Essential standards of quality and safety Guidance about compliance

Background to the guidance

A new system of registration

As the regulator of health and adult social care in England, we make sure that the care people receive meets essential standards of quality and safety and we encourage ongoing improvements by those who provide or commission care.

The new registration system for health and adult social care will make sure that people can expect services to meet essential standards of quality and safety that respect their dignity and protect their rights. The new system is focused on outcomes rather than systems and processes, and places the views and experiences of people who use services at its centre.

We will continuously monitor compliance with essential standards as part of a new, more dynamic, responsive and robust system of regulation. Our assessors and inspectors will frequently review all available information and intelligence we hold about a provider. We will seek information from patients and public representative groups, and from organisations such as other regulators and the National Patient Safety Agency.

If we have concerns that a provider is not meeting essential standards of quality and safety, we will act quickly, working closely with commissioners and others, and using our new enforcement powers if necessary.

Promoting improvement

In addition to the assurance about compliance with essential standards that registration will provide, we have an important function in promoting improvement by providing independent, reliable and timely information about the quality of care in providers above essential standards, and about the quality of care secured by commissioners for their local communities, which we describe as assessments of quality.

These assessments include: our periodic reviews of the performance of all health and adult social care providers, and of councils and primary care trusts as commissioners of care; and our special reviews and studies of particular aspects of care, on economy, efficiency and effectiveness, and information issues.

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Why we produced the guidance

Section 23(1) of the Health and Social Care Act 2008 requires the Care Quality Commission to produce guidance for providers of health and adult social care, to help them comply with the regulations within the Act that govern their activities.

The Act, the regulations and this guidance are part of a wider regulatory framework that includes regulation of professionals such as nurses, doctors and social workers. The framework is designed to ensure that people who use services are protected and receive the care, treatment and support they need.

We will use the guidance when deciding whether to register individual providers, and also when monitoring their services afterwards to check that they are continuing to comply with the regulations. We will also refer to it when using our powers of enforcement to bring about improvement in poor services or to prevent a provider from carrying out regulated activities.

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Who the guidance is for

The guidance is for providers of health or social care services who carry out the “regulated activities” shown in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Many of our own staff will also use the guidance in their work. In addition, courts and tribunals will take account of it when making decisions about our enforcement activities.

Other groups with an interest in the quality of health and social care may find the guidance helpful – for example, people who use services, other regulators, MPs and the general public.

The guidance does not apply to:

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How we developed the guidance

When developing our guidance about compliance for providers of health or social care, we carried out a large-scale public consultation. We sought the views of people who use care services and those who provide them, other regulators, and organisations that represent people who use services or providers, or that work in the wider system of health and social care.

When producing the final version of the guidance, we have

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How the guidance is structured

We have grouped the regulations and their associated outcomes into six key areas.

The guidance for each area is made up of a summary of the area and the regulations that it covers, and then for each regulation:

The detailed prompts are divided into:

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Do I need to read all of the outcomes?

We strongly recommend that you read all of the guidance that applies to you for all of the outcomes in the six key areas. This is because our expectations for one outcome may sometimes apply to a number of other outcomes. For example, Outcome 14 about supporting workers is the main part of the guidance that addresses staff training. But for providers to achieve the outcomes needed for, say, nutrition or safeguarding, they may need to meet staff training requirements in these areas.

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Do providers have to follow the guidance?

The detailed outcomes and prompts that we provide for each regulation indicate what providers should be doing to meet the requirements of the regulations. However, providers are not legally bound to use these and, although we must take it into account when deciding whether a provider is complying with the regulations, and in tribunals and courts, our guidance is not legally enforceable in its own right.

However, if you decide to follow other arrangements for demonstrating compliance with the regulations, Regulation 26 of the Health and Social Care Act (Regulated Activities) Regulations 2010 requires you to be able to show that you have taken account of our outcomes and prompts when judging your compliance.

If you choose not to use the prompts, you will still need to be able to show us that you are meeting the needs of people using your services, and to the standards that the regulations require. If you do not do so, we will ask you to explain why.

But if you feel you cannot follow our prompts because your services are particularly innovative and the evidence you will want to provide will be different from that which the prompts indicates, we will work with you to confirm that your services are reaching the essential standards of quality and safety.

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More about the underlying regulations

The regulations that govern your registration by the Care Quality Commission are the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Section 23 of the Act requires us to produce guidance about some of these regulations. These are called Section 20 Regulations and this guidance only relates to them.

When we refer to “the Act”, we mean the Health and Social Care Act 2008.

Regulation of the requirement to prevent or control healthcare associated infections

The Care Quality Commission is not required by the Act to produce guidance about legislation governing the prevention or control of healthcare-associated infections [regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010]. This guidance is available in the Department of Health’s publication: The Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

Other relevant legislation

The Act allows us to take account of a provider’s compliance with any other legislation that we believe is relevant to registration. In the prompts we have referred to legislation that we consider to be of particular importance, but we have not included all relevant legislation.

As a provider of care, you are responsible for knowing what other legislation is relevant to your service and making sure that you comply with it. We may consider your compliance with such legislation when monitoring and checking your services.

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Schedule of applicable publications by other organisations

In addition to following our guidance about compliance with the regulations, and other relevant legislation, please make sure that you read the schedule of applicable publications that we have drawn up for providers. The list will be updated from time to time, with the latest version available at

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