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January 2012

Involving, engaging and communicating with people who use services

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Background

CQC’s relevant duties in this area are set out in Sections 4 and 5 of the HSCA 2008

CQC (See Appendix A)

Our initial statement of involvement (Voices into Action 2009) set out our action plan

in relation to those duties with progress reported on every year. We plan to update the

board in May on progress this last year, and a draft new statement of involvement that

we intend to consult on this summer.

We have met our statutory duties in this area of our work, but we realise that robust

evaluation is needed to demonstrate its quality and impact. Progress will be taken

forward under the Strategic Review and Involvement will be a key priority of our

evaluation strategy

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About our involvement work

This paper summarises strategies that involve, engage and communicate with people who use

services and describes the breadth of our activities and early deliverables in these areas.

For the purposes of this paper the activities are described under 3 broad headings:

Communicating with people who use services to promote awareness and

understanding of our work;

Involving people who use services in our planning and development and checking

that providers involve people;

Taking into account the views of people who use services in our assessments of risk

and in our regulatory judgements.

Our engagement work as a whole covers a wide range of groups, including people who use

services, providers, stakeholders and government and parliament. The totality of this work is not

described here but it is illustrated in Appendix B of this paper.

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Communicating with people who use services to promote awareness and understanding of our work

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We do not market CQC to the general public - it would be prohibitively costly and insufficiently targeted

If people who use services come to us, our information is public-facing and assists choice

We have a digital platform from which information can be syndicated and we syndicate to third parties

We focus our communications on representative groups of people who most use services and voluntary and community groups, using a crude segmentation of the market by sector

We prioritize and segment groups best placed to act as channels out, to encourage voice in, and to inform public communications

Our strategy

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Communication with people who use services about what we do

A new public facing website with transparent, easy to access information about our regulatory

work and the results of our inspections. Makes prominent “What people told us” in our inspections

and an easy to use form to send us feedback

New, generic web content that is clear, plain English, and tested with users

A generic leaflet and web content telling people About Us, regularly updated; updated suite of

leaflets relating to mental health users planned

A new suite of What standards to expect from the regulation of your [care], leaflets and a new

one-page Summary of the essential standards and how to tell us about your care with associated

web content, promoting the new accessible ‘Tell Us Your Experience’ form on the CQC website.

All available in print, easy-read alternative and downloadable formats, all tested with the public

Distribution of leaflets to 150 LINks, 192 Overview and Scrutiny Committees, 192 Local Authority

newsletters and websites, 200+ PALs offices

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Communication about what we do - 2

Regular newsletters to 150 LINKs, 192 Overview and Scrutiny Committees, and SpeakOut

Network of 85 diverse community groups commissioned to support our work; a monthly e-bulletin

for the public currently reaching 40,000+

Pilot communications partnerships with Age UK, Alzheimers Society, and Rethink to include

regular communications via magazines, websites, radio, volunteer networks; briefing their

helplines about CQC’s work

Weekly list of inspection reports and local and national press releases about our regulatory

findings shared with LINks/OSCs and other local contacts; interactive map on our website

indicates publication of new inspection reports

Meeting with community and voluntary sector groups and other organisations and attending

conferences and other events nationally, regionally and locally

Plan to maximise communications channels via other third parties eg Citizens Advice bureaux,

Local Government Ombudsman; ADASS

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Communication about what we do - 3

We plan to syndicate our information to providers and to third parties for presentation on their

websites

We plan to offer people the opportunity to receive email alerts when a new inspection report has

been published

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Involving and engaging people who use services in our regulatory work

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Involve and engage individual people who use services, members of the public, representative groups of people who use services and national stakeholder organisations representing people who use services in the development of our strategy, methodologies, products and processes, in formal consultations, and in making our work accessible

Involve people who use services in our inspections and in training our staff

Work locally with LINks and other community representative groups

Involve and engage representative groups and individuals in the development of HealthWatch

Our strategy

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We involve and engage people in the development of our policy, strategy, methodology, products and processes – advisory groups

Our advisory and testing groups – some examples of recent involvement

National LINks advisory group (LINks hosts and members, face to face and by email)

Improving inspection reports and CQC websiteInforming DANI Inspections

Overview and Scrutiny Committees sounding board (Local authority officers and the local councillors they support, face to face and by email)

Met 3 times in last 12 monthsDeveloping how we work with OSCs and guide for how Overview and Scrutiny Committees work with CQC

Foundation Trust Councils of Governors, through the Foundation Trust Governors Association

Guide for how councils of governors work with CQC

SpeakOut network (85 diverse community groups across the country, independent of CQC, face to face, includes children)

See Slide 14 for examples

Service Users reference panel (Around 20 people who are, or have been, detained under the mental health act and who work with us on a regular basisby post, phone, email & face to face)

•Planning thematic reviews•CQC website•Methodology for MHS visits•Annual Mental Health Act report

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We involve and engage people in the development of policy, strategy, methodology, products and processes – advisory groups

Acting together (240 people who use/care for people who use serices, also trained as ExE, face to face and by email)

Judgement Framework and Enforcement policy consultationInspector induction

eQuality voices group(Group of people who use services who meet quarterly to influence CQC’s equality, diversity and human rights agenda)

The group has been involved in consultations on our emerging methodology. They are supporting scrutiny of our progress against our equality scheme.

Public reference group (100 members of the public, online)

Public leafletsMessaging

Healthwatch reference group (100 members of the public, online)

HealthWatch England model, the information system for HealthWatch, the communications and brand development work required

Public focus groups (series of workshops with 8-10 different members of the public, face to face)

Public leafletsInspection report

Website user testing (User centred design approach, with individual members of the public

Each stage of design and functionality tested with users

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We involve and engage people in the development of policy, strategy, methodology, products and processes – experts by experience

Some of the projects Experts by Experience have been involved in developing:

Leaflet for people who use dental services Learning Disabilities NHS Survey toolkitExperts by Experience methodology

May 2011

Excellence consultation and tender review NHS pilot interview toolkit

June 2011July 2011

Easy read outcomes for Learning Disabilities reviewMembership of Domiciliary Care Review Advisory Group

August 2011

Easy read feedback form September 2011

Inspector trainingEasy read guidance for Learning Disabilities review expertConsultation on Judgement Framework and enforcement policyEvent at National Customer Service Centre

October 2011October 2011November 2011

November 2011

Reviews of leaflets and other guidance May – November 2011

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We involve and engage people in the development of policy, strategy, methodology, products and processes – Service Users Reference Panel

Some of the projects the Service Users Reference Panel has been involved in developing:

Leaflet for people who use dental services May 2011

Acting together methodology for Mental Health Act visits June 2011

Meeting on safeguarding information for detaining patients and on the Second Opinion Service

June 2011

Annual Mental Health Act report August 2011

Meeting on Mental Health Act monitoring framework October 2011

Visit information for people on Community Treatment Orders January 2012

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We involve and engage people in the development of policy, strategy, methodology, products and processes – LINks advisory group

Some of the projects the LINks advisory group have been involved in developing:

Planning session for how CQC should work with LINks in the coming year

January 2011

Sharing learning on how some LINks work with CQCThe transition from LINks to local healthwatch

April 2011

How LINks can use the essential standards of quality and safety Healthwatch policy developmentsHow LINks enter and view visits and CQC inspections should complement one another

June 2011

CQC ‘s thematic reviews and how LINks can inform themHow LINks and CQC can work together to identify equalities issues in the NHSOptions for sharing CQC inspection reports with LINks

October 2011

Developing the operating model for Healthwatch EnglandDiscussion on how we gather people’s voices on GPs and primary medical services

February 2012

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We involve and engage people in the development of policy, strategy, methodology, products and processes – Speak Out Groups

Some of the projects Speak Out Groups have been involved in developing:

A video resource for staff on working with harder to reach communities

Planning for CQC national cross-cutting reviews – eg families of disabled children

Key CQC strategies and testing of the new website

Cross-cutting consultations, for example equality, diversity and human rights

consultation

Networking, training and developmental work to enable groups inform regulatory

activities including creative involvement with local communities.

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We involve and engage people in the development of policy, strategy, methodology, products and processes – consultation example

Example: consultation on our new judgement framework and enforcement policy

September – December 2011

Five focus groups held with Speakout Network and Experts by Experience

Included: Asian Disabled Association; Harrow Association of Somali Voluntary

Organisations; Brent Advocacy Concern; British Association of Visually Impaired

People

LINks members; Age UK, Challenging Behaviour Foundation; Alcohol and Drug

Service/Oxfordshire User Team, the Daffodil Advocacy Project, E-Quality Voices

Group

Accessible versions were produced – Easy Read, a mid and a full version)

42 of 174 consultation responses were from people who use services

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We work with national representative groups on the development of our policy, strategy, methodology, products and processes – stakeholder engagement

We do this through stakeholder engagement with national representative groups

which include representative organisations of people who use services on:

Our Advisory groups –task and finish groups supporting a piece of CQC work. The

members of these groups are pulled from the stakeholder register and also involve

individual Experts by Experience, carers and LINks members. These groups meet as

often as required for the duration of the project and give people an opportunity to

directly influence CQC’s work. Current advisory groups:

Dignity and Nutrition Inspections in adult social care: Age UK, Action on Elder Abuse, Expert by Experience, LINk Dignity and Nutrition Inspections in NHS (2): Patients Association, Age UK, Action on Elder Abuse, LINkDomiciliary Care Advisory Group: Age UK, Experts by Experience, LINk RichmondLearning Disability Advisory Group: Mencap, British Institute of Learning Difficulties, Sense, Turning Point, Scope, National Autistic Society

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We work with national representative groups on the development of our policy, strategy, methodology, products and processes – stakeholder engagement

Our Stakeholder register is a list of organisations and individuals who have

indicated their area of interest. The register is used to invite organisations to join

relevant advisory groups and we are looking to consult the wider stakeholder register

on which advisory groups we should set up for 2012-2013.

Our Stakeholder Committee is made up of a group of 20 organisations, including

voluntary groups which represent people who use services, which work with CQC’s

board at strategic and policy level. The group meets twice a year.

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We involve people in our board meetings

Any member of the public can attend our public board meetings. These are held 4 x

per year, two of which are outside of London. They are advertised on the CQC

website.

Proactive invitations to dinners the night before, to lunch on the day of the meeting,

and to the meeting itself are sent to local representative groups and others according

to the agenda

Options for improving our public board meetings are being presented to the board in

a separate paper.

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We involve people directly in our inspections

We include people who have experience of services - Experts by Experience (ExE) - in our

inspections

We Work with support organisations to recruit, train and support them. They include Age UK, The

Choice Support Consortium, The Challenging Behaviour Foundation, Addiction Dependency

Solutions/Oxfordshire User team

To date 243 ExEs have been recruited and trained representing: family carers of people with

high support needs; people who have used mental health services; people with experience of

detention under the Mental Health Act; people with experience of substance misuse services;

people with learning disabilities/autism

Experts by Experience involved in routine inspections and 100 Dignity and Nutrition inspections;

150 Learning & Disability inspections; will be involved in a further 550 Dignity and Nutrition

Inspections; 250 domiciliary care inspections and 60 extra Mental Health Act visits

Involving Experts by Experience in staff training and methodology review

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We involve people directly in our inspections - 2

Finalising methodology for Experts by Experience in different settings eg NHS; community

based; mental health service (including Mental Health Act visits); investigations – all

methodologies piloted with ExE

Involving Experts by Experience in staff training and methodology review, consultations,

workshops, events, public information materials development

Quarterly meetings held with ExE support organisations, ExE conference and newsletter planned

for 2012

Working with OFSTED/NCB on ways of involving young people in our inspections

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We involve and engage people in the development of HealthWatch

Extensive engagement with LINks, Speak out networks and other groups on

development of the Healthwatch brand

Leading a national project with 24 LINks aimed at improving our work with them and

preparing for local HealthWatch. Project includes:

Testing ways of working more closely on enter and view visits and CQC

inspections and developing training materials

Developing guides for LINks and HealthWatch on sharing information

Promoting our role and developing relationships through regional

LINk/Healthwatch transitional networks

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Listening to people’s voices about the quality and safety of services and checking that providers do the same

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Ensuring that the voices of people who use services influence our assessments of regulatory risk

Ensuring that our inspections focus on outcomes for people and that providers involve people

Ensuring that we engage with local people

Our strategy

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We monitor a wide range of sources of indirect and direct data from people who use services

We monitor and capture in the QRP ‘indirect’ data from the Parliamentary and Health Service Ombudsman; information from LINks and scrutiny committees in Quality Accounts; national patient surveys such as the Community mental health survey 2011; NHS Choices

We monitor and capture in the QRP ‘direct’ information: eg feedback on improved and more prominent Share Your Experience forms on our website; complaints about providers to CQC; feedback from LINks and other groups via Share Your Experience forms, LINks enter and view reports and local engagement with our inspectors

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Our methodology focuses on outcomes for people in our inspections and how we report on that

During inspections we talk to people who use the service and we observe care being delivered –

80% of our inspection time is spent doing this. Our regulatory judgments are based on outcomes –

the impact care has on people’s health and wellbeing and the experience they have whilst

receiving it – as well as on systems and processes. The action we take is determined by the

impact of non-compliance on people who use the service

We write about what people told us using direct quotes in a specific section of the inspection

report and website

We gather the views of people on all inspections using a range of tools including structured

interviews, SOFI 2 (a tool for observing the care of people with dementia) and others. Our

Domiciliary Care review piloted questionnaires and telephone interviews with people who use

services. Our investigation at Basildon interviewed more than a hundred local people.

We check that providers are having regard to the views, comments and views of people who use

services in the development of the service in our judgments about compliance with Outcome 16

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We engage with local people

We have established relationships between operational staff and 150 LINks across the country

We continue to build relationships with Overview and Scrutiny Committees and Foundation Trust

Councils of Governors across the country and supported those relationships with guidance for

them and for our staff.

Most compliance managers contact local LINks every 2 – 6 months; we received information via

email, via monitoring the LINks/scrutiny committees website, via the group feedback form on our

website or by face to face contact.

Compliance Managers and Regional Directors meet with voluntary sector organisations and

campaign groups

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Taking forward this entire area of our work under our strategy review

Ensuring we evaluate the quality and impact of our involvement work

Strengthening links between, and ensuring a systematic approach to, our

stakeholder and involvement work

Increasing our access to rich sources of people’s voice to improve our

assessment of regulatory risk – see Appendix C

Next steps

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Appendix A: Our statutory duties

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Our statutory duty

Under Section 4 of the HSCA 2008 CQC must have regard to

Views expressed by or on behalf of members of the public about health and social care services

Experiences of people who use health and social care services and their families and friends

Views expressed by LINks about the provision of health and social care services in their areas

Protecting and promoting the rights of people who use services (including in particular the rights of children, of persons detained under the MHA 1983, of persons who are deprived of their liberties in accordance with the Mental Capacity Act 2005 and other vulnerable adults)

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Our statutory duty

Under Section 5 of the HSCA 2008 CQC must publish a statement of involvement describing how it proposes to:

Promote awareness of our functions to people who use services and their families/carers

Promote and engage in discussion with people who use services and their carers about the provision of services and about how CQC exercises its functions

Ensure that proper regard is had to the views of people who use services and their carers

Arrange for any of our functions to be exercised by, or with the assistance of, people who use services and their carers

Appendix B: CQC Engagement

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Online communities (provider reference groups)

Provider sentiment tracking and benchmarking

Day to day contact via regional teams

Relationship managers for corporate providers

Providers

Advisory groups

Local LINks, Overview & Scrutiny Committees, Foundation Trust Councils of Governors

Local voluntary and campaign groups

Experts by Experience

Public reference and focus groups

HealthWatch reference groups

People who

use services

Parliamentary questions

Briefings for Department of

Health

Bi-monthly parliamentary

e-bulletin

1:1 meetings with MPs

Government and Parliament

Advisory groups

Stakeholder Committee

1:1 meetings

National Stakeholders

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Increasing our access to rich sources of people’s voice to improve our assessment of regulatory risk

Appendix C

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The challenges

We need people to tell us about their experiences of care - we can’t be everywhere

BUT there are potentially millions of voices that we could listen to – a potentially

complex and resource intensive exercise for CQC if we cast our net too wide

How do we identify and access additional valuable sources of user voice, for

example people who use adult social care and domiciliary care?

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Potential sources of people’s voice

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Pilot campaigns to encourage and evaluate new sources of public voice

We are setting up a series of experimental pilots with selected voluntary

organisations to obtain structured feedback and assess its value to CQC.

A ‘Tell us about your care’ pilot campaign with Relatives &Residents Association to receive

structured feedback from people who call their helplines (January 2012)

Train R&RA helpline to field calls /complete CQC coded webforms

A similar pilot campaign with Patients Association as above (February 2012)

Co-branded printed materials designed to raise awareness of standards and encouraging public to

‘Tell Us’ about their care (leaflets and tear off card)

Track feedback through CQC system

Report at 6 month point evaluating results against success criteria/impact of public feedback on

helping us improve poor care. Share evidence.

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Partnership working with selected Voluntary Organisations to test effectiveness

We have set up 6-9 month experimental communications partnerships with 3

organisations – Age UK (700k calls to helpline in year) , Alzheimers Society (25k

members) and ReThink Mental Illness (10k members, 52k people helped). Includes:

Helpline training seminars – supporting partner Advice Line staff with how to encourage

callers to feedback to CQC and what we are looking for

Training Activists to better understand the job of CQC and share knowledge with all people

who use services they meet, encouraging feedback, distributing CQC information.

Joint events CQC Ops staff and Voluntary Organisation meeting public and sharing

information

Distribution CQC leaflets as inserts to magazines, pick up points in charity shops/dementia

cafes, Friendship centres etc

Other ad hoc activity e.g. Age UK radio broadcast

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Partnership working with other organisations to test effectiveness

We are investigating whether we can also work in a similar way with:

Citizens Advice Bureaux

Alzheimer’s UK

Patient Concern

Public Concern at work

National Childbirth Trust

Local Government Ombudsman

.

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Testing within one region

Expand ‘Tell Us about your Care’ campaign to a region, based on the results of the

pilot.

Leaflet distribution to all GP surgeries in Region (+ all pharmacies optional)

Broadcast to all GP waiting rooms in Region via Life Channel

Regional press campaign

Evaluative research on effectiveness in both reaching and engaging the public.

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