Caring · KLOE 3
Independence, choice, and control
Are people empowered to maintain their independence and to make choices about their care and plans for their future, where they are able to?
CQC wording, secondary and specialist hospital care draft v0.6, pages 37 to 39.
Draft, not the current assessment framework
CQC's secondary and specialist hospital care draft v0.6, published March 2026. The current quality statements remain in use.
CQC draft scope
What this proposed KLOE covers
Scope of this key line of enquiry and topic areas include:
- Supporting communication and choice
- Access to friends and family (visiting rights)
- Specialist / adaptive equipment
- Supporting independence activities and wellbeing
- Complex care needs
- End of life and palliative care
How would this apply to your service?
The draft applies one framework across secondary and specialist hospital care, but useful evidence depends on your service and people.
Source: CQC, Hospitals (secondary and specialist care) assessment framework, draft v0.6, 19 March 2026, pages 37 to 39. Contains public sector information licensed under the Open Government Licence v3.0.
CQC draft rating characteristics
How the draft describes each rating
These are CQC's draft characteristics. CQC says rating characteristics guide judgements, they are not a mechanical checklist.
Outstanding
- People who use services, their families, carers and advocates are true, empowered partners in their care. Their expertise, lived experience and preferences meaningfully shape assessment, planning, treatment and review.
- Co-production with people, their families and carers is embedded as a core value rather than an occasional practice, and people consistently describe feeling listened to, respected and central to all decisions.
- Staff are fully committed to genuine partnership working. They actively create the conditions for shared decision-making – taking time to build trust, explain options in accessible ways, explore concerns, and support people to make choices that reflect their identity, culture, goals and recovery journey. Staff ensure families, carers and advocates are included in line with the person’s wishes, making personalised collaboration the norm for every individual person.
- The service is flexible and personalised, fully committed to providing informed choice and ensuring a seamless experience, including in relation to continuity of care.
- Staff always empower people to have a voice and to realise their potential.
- Staff are exceptional at enabling people to manage their own health and care and to remain independent for as long as possible.
- People are fully supported to maintain their social connections and to make significant life choices and choices at the end of their life.
- The service plays an active part in the local community and as part of the neighbourhood agenda, which benefits both the people it cares for and the wider society.
Good
- People are supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing.
- Staff work with people to support, empower and enable them to achieve their goals. This includes what matters to them about their future care preferences, their independence and care interventions.
- Staff respect people as autonomous individuals. They understand their power as care givers and act accordingly to protect people’s human rights.
- People are supported to receive visits from people they want to see and to be accompanied to appointments. This is done in accordance with relevant legislation, considering the appropriate balance between their right to a private and family life, their independence, choice and control, risk and safety. The laws and principles that apply specifically to protecting children are adhered to when making decisions about appropriate access and visiting.
- There is a range of appropriate equipment and technology to support and maximise people’s independence and outcomes from care and treatment.
- People who may be approaching the end of their life are identified to ensure their needs are met and the right support is provided. Where appropriate, end of life care planning is encouraged, including people’s preferences and decisions about resuscitation. People are informed and assured that they can update their choices. This information is shared with other services and staff.
- Where people are subject to the Mental Health Act 1983 (MHA), care and treatment follows the empowerment and involvement guiding principle, and the MHA Code of Practice is complied with. Any departure from the Code of Practice guidance is clearly justified.
Requires improvement
- Staff do not always consider involving people, carers and their families as an important part of providing care.
- People are not encouraged or enabled to manage their own care.
- Information is not always accessible to all. People say that staff do not always explain things clearly, give them time to respond, or help them to understand the information they are given about their care and condition. This includes during referral, discharge, transition or transfers between services.
- The service does not always take equality considerations into account and make reasonable adjustments in line with the Equality Act 2010.
- People’s choices about their care and treatment, including in the context of care at the end of their life are not treated as a high priority.
- Staff do not always adhere to the Mental Health Act Code of Practice. Deviation from Code of Practice guidance is not always clearly recorded.
Inadequate
- People are not involved in their own care or treatment, and neither are their carers or family members.
- People do not know how to seek help or are ignored when they do so. Their basic needs are not met.
- People do not know or understand what is going to happen to them during their care. They do not know who to ask for help.
- People are unable to access the care they need. Services are not set up to support people who may be approaching the end of their life, people who have complex needs, or those in vulnerable circumstances.
- Services are not set up to provide accessible information, or reasonable adjustments in line with the Equality Act 2010.
- The service does not support people to feel part of their local community. People may feel isolated and disconnected from their lives.
- Staff fail to comply with the Mental Health Act Code of Practice or other legislation.
Want to know how your service would fare?
Book a mock inspection run against the draft KLOEs, or call 020 8090 5346 to speak to one of our experts.