Using people's experience in our regulation

Our strategy makes a commitment to deliver regulation driven by people’s needs and experiences of care.

Our single assessment framework supports this commitment. These are the principles that we will embed as we regulate health and care.

We strive to include everyone’s experiences. ‘All people’ particularly includes those who:

• are fearful or traumatised
• whose first language is not English
• face communication barriers due to disability or sensory impairment
• have low literacy skills
• are digitally excluded

People's experience principles

1. People’s experiences drive our:
   • regulation of care services
   • assessments of ‘care pathways’, systems and local authorities
   • our thematic reviews of care.
2. We believe 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
   • 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 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.

Putting the principles into practice

How we gather people’s experiences

• We carry out surveys of people who use services at regular intervals and when we need to.
• We proactively seek out experiences that people are already sharing with others including with providers, trusted online spaces and from other sources.
• We encourage and support those who provide and organise care services to proactively and continuously promote ways for people to give feedback. This includes:
  • our give feedback on care service
  • their own communications channels (website, SMS text, email, display at the premises)
• We expect them to enable us to contact people who use their service, their families, unpaid carers and advocates at any time. This is so we can speak privately to people in residential care in person, by telephone or video link if we need to.
• We raise public awareness of CQC’s role and the importance of people’s experiences in our work.
• We share information effectively with local organisations representing or acting on behalf of people who use services. These include Local Healthwatch, voluntary organisations, advocates and other groups.
• We build relationships and work in partnership with trusted intermediaries and others. This is to understand the experiences of people who are:
  • from seldom heard communities
  • most likely to experience poorer care or inequalities.
• Our Experts by Experiences are people with lived experience of care services. They work with our local teams to understand the experiences of people using adult social care and mental health services.
• We store all the information we gather about people’s experiences securely and in line with GDPR requirements.
• We have the skills, training and accessible systems and tools so all people can share experiences with CQC.
• When we visit care services, we spend most of our time observing care and talking to people who use the service, their families, unpaid carers or advocates.

Analysing and understanding people’s experiences

• We recognise that people's experiences of care are unique diverse and complex sources of data. We will develop a robust approach to analysing these sources to inform our decision making across our operating model. We will develop analytical approaches to use the full range of people’s experiences data. This includes, for example, satisfaction data, narrative descriptions of care experiences and categorical data from surveys.
• Our analysis methods are appropriate for the service, provider, or system that we are reviewing. Our approach takes how people engage with services into account. For example, to assure ourselves that people’s experiences are good:
  • where people spend a long period of their lives in a service, we will look in-depth at individual experiences
  • for other services we may use representative samples, hearing from a broader group of people
• We consider people’s different needs from services when analysing experiences, for example people with long-term conditions and protected equality characteristics.
• We take into account the:
  • sources of people’s experience we can already access
  • situations where we need to gather more bespoke information.
• For example, we identify where we do not have enough information from seldom heard groups, including from people most likely to experience poorer care and inequalities. We target our activity to gather feedback from these groups. This includes working with partner organisations.
• Our data and analytical systems let us:
  • analyse people’s individual experiences in isolation
  • look across a range of experiences
  • contextualise these experiences alongside other data sources.
• We have:
  • tools and analytical expertise to draw out themes and trends across multiple sources of people’s experiences
  • wider intelligence and operational knowledge
• Together these inform our regulatory decision-making, thematic analyses and independent voice work.

Using people’s experiences in our assessments

• We use people’s experiences to build an understanding of the risk and quality of services and those who organise care across an area.
• People’s experiences are required evidence across all relevant quality statements. They are weighted as equally as other forms of evidence.
• Where people’s experiences are required evidence, our internal systems flag if:
  • this information is either unavailable or out-of-date
  • we do not have information from people who are most likely to experience poor care,
• We will then proactively gather new experience data.
• How we use people's experiences in our assessments is informed by the context and impact on people's care.
• When we gather additional experiences from people in our assessments, we track and record the information so we can use it use in our regulatory model.
• Any information from people’s experiences that indicates immediate risk of harm, abuse or breaches of human rights triggers immediate action. This could include:
  • notifying relevant third parties
  • gathering further evidence, including site-visits if needed
  • assessing relevant quality statements.
• We expect providers to demonstrate evidence that people are safe, and their human rights are protected.
• Where people raise concerns with us that indicates a change in the quality or safety of a service, we may seek assurance from providers that they are:
  • aware of the concerns people have raised
  • are taking appropriate steps to keep people safe and to improve.
• Where there is evidence of a change to the level of risk or quality in a service, provider or system, we use themes and trends we identify from people’s experiences to inform targeted assessment activities.
• Where information from people’s experiences indicates a likely risk of a closed culture, we will follow our closed cultures methodology.
• Information from people’s experiences will be required evidence for all areas of decision-making about services which have an inherent risk of developing a closed culture. This includes observations and information from our partners

What people can expect of CQC

• I understand the role of people’s experiences in CQC’s work and the importance of feeding back about good and poor care.
• I am confident that CQC values my feedback about my experiences of care as highly as other evidence.
• I am encouraged and enabled to give feedback about my experiences wherever I feel most comfortable, including to CQC, in ways that work for me.
• It is easy to give feedback to CQC and I am confident that CQC has the skills, training, accessible systems and tools to enable me to feed back about my experiences.
• CQC checks that my care services and local system encourage and enable me to give feedback to them about my experiences in ways that work for me. I understand how it has been acted on and can get involved in shaping improvements.
• When I give feedback to CQC I can remain anonymous if I choose to do so but I understand this limits CQC’s ability to act on it.
• If I share my contact details, I am confident that CQC will keep my personal information safe and not reveal my identity to the provider or other agencies. My identity will only be revealed if it is absolutely necessary because people are at risk of immediate harm.
• If I share my contact details with CQC, I am kept informed about how my feedback is being used in a timely way.
• I am confident that CQC will make the best use of my feedback and act on it in a timely way.
• I can clearly see in CQC’s reporting how feedback from people who use the service has been used to inform their assessment and ratings.