Archives: The 28 Outcomes (scrapped 30/9/2014) - Login required

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Archives section: The 28 Essential Guidance /Outcomes have now been superseded

The old outcomes framework has been scrapped as it was inadequate and not fit for purpose.
From 1st October 2014, all providers are subject to a new inspection regime based on 5 Key Domains and Key Lines of Enquiry.

The 28 Essential Guidance /Outcomes have now gone!

This section is now history, and for practices who organised their systems around the 28 Outcomes will be starting all over again.

From 1st October 2014, practices are required to follow new guidelines and inspection regime.


The 28 Essential standards guidance published by the CQC came under criticism not only from the Health Committee, but also from the House of Commons Public Accounts Committee and from within the CQC's own board.

In the report published on 09 January 2013 "The Committee concluded that the CQC's primary focus should be on ensuring that the essential standards it enforces can be interpreted by the public as a guarantee of acceptable standards in care. We do not believe that the CQC's essential standards in their current form succeed in this objective."

Commenting on the Health Select Committee report, Chief Executive David Behan has outlined CQC's "intentions to tailor the way we regulate different types of organisations based on what has the most impact on driving improvement." He continued that, "We have already begun to make some of these changes and will continue this process."

In fact, the actual Regulations are quite straightforward in that they specify what you should comply with and do not refer to the requirements in terms of outcomes.

The CQC is required to produce guidelines to help providers understand the regulations. What the CQC has attempted to do is produce a definitive document combining the Registration Act with the Regulations, and the result is the 278 page document titled "Care Quality Commission - Guidance about compliance".
The CQC believes that the process should be outcomes orientated and has reordered the various paragraphs of the regulations as outcomes 1 to 28.

Here are some problems with these guidelines:

  • Most providers find it a very difficult read because of the bureaucratic language used
  • It introduces the concept of "prompts" which have no legal basis, but will nevertheless be used to judge compliance
  • The same prompts may appear under several Outcomes, so presenting evidence in the same sequence as the Outcomes becomes problematic
  • Compliance with CQC does not mean you are compliant with everything. The guidelines have some glaring omissions and also state that they are not intended to cover everything.

 In these sections, we have tried to simplify the meaning of the Outcomes.


British Medical Association (BMA)

The BMA has produced an excellent guide, and we have referred to their material where appropriate. When reading the BMA material and quotes, please bear in mind the exclusion clause on their guide:

"This document should be treated and used as guidance only. You should consider the individual circumstances of your provider(s) on all occasions including before making declarations. Equally if there is any legislation or standards not mentioned in this guidance that your provider(s) should be compliant with, you should still comply with that legislation and those standards.
The BMA excludes all liability and has no responsibility for individuals failing to register their practice correctly or at all, or any action taken by CQC, including remedial action, enforcement action and penalties, or action taken by any other body against individuals and/or providers that have used this guidance."



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