect the scrutiny your service will actually face, using the five key questions as the primary frame and drawing on the latest available information about sector-specific expectations
- Evidence and governance reviews to systematically audit your current evidence base and quality assurance systems, with clear recommendations for strengthening both
- Regulatory briefings for leadership teams who need to understand what the framework changes mean for their specific service type
- Ongoing compliance support on a retainer basis that keeps you current as the frameworks develop, so you are not scrambling to catch up when the pilots conclude and roll-out begins
The changes the CQC is making are intended to improve regulation and make assessments more relevant to each part of the sector. Providers who engage with those changes early, rather than waiting for the finished framework to land, will be better prepared for whatever their next inspection looks like.
If you want to know where your service stands right now and what you should be doing to prepare, get in touch for a consultation.