Safe · KLOE 3
Safe systems, pathways and transitions
Are there systems to enable collaborative working across care pathways and services, to ensure that safety and continuity of care are prioritised?
CQC wording, secondary and specialist hospital care draft v0.6, pages 7 to 9.
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:
- Care co-ordination and information sharing
- Continuity and transitions of care (including from children to adult services)
- Referrals
- Admissions and discharges
- Handover and patient flow
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 7 to 9. 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
- Safety and continuity are embedded as core principles throughout the entire care journey. A fully integrated, collaborative approach unites people, their families and carers, staff teams, and partner organisations to ensure a safe, seamless experience across referrals, admissions, transitions, and discharge, including when people interact with multiple services.
- There is a collaborative, multidisciplinary approach to comprehensively identify and mitigate shared risks to ensure the delivery of safe care. This has led to enhanced standards of treatment and care at each step of a person’s care journey.
- Plans for transition to other services, handover, referral and discharge are co-produced with people, carers and staff to reflect their individual needs and personal preferences in managing their risk. Plans are continuously reviewed to ensure they are up-to-date and include appropriate support for people and carers.
- Plans for people’s care during transition between services are in place beforehand, enabling risks to be identified and mitigated and for continuity of safeguarding arrangements.
- Children and young people and their parents (or those with parental responsibility) are empowered and supported to navigate services confidently. They experience well-co-ordinated, developmentally sensitive transitions into adult services, underpinned by clear, consistent ways of working between teams, settings, and partner agencies, which result in exceptional outcomes.
- The service continuously reviews and develops its admission and discharge processes to ensure seamless patient pathways and flow through the system. It works with partners to alleviate pressure points and to find creative solutions for optimal continuity of care and transitions at a local, neighbourhood and system level.
Good
- Safety and continuity are prioritised throughout the care journey through a collaborative, joined-up approach involving people, staff, and partners. This includes referrals, admissions and discharge, and where people are moving between or accessing multiple services.
- People’s care pathways are joined-up, easy to navigate and efficient because of the cohesion and continuity between services.
- There is a collaborative approach with clear accountabilities to proactively manage shared systems and processes for safe care. This includes identifying risks, ongoing monitoring and shared learning and improvement.
- Multidisciplinary teams work together effectively to support safe delivery of care and to ensure effective handover between services.
- Plans for people's care during transitions between services are established beforehand to eliminate any avoidable risks and to ensure they receive continuity of care.
- Staff work well with other services and providers to ensure the sharing of timely and appropriate information when people are moving between services. This informs their understanding of people’s needs and enables them to appropriately assess, plan and deliver their care and treatment.
- The service plans and delivers handovers and referrals safely. They consider a person’s individual circumstances, co-occurring conditions, long-term needs and expected outcomes.
- The service works collaboratively with other services and system partners to ensure that admission and discharge processes are safe and effective, to facilitate optimal patient flow and timely discharge. People’s discharge from the service is smooth, and they are confident about the arrangements for their ongoing care.
- Children and young people and their parents (or those with parental responsibility) are involved and supported to navigate the different care settings. Their transition into adult services is properly co-ordinated with clear ways of working between teams and services.
Requires improvement
- Safety and continuity are acknowledged but not consistently prioritised throughout the care journey. Joined-up working is not embedded or consistently applied.
- People’s care pathways can be fragmented, disjointed and slow due to a lack of cohesion and continuity between services.
- Collaboration between people, staff, and partners is variable, with some gaps in communication at key transition points.
- Multidisciplinary teams do not always work together effectively to support safe delivery of care. Handovers between services are not always safe and effective.
- There are shared systems and processes for safe care, but collaboration across care pathways may be limited and processes are not fully embedded or used consistently.
- Plans for people's care during transitions between services are not always established beforehand and continuity of care may be inconsistent.
- Staff do not always have timely access to the information they need when people are moving between services. This means they do not always understand people’s needs and are not always able to appropriately assess, plan and deliver their care and treatment.
- Plans for handover, referral and discharge are inconsistently completed and do not always consider people’s individual needs, circumstances, co-occurring conditions, ongoing care arrangements and expected outcomes.
- Discharge processes can sometimes lack in timeliness or effectiveness, and the service may experience issues with patient flow. People’s discharge from the service can be disorganised, which leaves them uncertain about the arrangements for their ongoing care.
- Children and young people and their parents (or those with parental responsibility) are not always involved and supported to navigate care settings, and do not always experience properly co-ordinated transitions into adult services.
Inadequate
- Safety and continuity are not prioritised throughout the care pathway. The approach to care is not joined up and there is little or no collaboration between people, staff and partners. Points of transition, including referrals, admissions and discharge, are likely to be chaotic or unsafe.
- There is no effective collaborative approach to managing shared systems and processes to ensure safe care. Accountabilities across care pathways are unclear and there is no ongoing monitoring and sharing of learning and improvement.
- Multidisciplinary teams do not work together effectively to support safe delivery of care. Handovers between services are often unsafe and ineffective.
- Plans for people's care during transitions are not established before they move between services. This results in avoidable risks and means that people do not experience continuity of care.
- Staff do not have timely access to the necessary information when people are moving between services. This means they often do not understand people’s needs and are unable to appropriately assess, plan and deliver their care and treatment.
- Plans for handover, referral and discharge are deficient, unsafe, or do not consider people’s individual needs, circumstances, ongoing care arrangements and expected outcomes.
- Discharge processes are inconsistent and ineffective, resulting in issues with patient flow and delayed discharges. People’s discharge from the service is disorganised, rushed and sometimes premature. This may be due to bed shortages and pressures on other services.
- Children and young people and their parents (or those with parental responsibility) are not involved or supported to navigate care settings, and experience poorly co-ordinated transitions into adult services which can result in worse outcomes.
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.