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Posted on 26th June 2025
When it comes to choosing a healthcare provider, whether that’s a hospital, GP practice, care home or private clinic, trust and safety are paramount. This is where the Care Quality Commission (CQC) comes in. As the independent regulator of health and social care services in England, the CQC is responsible for inspecting services and issuing official ratings that help patients and families make informed decisions.
But beyond guiding public choice, CQC ratings can also serve as critical evidence in cases of medical negligence, where substandard care may have caused avoidable harm.
What Does the CQC Do?
The CQC monitors, inspects, and regulates services across the healthcare and social care sectors. Their goal is to ensure services are safe, effective, caring, responsive, and well-led. Every service is assessed across these five key questions, and each of these is given an individual rating.
In many cases, the CQC also provides an overall rating for the provider or trust.
The Four CQC Ratings Explained
Each service is rated using one of four categories:
- Outstanding – The service is performing exceptionally well.
- Good – The service is performing well and meeting expectations.
- Requires Improvement – The service is not performing as well as it should and must improve.
- Inadequate – The service is performing badly, and the CQC may take enforcement action.
These ratings are crucial indicators of care quality, and in some cases, warning signs of systemic failings that could lead to serious patient harm.
How CQC Ratings Are Structured
To ensure clarity and fairness in their evaluations, the CQC uses a five-tiered rating structure:
- Level 1: Ratings for individual key questions at the service level (e.g. how safe a particular maternity unit is).
- Level 2: Overall ratings for a specific service (e.g. the maternity service at a hospital).
- Level 3: Ratings for each key question at a location level (e.g. how effective an entire hospital is).
- Level 4: The overall rating for a location (e.g. the hospital as a whole).
- Level 5: A trust-level rating focused on leadership, culture, and governance especially for NHS Trusts.
Different types of providers receive ratings at different levels. For example, GP practices and online primary care providers are typically rated only at Levels 1 and 2, while acute NHS Trusts are rated across all five levels.
When Poor CQC Ratings Could Indicate Medical Negligence
Low or deteriorating CQC ratings may not always directly cause harm, but they often highlight patterns of risk, such as:
- Inadequate staffing levels
- Poor infection control
- Unsafe prescribing practices
- Delays in diagnosis or treatment
These are all areas that can contribute to medical negligence, when a patient is harmed by substandard care that falls below accepted standards.
As Blackwater Law specialising in medical negligence, we carefully monitor CQC reports for indicators that support or substantiate a client’s claim. For example, a hospital consistently rated as “Inadequate” for safety may be more likely to have failed in its duty of care to patients.
If you or a loved one has experienced poor care, especially in a facility with a low CQC rating, it may be worth exploring your legal options.
Press Release: CQC contacted by whistle blowers over 75,000 times in the last 5 years
Care Quality Commission Introduces Simplified, Trust-Level Ratings to Improve Transparency
The Care Quality Commission has updated its inspection and ratings framework, including significant changes for NHS Trusts. A single trust-level rating will now be issued based on the “well-led” key question, focusing on leadership, governance, and sustainability. This replaces the previously complex, multi-layered ratings at the trust level.
The new model relies on eight quality statements under the “well-led” category and considers service-level performance, changes over time, and broader indicators such as NHS England oversight.
This updated approach also enhances transparency in the public domain, while providing more streamlined data for decision-makers in healthcare and law.
The CQC emphasises that all key questions, Safe, Effective, Caring, Responsive, and Well-Led remain equally important, and each service will continue to be rated accordingly. A scoring system has also been introduced to clarify where a service sits within a rating range (e.g. a score of 88-100% indicates an “Outstanding” service).
Why This Matters for Patients and Blackwater Law
The revised rating system helps patients make quicker and more informed choices. From a legal perspective, these changes may assist solicitors in identifying patterns of inadequate care more efficiently, particularly in cases involving trust-wide systemic failures.
Final Thoughts
CQC ratings are much more than a public-facing label, they can be early warning signs of unsafe conditions that may lead to serious patient harm. If you believe that poor care in a facility with a low or deteriorating CQC rating contributed to an injury, delayed diagnosis, or avoidable complication, our team of medical negligence experts is here to help.
Contact us today to discuss your case confidentially.
