In our strategy from 2021, we set out our ambitions to deliver smarter regulation driven by people’s needs and experiences of care.
The strategy also outlined our plans to assess how care works in a local system and to tackle inequalities that people face with care. Here, we outline our ambitions and strategy for engaging with people who use services, their families and unpaid carers, and organisations who represent them or act on their behalf.
What we know
To deliver high-quality care, it is vital to listen to, understand and act on the experiences and needs of people who use health and care services. This applies to those who provide and organise care services as well as to CQC as the regulator. Engaging with people enables us to improve how we do our job, and to build trust and confidence with the public. Information from people’s experiences helps us to make better assessments of the quality of care and provide better information about them. It also improves how we monitor the rights of people who are detained under the Mental Health Act.
For this to work well, we need to get better at how we encourage and enable people to engage with us. This includes people who use services, their families and unpaid carers, and organisations that represent them or act on their behalf. It particularly applies to people who are more likely to have a poorer experience of care and who may face inequalities.
Where we are now
We published our last Public Engagement Strategy in 2017. Since then, we have made some significant achievements.
- People are now more aware of CQC. Public awareness has increased from 51% in 2016 to 67% in 2021/22, with unprompted awareness increasing from 17% to 36% over the same period.
Encouraging and enabling people to share their experiences of care
- Our new online Give feedback on care service is built around the needs of people who use services and more people are sharing their experiences of care with us online than ever before.
- We’ve heard from 150,000 – 200,000 people a year through our NHS Patient Survey programme and doubled the number of experiences of care we hear through our Give Feedback on Care Service from 61,000 in 2017/18 to 123,000 in 2021/22.
- We have made the NHS Patient Survey Programme more accessible by enabling people using services to feed back using online and paper- based methods, including translated and accessible questionnaire formats.
- We carried out a review of how well we listen and respond to people who use services who share their experiences with us as part of our Listening, Learning and Responding to Concerns Review.
- We’ve introduced new ways to enable us to hear from people who are detained under the Mental Health Act, as well as their advocates and unpaid family carers.
Information for the public
- We have upgraded our website so our information works well on mobiles and tablets, is accessible to everyone no matter how they need to use it, and works with assistive technology.
- 20% more people are also using our information about the quality of care.
- There are more people working with us to shape our policies and how we do our job. The number increased from around 3,000 people a year in 2017/18 to around 28,000 in 2021/22. We have improved how we do this, including how we involve people from seldom heard communities and people with protected equality characteristics.
- We’ve developed new ways of delivering our regulatory functions and other work together with people who have lived experience of care. Our commitment to this work continues through our flagship Experts by Experience programme.
- Through our Public Engagement Network, we’ve set up panels of people with specific characteristics and backgrounds to help us embed their voices in our work, this includes; children and young people, people from the Gypsy traveller community, autistic people and people with a learning disability.
- We’ve continued to build and maintain trusted partnerships with key organisations that represent or act on behalf of people who use services.
People tell us we need to do more to:
- raise awareness of our role and purpose, and about the standards of care people should expect
- encourage and enable people to give feedback about their experiences of care services either to us, to their local Healthwatch, or wherever they feel most comfortable doing so; this is particularly important for people more likely to have a poorer experience of care and who may face inequalities
- improve how we act on people’s experiences of care they share with us and provide a better service to people explain how we have acted on their information
- work with those who provide and organise care services to make sure they involve people in shaping services that meet their needs
- provide better information about the quality of care in a way that meets people’s needs
- encourage and enable people from a wider range of communities and backgrounds to get involved in developing how we do our job
- engage more with people who have protected equality characteristics, people from seldom heard communities and those who are more likely to have a poorer experience of care and who may face inequalities.
Our new Public Engagement strategy has 4 clear objectives:
- Build a trusted feedback service where people’s experiences drive improvements in care.
- Create a trusted, accessible information service that meets people’s needs.
- Develop an inclusive approach to involving people who use services, their family, carers and organisations that represent or act on their behalf in shaping our plans, policies and products.
- Work in partnership with organisations that represent or act on behalf of people who use services in our collective endeavour to improve care.
The implementation plan for this Public Engagement strategy sets out timescales and success measures for all the points. We’ll monitor our progress on implementing these objectives to make sure we are delivering them and report publicly on our progress.
We want to enable and encourage people to give feedback about their experiences of accessing care, using care services and moving between services. This can be wherever and however they want to do this. We want people to feel their feedback is valued and to understand what impact it had.
We’ll encourage a culture change to improve how people’s lived experience is welcomed, valued and used. We’ll lead by example in our work.
- Organisations that provide and organise care services in an area will be assessed using our single assessment framework. The framework uses quality statements based on what matters to people who use services. These are based on the Making It Real ‘I’ statements by Think Local and Act Personal, which are developed with people who use services and other partners and stakeholders.
- People’s experiences will be required evidence in our assessments of most quality statements . We’ll make sure people’s lived experience is valued equally alongside other evidence.
- We’ll assess how those who provide and organise care services in an area encourage and enable people and communities to provide feedback, how services act on what they hear, and how they work in partnership with them to design services. We are particularly interested in how services work with people more likely to have a poorer experience of care and who face inequalities.
- There will be more scrutiny of how well people’s feedback is obtained and used. This will be reflected in our assessments and ratings. We’ll also highlight good practice that we find and promote how this can drive improvements in care.
- We’ll make sure that people who are detained under the Mental Health Act have the right access to independent advocacy and information.
- Those who apply to register to provide care for autistic people or for people with a learning disability will face increased scrutiny. This is to improve how these services meet the requirements of our guidance.
- We’ll promote the value of people’s experiences of care, develop new ways to use it and share learning from the information.
- With our partners and other organisations, we’ll identify ways to further develop and embed a culture change in how care services and those who organise care in an area value people’s feedback about care and use it to improve.
We’ll make it easier for people to share their experiences of care with us. When they do, we’ll provide a high-quality service to let them know how we’re acting on it.
- By developing new ways of working with Experts by Experience, we’ll improve our understanding of people’s experiences of both individual services and care pathways. This includes how people access, use and move between services. Our Experts by Experience programme will continue to focus on people more likely to have a poorer experience of care and who face inequalities, including people who are detained under the Mental Health Act. We’ll work more with Experts by Experience who can tell us about services for people with a learning disability, people with mental health needs and autistic people.
- Our local teams will have the guidance and tools they need to engage with people more likely to experience poorer care and inequalities through our Public Engagement Network partners, Local Healthwatch and local voluntary and community organisations and track how well we are doing this.
- Services where there is a risk of a closed culture and where people are at risk of abuse and more likely to have a poorer experience of care will be prioritised for inspections and in-depth interviews. These services include residential services for older people, autistic people and people with a learning disability. We want to talk with people who use services, their advocates and unpaid family carers. We’ll use specific tools, such as Talking Mats, our Short Observational Framework and a quality of life tool, to enable us to understand the experiences of people who have cognitive, sensory or communication challenges.
- There will be more ways for people to contact us that are accessible to all. This includes Sign Live, our translation and interpreting services and web chat. We’ll also consider developing new citizen assessment tools.
- People who share their experiences will receive a better service from us and we’ll advise them about other sources of support where needed.
- Our improved Give feedback on care service will enable people and organisations who represent or act on their behalf, such as local Healthwatch, voluntary and community groups and advocates, to easily share feedback about experiences.
- We’ll keep people informed about how we use their experiences in our regulatory decisions. We’ll do this by providing a feedback loop to people in a way that meets their expectations and needs and through transparent reporting.
- Along with our partners across health and social care, we’ll work to reduce the complexity people face in understanding where and how they can give feedback.
We’ll make better use of all the experiences people take time to share with us, both positive and negative.
- We’ll make sure we are clear about what we mean by ‘people’s experiences’ and we’ll be transparent about how we use people’s feedback.
- Our local operational teams will be equipped with the skills and tools to make expert use of people’s experiences.
- Our new data systems will be developed to make the best use of insight from people who share their experiences with us or who contact us with a complaint about being detained under the Mental Health Act. This includes capturing demographic and other information that tells us more about who is sharing their experience, particularly if they are more likely to have a poorer experience of care or may face inequalities.
- Better insight on demographics will be enable us to take a more targeted approach to proactive public awareness activities.
- We’ll ensure that our new data platforms, analytical tools and methods enable us to combine people’s experiences with other evidence and use them in the right context. This includes complaints about being detained under the Mental Health Act. This will provide better insight for local teams and inform our work looking at specific aspects of care.
- We’ll improve how we share information between ourselves, Healthwatch England, local Healthwatch, and organisations that represent or act on behalf of people. This will enable a better understanding of different types of information from different sources and identify the most valuable information to ensure effective regulation of care in services and across an area.
We’ll increase the volume and range of information that we look for on people’s experiences as a key evidence source in our assessments of all care services and those who organise care in an area.
Improving our national data collections
- We’ll develop and deliver a data acquisition strategy. This will enable us to access sources of information where people already share their experiences and create new methods of asking for feedback where these currently don’t exist. This includes feedback shared with health and care providers, Healthwatch, integrated care systems and reviews about services posted online.
- By improving the areas our patient surveys cover, re-examining the questions we ask and using them more creatively, we’ll be able to better understand people’s experiences of care in their area.
- We’ll also develop data sharing partnerships across the health and social care system to improve our understanding of inequalities in access, pathways, and provision of care.
Working with those who organise and deliver care
- We want to encourage those who provide and organise care services to promote our role and purpose to people who use their services. It’s important to highlight the valuable role of feedback in improving experiences of care for people, their unpaid family carers, and advocates. People should have the information they need, in the way they need it. This should include information to tell them their rights and how to pursue a formal complaint.
- We’ll also make sure that those who provide and organise care services in an area can easily share people’s feedback with us.
Working with local and national trusted intermediaries
- Our new local teams will work more efficiently and effectively with local Healthwatch, local voluntary and advocacy groups and other organisations that represent or act on behalf of people who use services.
- We will develop partnerships with Healthwatch England, local Healthwatch, voluntary and community organisations, advocates and other trusted intermediaries to better understand people’s experiences, particularly those of people who face inequalities and people who are more likely to have a poorer experience of care.
- By working with these organisations, we’ll promote and improve awareness of CQC and our Give feedback on care service in places where people are looking for information about care.
Delivering targeted public campaigns
- We want to empower people from seldom heard communities, people who face inequalities, people more likely to have a poorer experience of care and people who are detained under the Mental Health Act to share their feedback. We’ll do this by investing in effective ways to engage with them through targeted public awareness campaigns.
We want our information to be relevant, up-to-date and meaningful for people who use services. It should also reflect their experiences. We want people to be easily able to access our information and use it to make informed decisions, where they can, about where to go for care.
We’ll raise public awareness of CQC, our role and purpose and the standards of care people have a right to expect.
- Through public awareness campaigns, we’ll focus on engaging with people who face inequalities and people more likely to have a poorer experience of care. We’ll use our insight to adapt the content and relevancy of our information and the methods we’ll use to reach the right audiences in the best way.
- We’ll maximise every opportunity to increase public awareness and understanding of CQC, starting from when a provider registers with us, through to our proactive media releases about our regulatory activity.
We’ll provide relevant, useful, up-to-date information.
- Working directly with people who use services, we’ll have a better understanding about the information they need from us. This includes what matters to people when they access, use and transfer between care services.
- We’ll improve information for the public about what we do and how we do it, the standards of care people should expect, how we protect people’s rights under the Mental Health Act and how to access and use care services.
- When reporting on our assessments of services, we’ll describe what we find in a way that reflects how people recognise and use them. Our reports will highlight how people’s experiences have informed our decision making and judgements.
- We’ll ensure our assessments of care services and those who organise care are timely enough to meet people’s expectations and needs.
- We’ll explore the possibility of publishing reports from our Mental Health Act reviewers.
- We’ll publish information to let people know where to find advice that people expect and need, but which is outside our regulatory remit. For example, the NHS website for information on topics such as online appointments or online repeat prescription ordering.
- We’ll explore whether we could use people’s reviews about services posted on other websites.
We’ll make sure our information is easy to access and use.
- Information for the public will be re-designed as HTML web content through rigorous content production processes. This will follow best practice guidelines relating to accessibility using clear, simple language.
- We’ll replace our existing systems for publishing inspection reports and redesign how we display our judgements, reports and data about care services around the needs of people who use them.
- We’ll design, test and embed personalised information and consider exploring citizen informed ratings.
- Our website will enable people to carry out geographical or postcode searches for community services. For example, catchment areas for ambulance services and health and social care provided in the community.
- We’ll identify where people look for information about care and proactively make our information available to people wherever they most need it and in the most suitable format.
- We’ll make all our information available to other organisations to enable more people to be aware of it and encourage them to use it.
We want to involve a broader range of people and organisations that represent them in shaping our plans, policies and products. We would particularly like to include people who are more likely to have a poorer experience of care and who may face inequalities.
Before we make any changes, we’ll start by understanding what people expect and need from care services and journeys through care, and from us.
- We’ll use discovery research to understand people’s needs and involve them as active partners from the start to genuinely co-design how we develop our strategies, regulatory approaches to assessing providers, local authorities and integrated care systems, and reviews of specific aspects of care. This means working alongside people who use services, including those who are more likely to have a poorer experience of care or who face inequalities. We’ll take into account their experiences and needs and demonstrate the impact and influence people have had.
- Working with people who use services, we’ll develop more ways to get involved in shaping how we do our job , both online and offline. We’ll make sure we involve people in ways that to meet everyone’s needs.
- We’ll work with Experts by Experience who have the relevant experience of services, in the right way and at the right time.
- We’ll make sure the voices of people who use services are heard by our Board and senior leadership team.
- In partnership with NHS England and Improvement, the Office for Health Improvement and Disparities, the National Institute for Health and Care Excellence, the Medicines and Healthcare products Regulatory Agency and others, we’ll improve the sharing of insight between our organisations and align with best practice in public engagement. We’ll develop a central database of insight to make the best use of this information.
We’ll encourage and enable people to get involved in designing how we work.
- We’ll increase awareness of how people can get involved in shaping how we do our job, especially those more likely to have a poorer experiences of care and who face inequalities, their carers and organisations that represent them. To promote opportunities to get involved in our work, we’ll invest in our partnerships with Healthwatch England, local Healthwatch, and other organisations that represent people.
- The process for getting involved will be equitable, fair, transparent and accessible and will be fairly rewarded in line with best practice.
- The way we provide feedback for people who work with us will explain clearly what we have done with the information they share and its impact.
- We’ll build on our methods, skills and experience to involve a wider range of people, their carers and organisations that represent them, including people who are more likely to have a poorer experience of care and face inequalities.
- Through our Public Engagement Network we will set up more panels of people from different communities such as, homeless people, and people from a range of ethnic backgrounds. We’ll build and maintain the Public Engagement Network to deliver a programme of engagement with seldom heard communities.
- We’ll look for opportunities for people who use services to lead our co-production forums.
We’ll value professional and lived experience equally in developing our strategies, regulatory approaches and other work, including how we review specific aspects of care and report on them.
- We’ll make it a requirement to engage with the public and use their insight when we develop or update new plans, policies and products that will have an impact on people who use services, their carers and organisations that represent them.
- We’ll understand what good and outstanding looks like, so we can assess whether we are delivering what people, or organisations that represent them, have told us they need.
- Working with our partners and internal stakeholders, we’ll further develop and embed a change in culture that emphasises how insight on people’s experiences informs how we deliver our role and purpose.
- We’ll be transparent about how insight from involvement activity with the public and organisations that represent people who use services has influenced our strategic approach. We’ll also provide a clear rationale for where it hasn’t.
- By continuing the Experts by Experience programme board, we’ll have independent oversight for the delivery of the contract, including any contract extensions and re-procurement.
We want to continue to develop high-quality relationships with organisations that represent people who use services or act on their behalf. We recognise that these partnerships are fundamental to maintaining trust and confidence with the public and to delivering our strategic ambitions.
We’ll continue to invest in building effective local and national relationships with organisations that represent people or act on their behalf.
- Our senior leadership team will maintain strong relationships with senior leaders of voluntary and community sector organisations that represent people who use services.
- Our new local teams will build strong working relationships with local Healthwatch, local voluntary community and advocacy groups and other organisations that represent or act on behalf of people who use services.
- We’ll strengthen our national relationships with organisations that work with and represent people who are more likely to have a poorer experience of care and who face inequalities.
- We’ll keep up-to-date with new and emerging organisations that advocate on behalf of people. We’ll treat these organisations as a priority for engagement and partnership, recognising their expertise as a trusted source for millions of people who use health and care services and their carers.
- We’ll develop meaningful opportunities to work with us for organisations that represent or act on behalf of people who use services. We’ll tailor these opportunities to the needs of the organisations wherever possible.
We’ll work in partnership to influence improvements in care.
- We’ll enable better sharing of insight about people’s access to care, the quality of care services and transfers between them, and aim to understand the factors that influence these areas.
- When people’s experiences, needs and expectations of care change, especially those more likely to have a poorer experience of care, their unpaid family carers, and those who face inequalities, we’ll understand and act on this to inform our strategic, operational and thematic work.
- We’ll encourage partners to use our information and work together to amplify community voices and influence improvements in care at a local and national level.
- We’ll use our independent voice to look at specific areas of inequalities, working in partnership with organisations that represent people and other partners.