Your ratings: NHS trusts

After an inspection, we rate NHS trusts for the quality of care overall and for our five key questions: are they safe, effective, caring, responsive and well-led?

For non-specialist acute trusts, we also give a rating for the trust’s use of resources, and award a combined rating for the trust based on the combination of the six trust-level ratings.

We award ratings on a four-point scale: outstanding, good, requires improvement, or inadequate.

It is a legal requirement for all providers to display CQC ratings.

We decide all ratings using a combination of aggregating the core service ratings and the professional judgement of inspection teams. We provide ratings at different levels and we use a set of ratings principles to help us to determine the final ratings.

Ratings characteristics

Each rating is based on our assessment of the evidence we gather against the key lines of enquiry in the assessment framework for health care services and, for relevant non-specialist acute trusts, the use of resources assessment framework. Inspectors refer to the corresponding ratings characteristics for the key lines of enquiry and use their professional judgement to decide on the rating.

When deciding on a rating for services, the well-led key question or use of resources, the inspection team asks:

• Does the evidence demonstrate a potential rating of good?
• If yes – does it exceed the standard of good and could it be outstanding?
• If no – does it reflect the characteristics of requires improvement or inadequate?

A core service or trust doesn’t have to demonstrate every characteristic of a rating for us to give that rating. For example, if a trust demonstrates just one of the characteristics of inadequate but it has significant impact on the quality of care or on people’s experience, this could lead to a rating of inadequate. On the other hand, even providers rated as outstanding are likely to have areas where they could improve. In the same way, trusts don’t need to demonstrate every one of the characteristics of good in order to be rated as good.

Inspection teams use the ratings characteristics as a guide, not as a checklist or an exhaustive list. They take into account best practice and recognised guidelines, and assure consistency through CQC’s quality control process.