Introduction of combined trust-level quality and Use of Resources ratings

From 5 March 2018, all non-specialist acute trusts who undergo a Use of Resources assessment will receive a combined trust-level rating of Care Quality Commission’s (CQC’s) five quality questions and a Use of Resources rating.


From 5 March 2018 Use of Resources assessments will be considered as a sixth key question – alongside CQC’s own quality ratings (for safe, caring, effective, responsive and well-led). Like CQC’s five quality questions, Use of Resources will be given a rating of outstanding, good, requires improvement or inadequate. The ratings on the five key questions on quality will continue to be combined to generate a single rating on quality for NHS trusts.

In November 2017, we asked for feedback on our proposals for implementing combined ratings.

The combined ratings consultation response sets out our response to your feedback.

Based on that feedback CQC has also updated its provider guidance to reflect this new approach. In particular, the provider guidance explains:

  • how CQC will turn NHS Improvement’s proposed Use of Resources rating into a final CQC rating
  • how CQC’s trust-level quality ratings will be combined with the Use of Resources rating to produce an overall trust-level rating

The provider guidance also contains more information about the CQC’s standard ratings principles and aggregation rules and limiters.

Implementing Use of Resources assessments

We began undertaking Use of Resources assessments in October 2017.

The assessments are designed to improve understanding of how effectively and efficiently trusts are using their resources – including their finances, workforce, estates and facilities, technology and procurement – to provide high quality, efficient and sustainable care for patients.

The assessments will help us identify your support needs, as part of the Single Oversight Framework. They will also enable us to identify good practice to spread and drive improvement across the sector.

Brief guide for non-specialist acute trusts’

We’ve prepared this brief guide to help you better understand the Use of Resources assessments. It includes the agenda for the onsite visit and other useful information.

If you have any questions about Use of Resources assessment, please refer to the framework document or email

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