Recommendation 253

Quality and risk profile information made public

The information behind the quality and risk profile – as well as the ratings and methodology – should be placed in the public domain, as far as is consistent with maintaining any legitimate confidentiality of such information, together with appropriate explanations to enable the public to understand the limitations of this tool.

The Care Quality Commission is developing a new approach to inspection, and has started routinely publishing for the NHS the information that it uses to focus its inspections. This information is based on monitoring a set of indicators of risk, which have replaced the former quality and risk profile approach. As the Care Quality Commission carries out each inspection under its new approach, it will publish a data pack at the same time as publishing the inspection report. A data pack is a detailed analysis of key information that the Care Quality Commission holds about a provider, including its performance on risk indicators, other sources of data, and qualitative information such as views of local organisations and feedback from patients.

In June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care. This set out the new approach to inspecting hospitals, and sought views on an annex with the full set of indicators that the Care Quality Commission proposed for monitoring hospitals, to identify potential risks and the priority order for inspection. On 24 October 2013 the Care Quality Commission published a full analysis of all its monitoring indicators for all acute hospital trusts, showing their performance against the indicators. The results of this intelligent monitoring work group, the 161 acute NHS trusts into six bands based on the risk that people may not be receiving safe, effective, high quality care.  The Care Quality Commission has undertaken to update and publish these analyses quarterly, with explanation of what should and should not be read into them.


The Care Quality Commission has replaced its Quality and Risk Profile with a system of Intelligent Monitoring to help decide when, where and what to inspect. This draws information and data from a range of sources to identify providers and services where there may be a greater risk of providing poor care. The evidence from the Intelligent Monitoring system is used to prioritise which providers will be inspected and the lines of enquiry during an investigation. The system triggers a response, for example, where there are a statistically significant number of severe harm incidents or avoidable deaths at a provider. “Never events” trigger an automated elevated risk in Intelligent Monitoring which inspectors follow up individually. The data it looks at includes information from:

  • Staff
  • Patient surveys
  • Mortality rates
  • Hospital performance information such as waiting times and infection rates

In October 2013, the Care Quality Commission began a pilot of its Intelligent Monitoring programme for acute and specialist NHS trusts. The pilot looked at more than 150 different sets of data (indicators), which related to the five key questions the Care Quality Commission asks of all services – are they safe, effective, caring, responsive, and well-led? Using this data, the Care Quality Commission grouped all acute NHS trusts into six priority bands for inspection. In March and July 2014, the Care Quality Commission updated its surveillance model for acute and specialist NHS trusts.

In November 2014, the Care Quality Commission published Mental Health intelligent monitoring reports, which display the results of its analysis of Tier 1 indicators for all Mental Health NHS trusts. Each trust will receive an individual report and banding, similar to those for acute hospitals. The bandings will range from one to four.

In November 2014 the Care Quality Commission published its first round of Intelligent Monitoring for GPs.

The Care Quality Commission has always used important information in statutory notifications as an indicator of quality and safety in the adult social care sector, alongside other information about safeguarding alerts and information provided by others such as people who use services, staff and the public. The Care Quality Commission does not have a lot of quantitative data consistently collected across the sector but it is taking steps to improve this. With a new, more thorough model, the Care Quality Commission intends to use all the available information to check whether there is a risk that services do not provide either safe or quality care.

Draft Intelligent Monitoring models for the Adult Social Care sector have been in place since October 2014, with separate sets of indicators for residential, community and hospice services. the Care Quality Commission will continue to develop these models with providers and stakeholders to develop a more robust Intelligent Monitoring system within Adult Social Care during 2015/16 and beyond