Self-Assessment Framework (SAF) Support

Self-Assessment Framework (SAF) Support

The landscape of health and social care regulation in England has undergone a significant transformation with the introduction of the Care Quality Commission’s (CQC) new Single Assessment Framework (SAF). This new framework represents a move towards a more dynamic, data-rich, and streamlined approach to regulation, aiming to simplify the process for providers and deliver a more up-to-date and accurate picture of care quality. For many providers, this change, while welcome in its intent, brings with it a host of new processes, requirements, and a need for a renewed focus on self-assessment and continuous improvement. This article will provide comprehensive support for navigating the SAF, offering insights into its structure, and practical steps for preparation, to not only ensure compliance but to genuinely enhance the quality of care delivered.

Understanding the Core Components of the SAF

At the heart of the CQC’s new approach is a shift in how services are assessed, moving away from the previous Key Lines of Enquiry (KLOEs) to a more focused set of “Quality Statements.” However, the foundational principles of CQC assessment remain.

The Five Key Questions: The five key questions that have long been the bedrock of CQC inspections continue to be central to the SAF. Every assessment will still be structured around determining if a service is:

• Safe: Are people protected from abuse and avoidable harm?
• Effective: Does the care, treatment, and support provided achieve good outcomes, help people maintain quality of life, and is it based on the best available evidence?
• Caring: Do staff involve and treat people with compassion, kindness, dignity, and respect?
• Responsive: Are services organized so that they meet people’s needs?
• Well-led: Does the leadership, management, and governance of the organization make sure it’s providing high-quality care that’s based on individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture?

Quality Statements: The most significant change in the new framework is the replacement of the KLOEs with 34 topic-specific “Quality Statements.” These statements are intended to be clearer and less duplicative than the KLOEs, setting out the CQC’s expectations of providers for each of the five key questions. They are the standards against which services will be assessed, and understanding them in detail is the first step towards successful navigation of the SAF.

Evidence Categories: Underpinning the Quality Statements are six new evidence categories. The CQC will gather evidence across these six categories to inform their assessment of a service. These are:

1. People’s experiences: This category focuses on direct feedback from service users and their families about their experiences of care.
2. Feedback from staff and leaders: This includes feedback from staff at all levels of the organization, as well as leaders, on the quality and safety of care.
3. Observations of care: This involves direct observation of care delivery by CQC inspectors.
4. Feedback from partners: This category considers feedback from other organizations and professionals who have experience of the service.
5. Processes: This looks at the systems and processes in place to ensure high-quality care, including policies, procedures, and records.
6. Outcomes of care: This category focuses on the results of the care and support provided, including data on patient outcomes and service performance against national benchmarks.

The New Scoring System and Ratings

The SAF introduces a more structured and transparent scoring system. Evidence gathered in each of the six categories is scored, and these scores are then used to generate a score for each Quality Statement. These scores are then aggregated to produce an overall rating for the service. The familiar four-point rating scale remains:

• Outstanding
• Good
• Requires Improvement
• Inadequate

However, these ratings are now associated with specific percentage scores, with the aim of providing a clearer and more consistent approach to rating decisions. While the CQC’s intention is for a more transparent system, it’s worth noting that the rollout of this new scoring system has not been without its challenges. An independent review has highlighted concerns about the complexity and inflexibility of the framework, and the CQC is already planning revisions to the scoring system to address these criticisms.

Preparing for the SAF: A Step-by-Step Guide

Proactive preparation is the key to successfully navigating the new Single Assessment Framework. A thorough and honest self-assessment will not only prepare a service for a CQC inspection but will also drive genuine improvements in the quality of care.

1. Deep Dive into the Framework: The first and most crucial step is to develop a deep understanding of the new framework. This means going beyond a superficial reading of the guidance and truly engaging with the Quality Statements and evidence categories. For each Quality Statement, consider what it means in the context of your specific service and what ‘good’ looks like.

2. Conduct a Thorough Self-Assessment: A robust self-assessment process is the cornerstone of SAF preparation. This should be an ongoing process, not a one-off exercise in the run-up to an inspection. Consider the following:

• Internal Audits: Conduct regular internal audits against each of the Quality Statements. These audits should be critical and searching, and should involve staff from all levels of the organization.
• Mock Inspections: Simulate the new assessment process by conducting mock inspections. This can help to identify areas of weakness and to prepare staff for what to expect during a real inspection.
• Utilize Self-Assessment Tools: There are a variety of self-assessment tools available that can help to structure your self-assessment and to ensure that you are considering all of the relevant evidence categories.

3. Empowering Your Team: Your staff are your greatest asset in delivering high-quality care. It is essential that they are fully engaged with the new framework and understand their role in maintaining and improving quality.

• Training: Provide comprehensive training for all staff on the new framework, including the Quality Statements and evidence categories.
• Open Communication: Foster a culture of open communication where staff feel able to raise concerns and to suggest improvements.
• Clearly Defined Roles: Ensure that all staff have a clear understanding of their roles and responsibilities in relation to quality and safety.

4. Evidence is Key: Under the new framework, the CQC will be placing a greater emphasis on evidence. It is crucial that you have robust systems in place for gathering, organizing, and reviewing evidence for each of the six evidence categories. This includes:

• People’s Experiences: Surveys, feedback forms, compliments and complaints logs, and records of meetings with service users and their families.
• Feedback from Staff and Leaders: Staff surveys, records of staff meetings, supervision and appraisal records, and exit interview feedback.
• Observations of Care: Records of internal observations of care, and feedback from external observers.
• Feedback from Partners: Letters, emails, and records of meetings with partner organizations.
• Processes: Policies, procedures, care plans, risk assessments, and training records.
• Outcomes of Care: Data on patient outcomes, performance against national benchmarks, and records of clinical audits.

5. Focus on People’s Experiences: The new framework places a strong emphasis on the experiences of people who use services. Actively seeking and responding to feedback is crucial. This means going beyond simply collecting feedback and demonstrating how you have used it to make improvements.

6. Strong Leadership and Governance: Effective leadership and governance are essential for delivering high-quality care. The CQC will be looking for evidence of a clear leadership structure, robust governance frameworks, and a culture of continuous improvement.

7. Monitor Outcomes and Drive Improvement: The SAF requires a proactive approach to quality improvement. This means regularly monitoring your performance against key outcomes and using this data to drive improvements. This should be a continuous cycle of monitoring, reviewing, and improving.

8. Stay Informed: The CQC is continuing to refine the new framework, and it is important to stay up-to-date with the latest developments. Subscribe to CQC updates, attend webinars, and collaborate with other providers to share best practice.

Challenges and a Proactive Approach

The transition to the SAF is not without its challenges. The new framework is complex, and there is a risk that it could lead to a “tick-box” approach to compliance. However, it is important to remember that the ultimate goal of the framework is to improve the quality of care for people who use services. By taking a proactive and person-centered approach to preparation, you can not only ensure compliance with the new framework but also drive genuine and sustainable improvements in the quality of care that you provide.

Conclusion

The CQC’s new Single Assessment Framework represents a significant change for health and social care providers in England. While the transition may be challenging, it also presents an opportunity to refocus on what really matters: providing high-quality, person-centered care. By developing a deep understanding of the new framework, conducting thorough and honest self-assessments, and empowering your team, you can not only navigate the new regulatory landscape with confidence but also use it as a catalyst for genuine and lasting improvement. The SAF is not just a new set of rules to be followed, but a framework for a more collaborative and data-driven approach to quality, and those providers who embrace it as such will be the best placed to succeed in the years to come.