Well-led · KLOE 4
Governance
Are there clear roles, responsibilities and systems of accountability to support good governance?
CQC wording, secondary and specialist hospital care draft v0.6, pages 59 to 61.
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:
- Roles, responsibilities and accountability
- Governance, quality assurance and management
- Statutory and regulatory requirements
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 59 to 61. 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
- Governance arrangements are clear, coherent and continuously tested, enabling effective decision-making, accountability and delivery of the organisational strategy. Governance systems are proactively reviewed to ensure they remain fit for purpose, proportionate and responsive to emerging risks, system changes and population needs.
- Governance structures operate with clear purpose and are supported by well-defined authority to make decisions, escalation routes and accountabilities. These are consistently understood across the service and routinely tested through real-time issues and learning.
- Governance systems are inclusive and empowering, enabling staff at all levels to identify risks, raise concerns and contribute to timely improvement. The service demonstrates a learning-focused governance culture, where insight from staff, people who use services and partners informs action and improvement.
- Leaders are assured of service performance through analysis of quantitative data, qualitative insight, audit, lived experience and external assurance. Focus is on patterns, trends and root causes, rather than isolated metrics, and this intelligence is used to challenge, learn and improve.
- Governance of partnerships, joint working arrangements and shared services is rigorous and mature, with clear shared objectives, defined accountabilities, and joint risk management. The service plays a leading role in the wider health and care system by supporting collaboration that delivers improved health and care outcomes.
- Governance arrangements explicitly support the delivery of high-quality, safe and equitable care. They enable early identification of risks to quality, safety and equity, and timely, proportionate action to address them. Relevant quality frameworks and recognised standards are implemented effectively and used to reduce inequalities in experience and outcomes.
Good
- There are clear and effective governance, management and accountability arrangements, including those to ensure compliance with any legal requirements and duties (including the Mental Health Act).
- The board and other levels of governance function effectively and interact well with each other to support delivery of the organisational strategy.
- Governance structures, roles and responsibilities are understood across the service and are regularly reviewed to maintain fitness for purpose.
- Structures, processes and systems of accountability, including the governance and management of partnerships, joint working arrangements and shared services, are clearly set out, understood and effective.
- Staff understand their roles and responsibilities. Managers and leaders are accountable for their own actions, behaviours and performance, and for those of their staff.
- Governance arrangements support the delivery of safe, effective and equitable care, including implementing relevant quality frameworks, recognised standards and best practice. Leaders use these frameworks to address known risks and inequalities.
- Leaders implement all relevant quality frameworks, recognised standards and best practice, to improve equity in experience and outcomes for people using services and to tackle known inequalities.
Requires improvement
- The service’s governance, management and accountability arrangements are not clear or do not always operate effectively.
- Governance, accountability and management arrangements to ensure compliance with any legal requirements and duties (including the Mental Health Act) are not always effective. There has been no recent review of the governance arrangements, organisational strategy, values, objectives or plans.
- Staff are not always clear about their roles and responsibilities, what they are accountable for, and to whom. Managers and leaders cannot routinely account for their own actions, behaviours and performance, and for those of their staff.
Inadequate
- The service’s governance arrangements and their purpose are unclear. There is a lack of clarity about authority to make decisions and how individual members of staff are held to account.
- Governance, accountability and management arrangements to ensure compliance with any legal requirements and duties (including the Mental Health Act) are ineffective.
- There is no process to review key items, such as the organisational strategy, values, objectives, and plans, or the governance framework.
- Staff and their managers are not clear on their roles or responsibilities.
- Accountability mechanisms are weak. There is a lack of systematic performance management of individual members of staff, or appropriate use of incentives or sanctions.
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.