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CQC Evidence Categories 5: People's experience of health and care services

As health and social care providers are starting to acclimatise to the CQC’s new single assessment framework, more providers are starting to ask questions about the ways on which they can start to collect the evidence they require to ensure they have what the CQC need to undertake their inspections.

In this blog we will take a look at the evidence category, People's experience of health and care services, and consider what this might require from providers of social care in the way of evidence collection as well as how Bettal may be able to help with fulfilling these requirements.

Remember People's experience of health and care services is only one of six evidence categories, each of which require the attention of the provider / registered manager, although as services exist to serve people, it is perhaps the most important:

• People's experience of health and care services.

• Feedback from staff and leaders.

• Feedback from partners.

• Observation.

• Processes.

• Outcomes.

Why collecting feedback from people is important

The CQC identify a number of ways the service might gather feedback from people,, these include:

• phone calls, emails and give feedback on care forms received by CQC.

• interviews with people and local organisations who represent them or act on their behalf.

• survey results.

• feedback from the public and people who use services obtained by:

• community and voluntary groups.

• health and care providers.

• local authorities.

• groups representing:

• people who are more likely to have a poorer experience of care and poorer outcomes.

• people with protected equality characteristics.

• unpaid carers.

Looking at these many service providers will worry that they do not have the capabilities to gather feedback in a way meaningful to them. This need not be the case as with a little thought and effort, providers can tap into this evidence category not only as a means of having something to share with the CQC, but also as a means of measuring service quality and driving forward service development.

Not collecting feedback on people’s experiences of a service is not an option as the CQC are clear in their description of the importance of this evidence category:

• People using services, their families, friends and advocates are the best sources of evidence about lived experiences of care. This includes their perspective of how good their care is.

• We value people’s experiences as highly as other sources of evidence and weight them equally with other evidence categories.

• We consider the context and impact of people’s experiences in our analysis.

• If we receive feedback that people have poor experiences of care, we will always identify it as a concern. We will review further and gather more evidence. This is even if other evidence sources have not indicated any issues.

• We increase our scrutiny of, and support for, how providers and systems encourage, enable and act on feedback. This includes feedback from people who face communication barriers. We look at how they work together to improve services.

How to collect feedback from people

There are many ways in which good service collect feedback from people, remembering this includes people who use the service as well as their family, informal carers and advocates, and use this to learn lessons and improve their practice. These strategies include:

• Surveys.

• Paper.

• Online / email.

• Face to face.

• By phone.

• Suggestions.

• Compliments.

• Complaints.

All of these can be fed into a matrix and considered as a means of ensuring the service does more of what it does well and less of what it does not do so well. This is the basis of good governance and quality assurance and a failure to look at patterns in feedback will mean a provider might be missing perennial issues.

Thought needs to be put into how to present surveys regardless of the format. There are many reasons for this including considerations of what the service wants feedback on as well as the form the feedback needs to take. For example feedback about care staff accessed via a questionnaire delivered by care staff might not elicit truthful responses, while understanding someone’s lived experience of a service in detail can only really be gained by skilful interviews and not a tick box survey.

We have all read surveys where the answer we want to give is not present and so understand how creating surveys is a skill. The skills involved in survey writing include the ability to frame questions correctly so that the respondent knows what they are answering, e.g. a yes / no question which asks, “does your carer usually arrive at the allotted time and are they well-presented?” is confusing as it asks two things which are mutually exclusive. Surveys also need to avoid using leading questions, e.g. “95% of people who use our services rate us as good, do you agree?”. It is for these reasons providers should use outsourced surveys.

These strategies however rely on the ability of people to provide feedback as well as them feeling comfortable to do so. There is a need in some social care settings to find other strategies for understanding people's experiences. For example, people living with learning disability may find a written survey difficult and many people will find it hard to provide free text feedback.

Some more innovative ways of collecting feedback might be required and may include:

• Pictorial surveys.

• Visual feedback tools.

• Easy read forms.

• Focus groups.

• Smiley face survey tools

• Involving advocates, informal carers and family members.

For many providers time and money will drive their engagement with collecting evidence about people’s experiences of services, although all providers must do something or they risk not being able to provide any evidence in this category for themselves.


Failing to spend time on creating and applying meaningful ways of gaining feedback from people accessing services and those important to them means providers could be missing feedback which may be useful for their development as well as that which the CQC might use in their assessment of the service.

Services need to consider the need for feedback, the questions they need answers to and the form in which the feedback should be gathered in order to make the gathering of feedback meaningful. Failure to do these means the feedback could be meaningless.

Bettal Quality Consultancy has a comprehensive and regularly updated suite of policies, procedures and risk assessments, as well as survey tools, to support busy registered managers and their teams in the provision of compliant care.

If you would like to know more, browse our website or get in touch:

Telephone: 01697741411

Peter Ellis MA MSc BSc(Hons) RN


Bettal Quality Consultancy

Photo credit: Andrea Piacquadio

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