The 6 Cs of care are care, compassion, competence, communication, courage and commitment. They were published by NHS England in 2012 as part of the Compassion in Practice strategy and have since become the shared values language for nursing, midwifery and adult social care in England. Most care staff can recite them. Far fewer can say what they look like at 6.45am when two residents need support at once, the hoist battery is flat and the night staff want to go home.
This guide follows one ordinary shift in a residential home and points at each C as it appears. It is written for registered managers, deputies and owners who want their teams to live the values rather than memorise them, and who need to show an inspector that the values are real.
The short answer
The 6 Cs are a values framework, not a checklist. Care is doing the right thing well. Compassion is doing it with warmth and dignity. Competence is having the skill and knowing your limits. Communication is listening, explaining and recording. Courage is speaking up when something is wrong. Commitment is turning up, following through and improving. On a real shift they are not separate; they overlap in every interaction. The manager's job is to name them when they happen, praise them when they are done well, challenge them when they are missing, and keep the records that prove all of that.
What are the 6 Cs of care?
- Care: the practical help a person needs, done properly, at the time they need it and in the way they want it.
- Compassion: delivering that help with kindness, patience and respect, so the person feels seen rather than processed.
- Competence: having the knowledge, training and judgement to do the task safely, and recognising when to ask for help.
- Communication: listening well, explaining clearly, sharing the right information with the right people, and recording what matters.
- Courage: doing the right thing when it is awkward, including raising concerns about colleagues, managers or the organisation.
- Commitment: reliability, follow-through and a willingness to keep learning, shift after shift.
Every one of these can be observed. That is the point. If a value cannot be seen, praised or challenged on an ordinary Tuesday, it is a poster rather than a value.
Where the 6 Cs came from
The 6 Cs were introduced in the NHS England strategy Compassion in Practice, led by the Chief Nursing Officer for England, in December 2012. The strategy followed the failings at Mid Staffordshire and was intended to restate what nursing and care were for. The values were written for nurses, midwives and care staff in the NHS, but adult social care adopted them quickly because they said in plain words what a good carer already did.
They now sit behind most Care Certificate workbooks, many induction packs and a large share of supervision templates. Skills for Care references the same values in its Code of Conduct for Healthcare Support Workers and Adult Social Care Workers. Inspectors do not ask about the 6 Cs by name, but the quality statements under Caring and Well-led in the CQC single assessment framework describe the same behaviours: kindness, respect, independence, choice and a culture where people can speak up.
That history matters for one reason. The 6 Cs are not a training-company invention. They were written in response to real harm, by people who had seen what happens when values are assumed rather than practised. When you teach them, teach that.
The 6 Cs at a glance
| Value | What it looks like on shift | What it looks like in the records | Where it usually fails |
|---|---|---|---|
| Care | Support given the way the care plan says, at the time the person wants it | Daily notes match the care plan; charts complete | Task lists done in staff order, not the person's order |
| Compassion | Knocking, waiting, asking, explaining; noticing mood | Notes describe the person, not just the task | Rushed personal care; talking over people |
| Competence | Right sling, right dose, right technique, every time | Training matrix current; competency sign-offs dated | Confidence outrunning training |
| Communication | Clear handover; family kept informed; person consulted | Handover notes, contact logs, care plan updates | Verbal-only handover; families finding out late |
| Courage | Reporting a near miss; challenging a colleague kindly | Incident reports, safeguarding referrals, whistleblowing log | Nobody wants to be the one who tells |
| Commitment | Reliable attendance; actions from last supervision done | Supervision records, attendance, improvement actions closed | Good intentions with no follow-through |
Why the 6 Cs still matter under the single assessment framework
The CQC single assessment framework, fully in force by 2026, assesses services against quality statements written in the first person plural: we treat people with kindness, we respect people's privacy, we support people to have choice and control. Those statements are the 6 Cs rewritten as commitments. An inspector gathering evidence for the Caring key question is looking for compassion and communication. An inspector looking at Safe is looking for competence and courage. Well-led is largely about commitment and the culture that lets courage exist.
So the 6 Cs are not a parallel system to inspection. They are the plain-English version of what inspection measures. A home that can show staff applying the 6 Cs in practice, with evidence, has most of its Caring evidence written before the inspector arrives.
The remainder of this guide follows a day shift in a fictional ten-bed residential home for adults with a learning disability. The people are invented. The situations are not.
6.45am: handover
The night senior hands over to the day team. Two residents had a poor night. One, Daniel, was up at 3am, distressed, and settled after a walk round the garden. The other, Priya, refused her night medication.
Communication is the whole of handover. A good handover is structured, short and specific: what happened, what was done, what needs watching. It happens from the record, not from memory. If the night senior says Daniel was unsettled and the daily log says he slept well, one of them is wrong and the day team has no way of knowing which.
Commitment is the night senior staying five minutes past the end of her shift to make sure the day staff have actually heard the medicines refusal and know to try Priya again before the GP surgery opens. A well-structured handover, as set out in our guide to how to structure a care home handover, is the first place the 6 Cs either show up or disappear.
7.00am: the morning round
Sarah, a support worker, starts with three residents who each need help getting up. One has a hoist and a PEEP. One is anxious and prefers to be woken slowly with the curtains half open. One is independent but likes someone to check she has her glasses.
Care is knowing all three things without reading them off a sheet, because the care plan was written properly and Sarah read it in induction. Compassion is knocking, waiting for an answer, and asking whether now is a good time rather than announcing that it is. Competence is checking the sling size and the loop attachment every single time, and saying so if the sling is frayed rather than hoping it lasts the week.
The test a manager can apply is simple. If an inspector watched this round through the door, what would they see? Not what the policy says, but what happened. Dignity in care is decided in these ten minutes far more than in any policy document.
8.30am: the medicines round
The senior on shift has ten residents on the round. Two have covert administration agreed under a best interests decision. One has a PRN protocol for anxiety. Priya, from handover, still does not want her medication.
Competence here is not just knowing the drugs. It is knowing what a covert administration decision actually authorises, checking the PRN protocol before offering, and understanding that Priya has capacity to refuse and that refusal must be recorded, not worked around. Courage is the senior noticing that a colleague signed the MAR before the tablets were swallowed, and raising it that morning rather than letting it go because the colleague is well liked.
An electronic MAR makes both easier. It prompts for the PRN reason and outcome, records the refusal with a code, and shows the manager the pattern over a month. Our guide to eMAR for care homes covers what to look for. But the system only records what the senior does. The value is in the person.
10.00am: activities and the person who says no
The activities plan says group baking. Daniel, still tired from his night, does not want to bake. He wants to sit in the lounge with the radio.
Care and compassion here mean respecting the no. The activities plan exists for Daniel, not the other way round. A worker who cajoles him into the kitchen so the attendance sheet looks good has confused the record with the person. A worker who notes that Daniel declined, offers again at eleven and records that he chose the radio has done person-centred care and has evidence of it.
Communication is the worker telling the senior that Daniel is lower than usual, so the senior can decide whether it is tiredness or something to watch. Small observations, passed on, are how homes catch infections, pain and low mood early.
Midday: mealtimes and dignity in care
Lunch is where dignity in care is tested by time pressure. Three residents need support to eat. One is on an IDDSI level 5 minced and moist diet. One takes forty minutes to finish a meal. The kitchen wants the trolley back by one.
Compassion is sitting at eye level, not standing over the person. It is not loading the next spoonful while they are still chewing. Competence is checking the texture matches the plan before the plate goes down, because a texture error is a choking risk, not a preference. Care is the person who takes forty minutes getting forty minutes, and the kitchen being told the trolley will be late.
Managers who want to see the 6 Cs in practice should eat lunch in the dining room once a week and watch. It is the most honest audit a home can do and it costs nothing. What you see at lunch tells you more about the culture than any survey.
2.00pm: the phone call from a family member
Daniel's sister rings. She heard from Daniel that he had a bad night and wants to know why nobody told her.
Communication is the senior having enough information to hand to answer honestly: what happened, what staff did, how he has been today. It is also acknowledging that the family should have been told that morning, and saying so, rather than becoming defensive. Courage is the senior admitting a gap to a family member instead of covering it.
The record matters here too. If the night was logged properly, the senior can read it back to the sister in a minute. If it was handed over verbally and not written up, the senior is guessing and the family can hear it. Contact with families should be logged as part of the daily record, with who was told what and when.
3.30pm: when something goes wrong
A resident falls in the corridor. She is shaken, has a graze on her elbow and says her hip hurts. The support worker who found her is new.
Competence is not moving her until the senior has checked, and knowing that hip pain after a fall means no hoist and a call to 111 or 999 depending on what is found. Courage is the new worker saying, honestly, that she did not see the fall and does not know how long the resident was on the floor, rather than filling the gap with a guess.
Communication is the incident report written that shift, factually, with times. Commitment is the manager reviewing it the next day, checking whether the corridor lighting, the footwear or the care plan needs to change, and closing the actions. A fall that is recorded and learned from is a system working. A fall that is recorded and filed is a system pretending.
6.00pm: records and daily notes
The day team write up. This is where communication and commitment either land in the record or evaporate.
Good daily notes describe the person, not the task list. Not: personal care given, breakfast eaten, activities attended. Instead: Daniel chose to stay in the lounge this morning after a poor night, ate well at lunch, brighter by mid-afternoon, sister called and was updated. That note supports the care plan, gives the night staff something to work with, and evidences three of the 6 Cs without trying.
The practical enemy of good notes is time. If writing up takes twenty minutes at the end of a shift, it gets rushed. Notes written at the point of care, in a few taps, are more accurate and more compassionate because they are written while the worker still remembers the person's face. That is the case for daily logs that take three taps rather than three paragraphs.
9.00pm: night handover and the tired shift
The day team hand over. Everyone is tired. This is when commitment shows.
The senior hands over Priya's medication refusal, the fall, Daniel's mood, and the fact that his sister wants a call tomorrow. She does it from the record, in order, and checks the night senior has understood. She does not skip the fall because the night staff were not involved. The night team are the people most likely to notice if the resident who fell deteriorates.
Managers should occasionally sit in on the evening handover unannounced. Not to catch people out, but because the handover at the end of a long day is the most accurate measure of whether the team's commitment is real or performed for the manager's benefit.
Applying the 6 Cs in practice: care
Care, as a value, means the practical support is right for the person. That sounds obvious and is constantly missed. Care goes wrong when the routine belongs to the staff rather than the resident: everyone up by eight, everyone in the lounge by ten, everyone in bed by nine.
To apply it, start with the care plan. If the plan says the person likes a bath in the evening and the shift pattern only allows baths in the morning, the value has already been lost before anyone comes on shift. Check that daily practice matches the plan, and where it does not, change one or the other honestly. Care also means competence of the organisation: enough staff, working equipment, stock on the shelves. A worker cannot deliver good care with a broken hoist. Care records that show what was planned against what was done are how a manager sees the gap.
Applying the 6 Cs in practice: compassion
Compassion is the value most often talked about and least often measured. It shows in small things: tone of voice, whether staff sit or stand, whether they explain what they are about to do, whether they use the person's chosen name.
It is also shown by the organisation. A home that expects compassion from staff while giving them twelve-hour shifts with no break, no supervision and no thanks will get compliance rather than compassion. Managers apply this C by modelling it: how you speak to staff is how they will speak to residents.
To evidence compassion, use observation. A short, structured observation of a mealtime or a personal care interaction, recorded and discussed in supervision, is far stronger than a training certificate. Resident and family feedback, gathered and acted on, is the other half. Compliments are evidence too; keep them.
Applying the 6 Cs in practice: competence
Competence is the easiest C to evidence and the easiest to fake. A training matrix full of green cells says that people attended courses. It does not say they can do the task.
Applying competence properly means three things. Training that is relevant to the people in the home, not a generic list. Competency assessment for anything with risk attached: moving and handling, medicines, PEG feeding, epilepsy rescue medication, restraint if used. And a culture where saying I have not done this before is rewarded rather than punished. The most dangerous worker on a shift is the one who will not admit a gap.
The Care Certificate's 15 standards are the baseline for new staff. Our guide to evidencing the Care Certificate standards sets out how to sign them off properly. A training matrix with competency sign-offs and expiry dates is how a manager sees, in one screen, who is competent for what and who is due.
Applying the 6 Cs in practice: communication in health and social care
Communication in health and social care covers four directions: with the person, with the family, within the team, and with outside professionals. Homes tend to be good at one or two and weak at the others.
With the person, communication means finding the way they communicate, which for many people with a learning disability is not speech. It means Makaton, objects of reference, easy read, or knowing that a particular sound means pain. The communication section of the care plan should be specific enough that a new worker could use it on day one.
With the family, it means proactive contact, not reactive apology. Within the team, it is handover and records. With professionals, it is the hospital passport, the GP summary, and being able to answer a paramedic's questions in the first minute. Effective communication skills in health and social care are taught in the Care Certificate, but they are maintained by systems that make good communication the easy option.
Applying the 6 Cs in practice: courage
Courage is the C that determines whether the other five survive contact with reality. Every home has moments where a worker sees something wrong: a colleague being rough, a medicines error, a manager cutting a corner. Whether they speak is a function of the culture the manager has built.
Applying courage means making it safe. Staff need to know how to raise a concern, what will happen when they do, and that they will not be punished. That is the point of a whistleblowing policy, and of telling staff at induction that CQC is a prescribed body they can go to directly. But the policy is the least of it. The real signal is what happened to the last person who raised something.
Managers apply courage themselves too: by telling a family a hard truth, by making a safeguarding referral about their own home, by telling the owner that staffing is unsafe. Staff watch that closely. A manager who never shows courage will not get it from the team.
Applying the 6 Cs in practice: commitment
Commitment is the least glamorous C and the one that keeps a home running. It is turning up on time, finishing the task, doing the action from last month's supervision, and coming back the next day.
Managers apply commitment through consistency. Supervision that happens when the policy says it will. Actions that are tracked to closure. Improvement plans that are revisited, not just written. Staff who see the manager follow through learn that follow-through is expected.
Commitment also has a fairness dimension. Reliable staff carry unreliable ones, and if that is never addressed the reliable ones leave. Attendance, lateness and follow-through should be discussed in supervision, fairly and with records, so that commitment is recognised and its absence is not ignored.
How to use the 6 Cs in induction
The 6 Cs are usually delivered in induction as a slide with six words on it. That teaches nothing. A better approach takes about an hour and uses the new worker's own experience.
- Give the six words and one-line definitions. Do not dwell.
- Walk the new worker through a real shift in your home, hour by hour, using anonymised examples like the ones above, and ask them to name which C is in play at each point.
- Ask them to describe a time they were cared for well, and a time badly, in any setting. Map their answers to the six values.
- Show them the records: a good daily note, a good incident report, a good handover sheet. Point at where the values are visible in the writing.
- Explain how to raise a concern and who to go to, and tell them about a time someone did and what happened.
- Shadow them for the first week and give one specific piece of 6 Cs feedback each day, positive or corrective.
- Record the induction session in their file, with the date and the examples used.
This takes the values from abstract to observable in a week, and gives the manager an induction record that an inspector can read and believe.
How to use the 6 Cs in supervision and appraisal
Supervision is where the 6 Cs stop being induction content and become performance language. A supervision template with a section for each C invites the worker to bring their own examples and gives the supervisor a structure for feedback that is about values rather than tasks.
It works best when specific. Not: you show good compassion. Instead: on Tuesday I saw you wait outside Priya's door until she answered, and that mattered to her. Or: the MAR was signed before the medicines were taken on Thursday, and we need to talk about why. Specific, dated observations are the evidence base for both praise and improvement, and they hold up if a capability process is ever needed.
Our guide to supervision in care covers frequency and structure. The 6 Cs give it a spine. Over a year, six supervisions with dated examples against each value become a genuine record of a worker's practice, and a genuine record of the home's culture.
A self-check for staff
Give this to staff at the end of induction and again at appraisal. Honest answers matter more than perfect ones.
- Care: did I support people the way their plan says, at the time they wanted, or the way the routine wanted?
- Compassion: did I knock, wait, explain and ask today, every time, including when I was rushed?
- Competence: is there anything I did today that I have not been trained or signed off for? Did I say so?
- Communication: would a colleague reading my notes tonight know how each person actually was today?
- Courage: did I see anything today that was not right? Did I raise it? If not, why not?
- Commitment: did I do what I said I would do, from last shift, last handover and last supervision?
- Which of the six was hardest today, and what would have made it easier?
The last question is the most useful for the manager. If the same answer keeps coming back, it is usually a system problem rather than a people problem.
The 6 Cs in learning disability and mental health services
The 6 Cs were written with hospital wards in mind, and some translation is needed for a supported living service or a mental health rehabilitation home.
Care and compassion in these settings are as much about enabling as about doing. The value is in supporting someone to make their own toast, not making it for them faster. Competence includes positive behaviour support, understanding trauma, and knowing the Mental Capacity Act well enough to apply it at 3am. Communication includes easy read, total communication approaches and, for many, the hospital passport that speaks for the person when they cannot.
Courage has a specific edge here. Restrictive practices, closed cultures and the risk of abuse in services for people who cannot easily complain are well documented. Staff in these services need to be more willing to speak up, not less, and managers need to build a culture where challenge is normal. Commitment is about consistency of staff, because for many people with autism or a learning disability, a familiar face is the intervention.
Common mistakes
- Treating the 6 Cs as a poster or an induction slide rather than a performance framework used in supervision.
- Confusing competence with training attendance. A certificate is not a competency sign-off.
- Expecting compassion from staff while managing them without any.
- Letting communication live in verbal handover, so the record and reality drift apart.
- Praising courage in the policy and punishing it in practice, usually by how the last concern was handled.
- Ignoring commitment problems because the worker is otherwise good, until the reliable staff leave.
- Recording tasks rather than people in daily notes, so the values are invisible in the evidence.
- Applying the 6 Cs to residents but not to how the home treats families, agency staff or new starters.
What good looks like on inspection day
An inspector will not ask you to recite the 6 Cs. They will watch a mealtime, read five care plans, talk to staff and residents, and look at your supervision and training records. The 6 Cs should be visible in all of it without being named.
In practice, good looks like this. Staff can describe, in their own words, how they support a specific person and why. Daily notes describe people, not tasks, and match what the care plan says. The training matrix shows competency sign-offs with dates, not just attendance. Supervision records contain dated observations of practice, positive and corrective. Incident reports show learning and closed actions. The whistleblowing log shows that concerns have been raised and handled, which is far better evidence than a log that is empty. Residents and families say that staff are kind, and can give examples.
Managers who want to check their own readiness should pick one resident and follow the six values through that person's records for a month. If you can find care, compassion, competence, communication, courage and commitment in the file, so can the inspector. If you cannot, you have found your improvement plan. A compliance view that links training, supervision, incidents and care records makes that monthly check a ten-minute job rather than an afternoon.
Final conclusion
The 6 Cs of care are not complicated. They are what a good carer does and a good manager protects. The difficulty is not understanding them but sustaining them at 6.45am on the fourth long day in a row, and being able to prove afterwards that they happened. Teach the values through real shifts, use them as the language of supervision, keep records that show people rather than tasks, and build a culture where courage is safe. Do that and the 6 Cs stop being a slide and become the home.
Frequently asked
What are the 6 Cs of care?
The 6 Cs are care, compassion, competence, communication, courage and commitment. They are a set of shared values for nurses, midwives and care staff in England, and are widely used in adult social care induction, supervision and appraisal.
Where did the 6 Cs come from?
They were introduced by NHS England in December 2012 in the Compassion in Practice strategy, led by the Chief Nursing Officer for England. The strategy followed the failings at Mid Staffordshire and was intended to restate the values of nursing and care in plain words.
Do the 6 Cs apply to social care as well as the NHS?
Yes. Although written for the NHS, the 6 Cs were adopted across adult social care and are reflected in the Skills for Care Code of Conduct for Healthcare Support Workers and Adult Social Care Workers. Most Care Certificate workbooks reference them.
How do you apply the 6 Cs in practice?
Use real shift examples in induction, make the six values the structure of supervision with dated observations, and keep records that describe people rather than tasks. Managers should model the values in how they treat staff, and make raising concerns safe so that courage is possible.
Does CQC inspect against the 6 Cs?
Not by name. The CQC single assessment framework uses quality statements, particularly under the Caring and Well-led key questions, that describe the same behaviours: kindness, respect, choice, and a culture where staff can speak up. Evidence of the 6 Cs in practice is evidence for those statements.
Which of the 6 Cs is the most important?
They are meant to work together, but courage is the one that protects the others. Without a culture where staff can raise concerns, poor care, poor competence and poor communication go unchallenged. Managers should treat the safety of speaking up as the foundation.
How can a manager evidence compassion?
Through structured observations of practice recorded and discussed in supervision, through resident and family feedback that is gathered and acted on, and through daily notes that describe how a person was rather than what was done to them. Compliments and complaints are both evidence.
Sources
- NHS England: Compassion in Practice (the 6 Cs)
- Skills for Care: Code of Conduct for Healthcare Support Workers and Adult Social Care Workers
- Skills for Care: The Care Certificate standards
- CQC: Regulation 10 Dignity and respect
- CQC: Single assessment framework quality statements
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
