Draft framework. This is CQC's draft for hospitals, secondary and specialist care, issued for feedback. It is not the framework your service is inspected and rated against today.
Current position. The existing published framework remains in force while CQC tests and evaluates the proposed approach.
Last reviewed. 23 July 2026.
This page is the hospitals companion to our main explainer, CQC's proposed 2026 assessment framework. Read that first for what is changing across all four sectors and why. Here we cover only what the hospitals draft asks that the others do not.
The shared part, in one paragraph
All four drafts keep the five key questions and the same 26 assessment concepts, and move from quality statements to supporting questions with rating characteristics at every level. Hospitals display all 26 as separate headings. Your incident data, clinical audit, mortality review, governance minutes and outcome data all carry across; the headings above them are being renamed, not abolished.
Where hospitals are distinctive
Deterioration is a named, tooled expectation
Under Managing risks during care and treatment, the hospitals draft is explicit where adult social care is general. It names the early warning scores directly, NEWS, MEWS and PEWS, alongside clinical risk assessment, clinical records, and virtual wards and remote care.
The test is not whether you have an escalation policy. It is whether the record shows a deteriorating patient was scored, escalated on time, and reviewed, including on a virtual ward where the patient is not physically in front of the team.
Flow, admissions, discharge and surges
The hospitals draft treats patient flow as a safety domain. It names managing periods of increased demand, and its systems and transitions scope covers admissions, discharge and handover. A safe service under this draft is one that can show it managed the pressure points where patients move or wait, not only the care delivered once they are settled.
Layered governance and benchmarked outcomes
Hospitals is one of only three sectors that displays Governance and Management of risk, performance and issues as two separate headings, rather than the single combined heading adult social care uses. That split is deliberate: a hospital is expected to show corporate governance and clinical governance as distinct, connected systems.
Under Delivering evidence-based care and treatment, the draft names clinical reviews and medical committees. The draft expects outcomes to be measured and compared, so service-line outcome data and external benchmarking are core evidence, not extras.
Specialist treatment, consent and equipment
The medicines scope names intravenous medicines, fluids and medical gases, roles and delegation, and STOMP and STAMP. Consent scope names DNACPR and ReSPECT explicitly. Under Independence, choice and control, the draft names visiting rights and specialist or adaptive equipment. These are the details of complex, high-acuity care that a generic framework blurs.
Access as a hospital problem
Under Timely and equitable access, the hospitals draft names waiting times, delays and cancellations, reasonable adjustments and digital exclusion. Access here is measured in the specific currency of secondary care: the wait, the cancelled list, the patient who cannot navigate a digital pathway.
What to do now
Work the pillar's assurance test against the hospital-specific items above. For each of deterioration, flow, clinical governance and benchmarked outcomes, check the loop closes: the control exists, is used under real pressure, is monitored, drives owned action, and shows a measurable result.
A hospital's usual weak point is not the absence of a system. It is the join between corporate and clinical governance, and the gap at the interfaces, admission, handover, discharge, where the draft looks hardest. Regulation 12 safe care and treatment and Regulation 17 good governance are the statutory anchors that do not change with the framework.
Do not rebuild your governance structure around draft wording, and do not buy compliance with a framework CQC is still testing. That includes us.
Related guidance
- Start here: CQC's proposed 2026 assessment framework
- Sector overview: independent secondary care
- Regulation explainer: Regulation 12 safe care and treatment
- Regulation explainer: Regulation 17 good governance
- Regulation explainer: Regulation 20 duty of candour
- Library: sample policies
- How we work: our methodology
Sources
- CQC, draft Hospitals (secondary and specialist care) assessment framework v0.6, 19 March 2026. Sector-specific scope items above are taken from this document.
- CQC, Better regulation, better care, Summary of Consultation Responses, February 2026.
Sector-distinctive scope is our analysis of the draft, not a formal CQC publication. Where this page says what the draft is likely to mean in practice, that is our reading as an ex-CQC inspector, not CQC guidance.