Continuing to put people and communities at the heart of our work

Chris Day, director of engagement, CQC

In my last blog in June, I spoke about putting people at the centre of system regulation. In this blog, I want to explain how we are continuing to improve how we put people and communities at the heart of all our work.

Our ‘strategy for the changing world of health and social care’ made ambitious commitments to deliver smarter regulation driven by people’s needs, views and experiences of care. We also committed to assessing those who organise care locally as well as individual care services themselves, and to focus on addressing inequalities, and the causes of inequalities, in health and care. To deliver on these commitments, we are equally ambitious in our approach to consistently engage with people throughout our work — including people who use services, their friends, families and unpaid carers, and organisations who represent them or act on their behalf.

Listening and learning

I’m extremely grateful and would like to thank people for engaging with us because we know that to improve the quality of care, it’s vital to actively listen and understand what local people and communities expect and need from services in a way they wish, to learn from their experiences of care and to involve them in shaping how services are planned, delivered and paid for.

Always reflecting and having this understanding will enable those who provide and organise care in a local area to improve people’s experiences when they need to use care and when they move within and between different care services. For CQC, having this insight and understanding enables us to judge whether these local needs are being met consistently and adequately, make better assessments about the quality of care, and provide better information to the public. All of this helps to build and keep public trust and confidence in how we do our job.

But it’s not just CQC who needs to gather this valuable information — all those who provide services and organise care in a local area also need to encourage and make it easy for people to share their views and experiences of care. This particularly includes those who are most likely to have a poorer experience of care, present late for diagnoses and treatment, and who may face avoidable inequalities.

We’ve started to set out the detail of our new single assessment framework, which supports our commitment to regulation that’s driven by people’s needs and experiences of care. We also now have a set of principles to guide how we use people’s experiences in our new way of regulating.

These principles were developed by engaging with a whole host of people and communities who use services and who care for friends and families receiving care, and groups that represent and advocate for them, and those who provide services — as well as with our colleagues in CQC and other key stakeholders. I am grateful to everyone who continues to support us to develop our new way of regulating so that we deliver, and demonstrate that we are delivering, our purpose.

These are our principles:

1. People’s experiences drive our:

· regulation of care services

· assessments of ‘care pathways’, systems and local authorities

· thematic reviews of care.

2. We believe that people using care services, their unpaid carers, families, friends and advocates are the best sources of evidence about their lived experiences of care and how good it is from their perspective. We champion this in our work.

3. We value people’s experiences as highly as other forms of information or data.

4. We encourage and enable people to give feedback to CQC at any time about good and poor experiences of care in ways that work best for them. We actively seek out experiences from people:

· whose voices are seldom heard

· who are most likely to have poorer access to care, poorer experiences and poorer outcomes from care.

5. We make it easy for all people who use services to give feedback to us and make sure they have a good experience when they do so.

6. We expect and support those who provide and organise care to encourage and enable all people to give feedback to them and to others. We scrutinise how well they do this and how they have acted on it. This includes how they have responded to formal complaints.

7. We make maximum use of all the experiences that people take the time to share with us and we do this consistently. We take timely, appropriate action where people’s experiences indicate immediate risk of harm, abuse or breaches of human rights.

8. We keep people informed about how we are using their feedback if they provide their contact details. We are transparent about how people’s experiences have informed our assessments and ratings.

9. We keep people’s personal information safe and protect their confidentiality.

10. We do not resolve concerns or complaints on behalf of individuals. We do:

· scrutinise how providers have acted on feedback and complaints

· signpost people to other organisations that have the powers to resolve complaints

· have a specific duty to resolve individual complaints for people detained under the Mental Health Act.

As well as helping us to develop how we’ll use people’s experiences of care, I’m very grateful to stakeholders for supporting us to develop a Public Engagement Strategy that will support us to always put people at the heart of our work. The strategy, which we hope to publish in the autumn, will focus on four objectives:

1. A trusted efficient and effective feedback service where people’s experiences drive improvements to care.

2. A trusted, accessible information service that meets people’s needs to understand and choose between services if they want to.

3. An inclusive approach to proactively involving people who use services, their family carers and organisations that represent or act on their behalf in shaping our plans, policies and products

4. Working in partnership with organisations that represent or act on behalf of people who use services in our collective endeavour to improve care — particularly for people and communities facing and experiencing inequities.

We are building a reflective process into our strategy, so we are assured and re-assured that it is achieving its aims and objectives.

Gathering more experiences of care

People’s views and experiences are a key source of evidence in our assessments of all care services and those who organise care in an area. We use the information to make judgements about the quality of care.

To enable us to do this, we need to hear from more people about their experiences of care, particularly those more likely to have a poorer experience of care and who may face inequalities.

One way we are doing this is through our public campaigns.

Jointly launched with Healthwatch England, our year-long Because We All Care campaign encourages more people to give feedback about their experiences of health and social care, or those of a loved one. We want to normalise how people share experiences routinely — we want to hear what is working to celebrate great care as well as understand where it could improve and keep improving.

Since launching in July 2020, we’ve received over 65,000 pieces of feedback during the campaign to our online Give Feedback on Care form. Through research and testing with people, we’re making sure that this online facility is as easy as possible for everyone to share their experience of care in a way that suits them.

We’ve focused on a range of audiences including, carers, people who suffer from chronic illness, people with a learning disability and autistic people, and more recently people who are deaf or hard or hearing. In our 2023 campaign, we’ll increase our focus on engaging with people with protected equality characteristics, people from seldom heard communities and those who are most likely to have a poorer experience of care.

There’s also our work with our ‘Tell us about your care’ partners, which helps us gather information from people we might not otherwise hear from. We work with Carers UK, Disability Rights UK, Mind, the Patients Association, the Relatives and Residents Association, and smaller local charities, so that we hear from more people about their views and experiences of health and care services.

We recognise that people and communities are not static and so we’ll adopt our approach to meet these changing needs and circumstances and contexts. We’ll also be making sure our local teams have the time and training to confidently engage with local organisations who represent people or act on their behalf, such as Local Healthwatch, and local voluntary, community and advocacy groups and individual people.

What’s next

Through our public and provider participation platform, you can contribute to our work — this is crucial to understanding how services are working together to provide quality care.

We’ll be publishing a ‘You said, we did’ on our Public Engagement Strategy, which includes areas of further development:

· Encouraging and enabling people to provide feedback about their experiences of care services — either to CQC, to local Healthwatch, or wherever they feel most comfortable doing so. This is particularly true for those who are most likely to have a poorer experience of care and may face inequalities in how they get access to care, when they use and experience services and their outcomes from it.

· Providing a better feedback loop, so that when people share their views and experiences, they understand how we’ve used their feedback.

· Providing better information about the level of quality of care in a way that meets people’s needs

We intend to be a learning and responsive organisation, and we recognise that we will improve how we work through external support and challenge.

But we all need to focus on the importance of regulation, which is vital in ensuring better care for people and communities — everyone rightly deserves this.

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