Well-led · KLOE 1
Strategic direction
Is there a clear vision and strategy that addresses the changing needs of the population and communities it serves?
CQC wording, secondary and specialist hospital care draft v0.6, pages 49 to 52.
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:
- Strategy and vision
- Values
- Organisational sustainability
- Addressing social impact
- Environmental sustainability: staff awareness and practice, carbon reduction practices – e.g. travel and transport, medicines and supply chain, estates and facilities, efficient service delivery with resource optimisation
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 49 to 52. 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
- The vision, strategy and supporting objectives are clear, compelling and shared. These respond proactively to the changing needs of the population and communities. They are co-produced with staff, people, their families and carers and community partners. The vision, strategy and supporting objectives are well-understood, owned and embedded across the service.
- The strategy delivers measurable improvements in population health, access to care and people’s experience and outcomes, including demonstrable reductions in health inequalities. Equality, diversity and inclusion are embedded as core strategic priorities, with anti-racism and stigma awareness integral to long-term care models, workforce strategies and service transformation.
- An inclusive, culturally sensitive and non-discriminatory person-centred approach is engrained in the values of the service and is evident in everyday interactions with staff, people who use the service and the public. People feel respected, listened to and safe, and services are designed around what matters most to communities served.
- Leaders provide visible, values‑driven leadership, actively shaping and testing the strategic direction through curiosity, constructive challenge and learning. They analyse data, people’s lived experience, insight from staff and research evidence to ensure that the strategy remains relevant, equitable and impactful.
- Staff are proud of the service and consistently report high levels of engagement, pride and trust in leadership. They report that the service is an inclusive, supportive and empowering place to work. Staff feel alignment with and ownership of the service’s culture, vision and values.
- Strategies and plans are fully aligned with those of the wider health and care system and actively shape it, and the service plays a strong role within the system. Through effective collaboration with system partners, community-led organisations and local stakeholders, the service contributes to shared priorities and continually improving outcomes.
- The strategy and vision are ambitious, challenging and innovative, yet grounded in a clear understanding of risk, capacity and resources.
- Feedback from staff and people using services includes culturally rooted forms of insight. This is systematically gathered, analysed and used to inform decision-making. The service demonstrates how learning from feedback leads to tangible improvement, and shares this transparently in accessible ways with staff, people and communities.
- There is strong collaboration and team working, and a common shared focus on improving the quality, experience and sustainability of care.
- Environmental sustainability is embedded within strategic decision making and leaders recognise its role in improving population health, delivering value and ensuring the long-term sustainability of services. Staff understand how sustainability relates to their roles and take pride in initiatives that measurably reduce waste, minimise energy use and support greener models of care.
Good
- Leaders ensure there is a clear shared vision and strategy that responds to the needs of the population and communities served. The vision and values are communicated effectively, and staff across the service understand them and how their role contributes to delivering them.
- The vision, strategy and supporting objectives have been developed through a structured planning process, through meaningful engagement with staff, people who use services, carers, communities and external partners. Equality, diversity and inclusion are reflected within the strategy, with anti-racism and stigma awareness recognised as important strategic principles.
- The strategy is credible and achievable, promoting high-quality, person-centred, culturally sensitive and non-discriminatory care. There is clear intent to reduce health inequalities supported by identified priorities and improvement actions. Progress in improving outcomes is evident, and further areas of work are allocated to leaders. There are clear plans to deliver further improvements.
- Leaders provide effective oversight of the strategy through regular monitoring of progress against delivery plans, key performance indicators and risks. Leaders use data, insight and research to inform decision making and to understand the needs of the local population.
- The service actively asks for feedback from staff and people who use services, including culturally-informed forms of feedback. It considers feedback in shaping and reviewing the strategy. Information about feedback and resulting actions is shared in accessible ways.
- The strategy has clear, time-bound equity goals, with resourced plans and board level key performance indicators (KPIs).
- Staff and leaders use data and research information to ensure any risks to delivering the strategy, including relevant local factors, are understood and have an action plan to address them. They monitor and review progress against delivery of the strategy and relevant local plans.
- Sustainability is actively considered, with actions taken to reduce the impact of care on the environment, to support sustainable practice, reduce waste and minimise energy use.
- Staff are empowered to know how environmental sustainability relates to their role including through planning and delivering care, preventing diseases and good practice in the use of medicines.
Requires improvement
- The vision, strategy and plans have some significant gaps or weaknesses that undermine their credibility. They are either incomplete, out of date, not sufficiently clear or not well-understood.
- Equality, diversity and inclusion principles, including tackling racism and stigma, are not consistently promoted and they are not necessarily central to the service’s vision, values and strategy.
- The strategy and vision may not have been co-developed with staff, people who use services and other stakeholders, so there is no feeling of co-ownership among these groups.
- Results of consultations with stakeholders and feedback from staff and people who use services are not always taken into account in developing or evaluating strategies or plans. Culturally rooted feedback is not always gathered, considered and made available in transparent and accessible ways.
- The plan and strategy do not fully reflect the health economy in which the service operates. Use of engagement, data and research to help inform them is limited and not always effective.
- System-wide collaboration with partnership agencies and community-led organisations, is inconsistent, and leaders are not always visible.
- Leaders at all levels are not always held to account for the delivery of the strategy.
- Staff do not always feel actively engaged or empowered. They do not always feel pride in their service and do not always trust its leadership. Some staff with protected equality characteristics or from diverse ethnic and cultural backgrounds feel they are treated differently.
- Sustainability is not a primary consideration for the service.
Inadequate
- There is no credible statement of organisational vision and guiding values. These are either outdated or not underpinned by detailed and realistic plans and objectives.
- Equality, diversity and inclusion considerations, including a commitment to anti-racism, are often neglected, or are not included at all in the service’s strategy and vision.
- Key stakeholders have not been engaged in creating the organisational strategy. Collaboration and co-production with people and local communities to gather feedback, including culturally rooted forms of feedback, is not happening.
- Staff do not understand the vision and values and do not understand how their role contributes to achieving the strategy.
- Strategies and plans are not aligned with the wider health economy in which the service operates.
- There is no effective approach to monitoring, reviewing or providing evidence of progress against delivery of the strategy or plans.
- Leaders at all levels are not held accountable for the delivery of the strategy.
- Staff feel disengaged, disempowered and often feel no pride in their service. Staff with protected equality characteristics or from diverse ethnic and cultural backgrounds are treated differently.
- Sustainability is either poorly or ineffectively communicated, or is completely missing from the strategy and vision.
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.