1. 1 January 2012 Involving, engaging and communicating with people who use services

2. 2 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

3. 3 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.

4. 4 Communicating with people who use services to promote awareness and understanding of our work

5. 5 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

6. 6 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

7. 7 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

8. 8 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

9. 9 Involving and engaging people who use services in our regulatory work

10. 10 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

11. 11 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 website Informing 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 months Developing 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 basis by post, phone, email & face to face) Planning thematic reviews CQC website Methodology for MHS visits Annual Mental Health Act report

12. 12 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 consultation Inspector 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 leaflets Messaging 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 leaflets Inspection report Website user testing (User centred design approach, with individual members of the public Each stage of design and functionality tested with users

13. 13 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 toolkit Experts by Experience methodology May 2011 Excellence consultation and tender review NHS pilot interview toolkit June 2011 July 2011 Easy read outcomes for Learning Disabilities review Membership of Domiciliary Care Review Advisory Group August 2011 Easy read feedback formSeptember 2011 Inspector training Easy read guidance for Learning Disabilities review expert Consultation on Judgement Framework and enforcement policy Event at National Customer Service Centre October 2011 November 2011 Reviews of leaflets and other guidanceMay – November 2011

14. 14 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 servicesMay 2011 Acting together methodology for Mental Health Act visitsJune 2011 Meeting on safeguarding information for detaining patients and on the Second Opinion Service June 2011 Annual Mental Health Act reportAugust 2011 Meeting on Mental Health Act monitoring frameworkOctober 2011 Visit information for people on Community Treatment OrdersJanuary 2012

15. 15 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 CQC The transition from LINks to local healthwatch April 2011 How LINks can use the essential standards of quality and safety Healthwatch policy developments How LINks enter and view visits and CQC inspections should complement one another June 2011 CQC ‘s thematic reviews and how LINks can inform them How LINks and CQC can work together to identify equalities issues in the NHS Options for sharing CQC inspection reports with LINks October 2011 Developing the operating model for Healthwatch England Discussion on how we gather people’s voices on GPs and primary medical services February 2012

16. 16 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.

17. 17 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

18. 18 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, LINk Domiciliary Care Advisory Group: Age UK, Experts by Experience, LINk Richmond Learning Disability Advisory Group: Mencap, British Institute of Learning Difficulties, Sense, Turning Point, Scope, National Autistic Society

19. 19 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.

20. 20 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.

21. 21 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

22. 22 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

23. 23 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

24. 24 Listening to people’s voices about the quality and safety of services and checking that providers do the same

25. 25 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

26. 26 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

27. 27 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

28. 28 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

29. 29 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

30. 30 Appendix A: Our statutory duties

31. 31 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)

32. 32 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

33. Appendix B: CQC Engagement 33 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

34. 34 Increasing our access to rich sources of people’s voice to improve our assessment of regulatory risk Appendix C

35. 35 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?

36. 36 Potential sources of people’s voice

37. 37 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..

38. 38 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.

39. 39 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.

40. 40 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..