The CQC has this week published up -to-date guidance setting out a new methodology for awarding overall ratings to NHS Trusts. The guidance explains that the CQC will now combine the ratings given to NHS Trusts for Use of Resources with the Quality ratings that we are now used to (safe, effective, caring, responsive and well-led). 

We have moved on from 'shadow ratings' and as from 5 March 2018, Trusts will received a new combined rating (on the scale of outstanding, good, requires improvement or inadequate) which will be arrived at by aggregating the ratings on the five key questions plus the Use of Resources rating

The CQC consulted on these proposals but only 16 out of 240 or so NHS Trusts took the time to respond (or had the time to respond?). 

The CQC's new guidance ( addresses one of the concerns raised during the consultation that a negative rating for Use of Resources could lead to a disproportionate number of Trusts being rated as Requires Improvement overall.  The usual aggregation rule is that if, within a set of 4 to 8 ratings, there are 2 requires improvement ratings then the overall rating will be limited to requires improvement (sometimes known as 'the rule of two'). The new guidance has lifted the tolerance level to 3 so a trust can have 2 requires improvement ratings on the overall ratings for safe, effective, caring, responsive, well-led and use of resources and still achieve a 'good' overall rating, provided that the other 4 ratings are all 'good' or better. If the same Trust were to have 3 requires improvement ratings out of the 6 ratings then this will lead to an overall rating of 'requires improvement' as illustrated by the image above. 

What should we take from this?

1) The Use of Resources inspection is important and will have a bearing on the overall Trust rating.  At the moment, only non-specialist acute trusts get inspected by NHSI on use of resources but it will be rolled out more widely to other trusts in the future. Learn more about how to prepare for a UoR inspection here:

2) The new aggregation rules apply to all inspections undertaken after 5 March 2018. When considering the factual accuracy of draft reports (from CQC and NHSI) consider how the findings will merge to create the overall rating.

3) As with existing rules, all ratings need to be displayed on Trust premises for patients and the public to see.