Last reviewed 28 April 2015
A new legal requirement has been introduced by the Care Quality Commission for health and social care providers to display the performance ratings they receive following an inspection. Martin Hodgson explains what the “duty to display” is and what service providers need to do in order to comply with it.
The duty to display
The new legal duty to display performance ratings has been introduced as Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Requirement as to Display of Performance Assessments.
The duty applies to all service providers regulated by the CQC. It requires that, where providers have been given performance ratings by inspectors, they must ensure that the ratings are displayed “conspicuously and legibly” at each location delivering a regulated service.
Providers must also publish the ratings in their main offices and on their website, if they have one. This requirement applies from 1 April 2015.
Under the updated CQC inspection system, which has applied to providers since October 2014, performance ratings are usually provided by CQC inspectors at the end of any comprehensive inspection.
To make their ratings judgements, inspectors use a “five key-question test” to assess services, asking:
Are they safe?
Are they effective?
Are they caring?
Are they responsive to people’s needs?
Are they well-led?
Inspectors use the Key Lines of Enquiry (KLOE) published in the relevant CQC handbooks to inform their judgements. Providers will be accorded either an “Outstanding”, “Good”, “Requires Improvement” or “Inadequate” rating for each question. An overall rating is then calculated and included in the inspection report.
Prior to the implementation of the new duty to display, performance ratings were published on the CQC website along with the inspection report. This provides the general public with information about the quality of services and can be used to inform decisions about which care services to access.
Yet, the regulators wanted to go further in order to ensure that the general public had as much access to ratings information as possible. Hence, following consultation, legislation was introduced to make publication and display by the provider a legal requirement.
The regulation specifies the information that must be included in any display. CQC has also published guidance on their website to support compliance: Display of ratings - A guide for care providers on how to display ratings.
This guidance states that any service which has been awarded a CQC rating must display the most up-to-date rating prominently in each and every premises where a regulated activity is being delivered. This must be displayed in the main place of business as well as on the service provider’s website, where the service has one.
Services must display ratings within 21 calendar days of receiving their inspection report.
To help service providers achieve compliance, CQC have produced a series of official posters which are available for download from the CQC website. These are designed to be printed and used to display ratings on-site.
Three types of poster are available from CQC: a Provider Poster, a Premises Poster, and an Activity Poster. Display of ratings contains guidance about which poster applies to each type of provider.
CQC guidance states that inspectors will expect the display of the poster to be “conspicuous” and printed in colour, in order to show the colour-coded ratings most effectively. They should be at least A4 sized or bigger to suit the place where they are displayed, and to make them easy to read.
The posters include a space which providers can use to inform people how they can find out more about how the service is improving, or what has changed since the ratings were published.
CQC also encourage providers to display additional information alongside the poster to make the information easier to understand. However, this additional information should not replace the CQC display.
Placement of posters
The regulation requires providers to physically display their ratings in each and every premises where a regulated activity is being delivered and in the main place of business. They must be placed conspicuously — that is, in a place where as many people as possible will see it.
CQC advise that they would expect the poster to be displayed in the waiting area of GP practices.
In premises where several registered providers operate, it is the responsibility of each provider to ensure that their ratings are displayed.
For the purposes of Regulation 20A, vehicles are not considered to be premises.
CQC state that their posters will be used as a “benchmark” by inspectors in any decision about the adequacy of a display. Using the official poster and displaying it correctly is therefore the best way of ensuring compliance.
It is also noted that it is providers themselves that are ultimately responsible for meeting the regulations, and that if they decide to use an alternative design of poster this is allowed. However, in such cases inspectors will ask them to provide evidence that their alternative approach still enables them to meet the legal requirements.
As with the physical posters, CQC do provide a template and a web app to help providers get the online display of their ratings right. These are also available from the CQC website.
CQC encourage the use of their logo and state that the display should appear either on the main homepage of the website or on an appropriate “landing page” where people are most likely to see it. The ratings must appear in all websites that describe the services provided. The information can be split up if a provider has separate pages for different premises.
Display of ratings states that, where a service chooses not to use the CQC templates, they must include the name of the rated service, all provider and premises ratings awarded by CQC and the date the inspection report was published.
Providers must also include CQC’s website address (www.cqc.org.uk) and a link to the location on CQC’s website where the assessment and ratings of the provider’s performance may be accessed.
Failure to display
CQC are authorised to prosecute for a breach of the new regulation, or a breach of part of the regulation, and can move directly to prosecution without first serving a warning notice. It also has recourse to a range of regulatory actions in such instances.
Inspectors will assess whether or not ratings are displayed legibly and conspicuously enough when they visit. Where the ratings are not displayed clearly enough the inspector may impose a fine and take the non-compliance into consideration in future inspection ratings.
Ratings and marketing
CQC point out that the duty to display ratings should be looked at as a positive marketing opportunity by providers, and not as a threat. Providers are encouraged to “celebrate” an “Outstanding” or “Good” rating by displaying the information widely, suggesting that they consider using the rating on things such as letter headings and emails, displaying banners at premises and highlighting ratings through local media.