Safe · KLOE 1
Safety culture
Is there a positive and equitable safety culture, where risks are proactively managed, concerns are listened to, incidents are thoroughly investigated, and lessons are learned to improve care?
CQC wording, secondary and specialist hospital care draft v0.6, pages 2 to 5.
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:
- Safe culture
- Raising safety concerns
- Closed cultures
- Duty of candour
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 2 to 5. 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
- There is a proactive, systematic approach to managing safety, which is everyone’s top priority.
- All staff model and champion an exceptional culture of openness and psychological safety and they consistently seek out opportunities to increase learning. They prioritise reflection and learning from positive safety outcomes, as well as from safety incidents and near misses, to drive continuous improvements in delivering safe care.
- Specialist safety roles are embedded and highly visible, acting as system leaders for safe practice. Staff feel genuinely empowered and trusted to raise safety concerns or propose improvements. Leaders demonstrate and reinforce that every safety concern is valued, responded to compassionately and used to strengthen collective learning.
- People more likely to face safety risks are encouraged and enabled to participate in decisions about risk relating to their care.
- Hazards and risks are identified proactively. These are thoroughly assessed and managed to avoid adverse outcomes. Solutions to risks are developed collaboratively with the right people and the effectiveness of the controls in place is continuously monitored and measured. This includes solutions to hazards and risks more likely to affect particular groups of people, which would otherwise result in safety inequalities.
- Intelligence about safety is treated as a critical asset. Safety data is reviewed continuously to enable safety risks to be identified proactively. These include concerns from staff and people using the service, incident reporting data, clinical outcomes, restrictive practice data and safeguarding concerns.
- Systems and processes for reporting and learning from safety incidents are exemplary in their accessibility, responsiveness and fairness. All staff – including agency staff, temporary workers and volunteers – are trained and supported to use and engage with them. Responses to incidents are proportionate, well-resourced and focused on learning.
- The service actively seeks out learning from other organisations, adapts this insight to improve its own practice, and routinely shares its learning and innovations with partners to strengthen care provision.
Good
- Safety is a top priority that involves everyone, including staff and people using the service.
- There are clear roles and responsibilities for safety.
- A culture of safety and learning is embedded throughout all levels of the service. This is based on openness, transparency and learning from events that potentially put people and staff at risk of harm, or that have caused them harm.
- Care is monitored and assured to ensure its safety. Risks are proactively identified and mitigated to reduce the potential harm. They are not overlooked or ignored, but are dealt with willingly, as an opportunity to put things right, learn and improve.
- There is a safety culture of speaking up. People and staff are encouraged and supported to raise safety concerns, they feel confident that they will be treated fairly, and will not be blamed, or treated negatively if they do so.
- The review of safety information, including complaints and concerns, is prioritised to proactively identify, manage and control risks before safety incidents happen. The service takes appropriate action to keep everyone safe.
- Any safety risks that result from inequalities, or affect particular groups of people, are identified and acted on.
- Patient safety data is analysed by equality characteristic to identify any inequalities. The service takes appropriate action to address these inequalities.
- There is a proportionate approach to recording, investigating and responding to safety and safeguarding events. Lessons are learned, enabling good practice to be continually identified and embedded. Lessons are shared both internally and externally.
- Staff have a good understanding of the duty of candour. The service is always open and transparent with people, those close to them, and staff. When a notifiable incident has occurred, people receive full details of what happened, why, and what has been learned. People receive the support they need.
- Staff are aware of themes and trends in safety incidents and there is a commitment to improving safety in the service.
Requires improvement
- Safety is recognised as important but is not consistently prioritised and does not always involve staff and people who use the service.
- Roles and responsibilities for safety are not clear to everyone and there may be gaps.
- Safety and learning culture is not fully embedded throughout all levels of the service. There is limited or inconsistent learning from incidents that could potentially expose people and staff to the risk of harm, or that have caused them avoidable harm. Learning from safety incidents and complaints does not always result in changes that improve care for others.
- There is limited monitoring of care to assure its safety. Risks of harm, including those in alerts and recalls, are inconsistently identified and managed.
- There is limited analysis or understanding of safety risks that affect particular groups of people.
- People and staff do not always feel supported to raise safety concerns. They do not always feel confident that they will be treated fairly and may have concerns that they will be blamed or treated negatively.
- The review of safety information, including complaints and concerns, is inconsistent and safety risks are not always identified or mitigated to prevent harm.
- Systems for reporting safety incidents and complaints may not be used consistently.
- When a notifiable safety incident has occurred, the service is not consistently open and transparent with people, those close to them and staff. People may receive some support, but it is insufficient or inconsistently provided.
- Staff have inconsistent awareness of themes and trends in safety incidents.
Inadequate
- Safety is not prioritised within the service.
- Roles and responsibilities for safety are either not clear or do not exist, and there is no clear accountability for safety.
- There is no effective culture of safety and learning. A lack of transparency and openness means that incidents may be ignored or not reported, and a closed culture is more likely to develop.
- There is a lack of monitoring and assurance of the safety of care. Risks of harm, including those in alerts and recalls, are not identified and mitigated.
- There is no analysis or understanding of safety risks that affect particular groups of people, leading to higher risks of harm for some groups.
- People and staff do not feel supported to raise safety concerns and there is evidence that when they have done so, they have not been treated fairly and may have been blamed or treated negatively.
- Information about safety, including complaints and concerns, is not adequately reviewed and safety risks are not identified or managed to prevent exposure to the significant risk of harm or actual harm.
- Systems for reporting safety incidents and complaints are not used appropriately. As a result, the service does not learn from incidents and complaints.
- When a notifiable safety incident has occurred, the service is not open or transparent with people, those close to them and staff. People do not receive the support they need.
- Staff are unaware of themes and trends in safety incidents.
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.