What is the CQC Single Assessment Framework in Health and Social Care?

The Care Quality Commission (CQC) regulates health and social care services across England. It makes sure people get safe, effective, compassionate, and high-quality care. In 2023, CQC introduced a new way of inspecting and rating services: the Single Assessment Framework (SAF). The SAF brings together different assessment methods into one central approach. It covers NHS services, adult social care, general practices, and other types of care. This framework aims to create consistency in how services are checked, so people know what to expect wherever they receive care.

The Reason Behind the Single Assessment Framework

Before SAF, the CQC used various frameworks for different types of settings. This sometimes led to confusion for providers and the public. The introduction of SAF marks an effort to standardise assessment across services. By using common language and shared key themes, the CQC now makes it easier for everyone to understand what good care looks like and what needs to improve.

What the CQC Wants to Achieve

The main purpose of the SAF is to:

• Strengthen trust in care services
• Make expectations clear for providers
• Provide meaningful, easily understood ratings
• Focus inspections on what matters to people using services
• Encourage continuous improvement

This framework supports both those delivering care and the people who rely on these services.

The Six Key Quality Statements

The SAF is built around six key quality statements. These are the main questions the CQC asks when reviewing any service. Each statement helps shape the evidence that inspectors gather and the judgements they make.

The six statements:

• Safe: Are people protected from abuse and avoidable harm?
• Effective: Does care, treatment, and support achieve good outcomes?
• Caring: Do staff involve and treat people with compassion, kindness, dignity, and respect?
• Responsive: Are services organised so that they meet people’s needs?
• Well-led: Does leadership, management, and governance assure delivery of high-quality person-centred care?
• People’s experience: Does the service listen and act on feedback to improve care for individuals?

These statements apply to all types of health and social care providers.

Quality Statements in Detail

CQC supports the key statements with a set of quality statements. These break down each area into further detail, showing both what good care looks like and what inspectors will be seeking.

For example, under “Safe,” inspectors will look at:

• Safeguarding from abuse
• Infection prevention and control
• Safe medicines management

Under “Well-led,” inspectors want evidence of:

• Strong and visible leadership
• Inclusive and supportive culture
• Clear vision and values shared by the whole team

Each quality statement comes with clear guidance and specific examples. This means both staff and people using services can see what is expected and how to meet or challenge these standards.

Gathering and Using Evidence

Under the SAF, evidence gathering is at the heart of inspections. The CQC gathers information from a much wider range of sources than ever before, including:

• Direct observations—seeing how staff interact with people
• Speaking with people using the service, relatives, and staff
• Reviewing feedback from patients, families, staff, and commissioners
• Examining records, incident reports, and audits
• Monitoring data about complaints, safeguarding alerts, and improvement notices

Inspectors assess evidence against each quality statement. This helps create a full picture of the strengths and weaknesses of a service.

Types of Evidence

CQC organises evidence into six main categories:

• People’s experience: Direct feedback from people using the service
• Feedback from staff and leaders: Staff surveys, interviews, and whistleblowing statements
• Processes: Policies, procedures, audits, and care planning
• Outcomes: Health improvements and quality of life evidence
• Observation: How staff deliver care and respect people’s dignity
• Environment: Condition, cleanliness, and suitability of the setting

This system supports a fair, accurate, and rounded assessment.

Ratings Under the Single Assessment Framework

Each provider receives a quality rating for every key statement area. These ratings use a four-point scale:

• Outstanding
• Good
• Requires Improvement
• Inadequate

This scale helps people using services, professionals, and funders compare services easily. The CQC publishes these ratings online so everyone can see how each provider is performing.

The Frequency and Focus of Assessments

With SAF, inspections are more flexible and targeted. Rather than waiting for set periods, the CQC now uses live data and feedback to decide when and where to inspect. This allows inspectors to respond quickly when concerns arise or when services are likely to have improved.

Spot checks can focus on just one or two quality statements if specific risks or improvements are identified.

Benefits for People Using Services

For people using health and social care services, the SAF provides:

• Consistent standards and a clear idea of what to expect
• Published, easy-to-understand ratings for all providers
• Greater voice, as direct feedback is a key part of the evidence
• Focus on personal experience, dignity, and outcomes
• Expectations of improvement if issues are found

This makes it easier for people to make informed decisions and challenge poor care.

Why This Matters for Providers

Providers use the SAF to understand exactly what the CQC expects. It sets a clear benchmark across all services. This helps teams prepare for inspections, identify areas to improve, and share success. The framework is designed for learning and development as much as for inspection.

Benefits for providers:

• Clear standards for self-assessment
• A chance to show good practice
• Focused guidance on problem areas
• Consistency across services, making comparisons and improvements easier

How Services Prepare for SAF

Many services have changed how they collect and review information about care. They now:

• Use regular surveys to gather people’s experience
• Carry out staff feedback exercises
• Audit care records and procedures
• Review complaints, incidents, and compliments
• Train staff on safeguarding, dignity, and leadership

By gathering this information, providers can present clear evidence during an inspection.

Involvement of People and Relatives

A central feature of SAF is the priority given to people’s direct feedback and involvement. This means:

• People using services share their experience regularly
• Families are invited to give views on the care their loved ones receive
• Complaints, concerns, and compliments are gathered and reviewed

This feedback is used to challenge or support the evidence the provider gives, making the assessment fairer.

The CQC’s Role After Inspection

Following an inspection under the SAF, the CQC will:

• Publish its findings and ratings
• Set requirements and give advice if action is needed
• Revisit if services need to improve
• Offer clear explanations of decisions

Providers are expected to respond to feedback, learning, and improving as necessary.

The Impact on Staff and Leaders

Staff and leaders are now assessed on how they create a supportive, open, and improvement-focused culture. The SAF expects managers to:

• Be visible and approachable
• Champion person-centred care
• Listen and act when staff or people raise issues
• Lead on regular learning and development

A strong leadership approach links directly to better care and better ratings.

Equality, Diversity, and Inclusion

The SAF places importance on fair, accessible, and inclusive care. Services are now checked on how they:

• Include and respect people from all backgrounds
• Meet the needs of those with disabilities or communication challenges
• Provide care without discrimination

Inspectors look for evidence that all people get safe, caring, and respectful support.

Transparency and Openness

The new system makes ratings and findings available for all to see. Providers must display ratings in their settings and on their websites. This helps people trust the information and make choices based on the best evidence.

How the Framework Affects Different Settings

The SAF covers a wide range of care settings:

• NHS hospitals and mental health services
• GP practices and clinics
• Care homes and domiciliary care
• Community health teams and supported living services

The core framework remains the same, but some specifics (such as infection control for care homes) are tailored to different settings.

Responding to the Framework: What Providers Do

After receiving CQC feedback, providers might:

• Run action plans to fix weaker areas
• Offer refresher training for staff
• Update policies and procedures
• Involve people using services in making improvements

This cycle of assessment, action, and review is at the core of SAF.

Ongoing Changes and Development

The CQC has stated that SAF will be reviewed and refined over time. This means that the system will grow to reflect public expectations, new laws, and the needs of people using services. Providers can get updates and support through CQC’s website, webinars, and forums.

Tips for Staff and Providers

• Review the six quality statements and relevant quality statements for your setting
• Collect and act on feedback from everyone involved
• Keep training and support up to date
• Use CQC guidance documents and examples to support improvement
• Be transparent with staff, people using services, and inspectors

Final Thoughts

The CQC Single Assessment Framework represents a major change in how care services are checked in England. By focusing on key statements, people’s experiences, and flexible, evidence-based inspection, SAF empowers people and providers alike.

It brings together clear standards, open reporting, and a drive for continuous improvement. Everyone involved in health and social care in England now works from the same script—making care safer, kinder, and more person-focused for all.