The Quality Framework is a self-assessment tool you can use to understand whether your work is practical or needs to improve. 

Healthwatch Cambridgeshire and Peterborough deliver their services to around one million residents, serving one Integrated Care System and seven local authority areas. They talk us through how they use the Quality Framework to support their work.

Why is quality important to you? 

We believe that a visible commitment to quality shows that we are a well-governed organisation that operates with transparency. This increases our commissioner’s confidence in us. 

In 2018 we decided to apply for the Practical Quality Assurance System for Small Organisations (PQASSO) accreditations designed for small charities. We completed the assessment in 2019 and drafted an action plan to work on the identified improvements. 

Why did you decide to complete the Quality Framework?

Despite having just completed the PQASSO, we decided to undertake the Quality Framework because it was far better suited to our needs as it specifically related to Healthwatch. 

How did you carry out the assessment?

The project was led by our Chief Executive Officer, but all the staff helped complete the work. 

We identified a manager to lead for each of the six domains of the quality framework (Leadership and Decision-Making, People, Sustainability and Resilience, Collaboration, Engagement Involvement and Reach, and Influence and Impact.)

The domain lead would work through the questions within the Quality Framework and identify areas for improvement.  

The action plan that we had created for the PQASSO assessment was used and absorbed into our new action plan. 

The initial findings were presented to our Board, who checked that the improvement areas we had highlighted aligned with our strategic direction.

What benefits did you find? 

The benefits of using the Quality Framework can be split into three sections: 

1. People
2. Sustainability and resilience 
3. Engagement, involvement and reach

People

We prioritised gaining our “Investing in volunteers” accreditation. We reviewed our volunteering policy and processes to achieve this, and our existing volunteers helped us with this. 

We also reviewed the Human Resources systems we use to ensure all our records are GDPR compliant. 

Sustainability and Resilience

We developed a better understanding of the value of a business development strategy and put one together. We were also able to write a work plan to support this strategy. 

These written plans in place gave us better clarity of our business goals and offer and enabled us to introduce a project cost analysis review. 

Engagement, Involvement and Reach

The benefits include that we have been able to introduce a demographic analysis of our reach so that we can better target people we do not hear from. 

We have also been able to include engagement with young people in this year’s work programme as it was highlighted as an area we could improve in. To achieve this, we have recruited for a new role of Associate Director to help advise on youth engagement. 

What outcomes did you get from the Quality Framework? 

Many of the changes we have implemented due to the Quality Framework have led to positive outcomes. 

Short term outcomes include:

• Increased volunteer confidence due to our “Investing in volunteers” accreditation.
• Better team working and improved project planning.
• Improved public understanding of our impact through better tracking and reporting. 

Longer-term outcomes include: 

• Increased voice for younger people across Cambridgeshire and Peterborough.
• We can better target who we can influence.
• Our understanding of resource allocation has been improved through the project management systems we now use. 
• We can better amplify the voices of people less often heard from as we enhance our understanding of our reach. 

How will you continue to check quality?

Areas that we are aware of that still need improvement have been included in our annual work programme to ensure we continue to improve. These include: 

• Delivery of our communications and engagement strategy
• Delivery of our business development strategy
• Targeted engagement with less heard from communities
• Embedding use of the Healthwatch England Impact Tracker

As part of our strategic review in 2022, we plan to gather stakeholder perceptions to get more information and insight into areas we can continue to improve. 

What are your overall views of the Quality Framework?

Completing the Quality Framework assessment was a very worthwhile investment of our time. We found it hugely beneficial in identifying areas for improvement. 

We found spreading the different areas of the Framework across the team helped break down the workload and keep it more manageable alongside the rest of our workload. 

The Quality Framework provided our Board and commissioners with the reassurance they wanted, and our quality action plan keeps them informed of our ongoing progress. 

Many of you have already used the Quality Framework with our support, working with staff and volunteers to review six key domains that apply to every local Healthwatch.

Healthwatch Haringey has worked with Healthwatch England on the development of the Quality Framework since the beginning. Here they share more about their approach and immediate and longer-term benefits.

What made you want to use the Quality Framework?

We have helped with the work to develop the Quality Framework from the start, so we were already aware of the benefits it could bring. 

We volunteered to be one of the early adopters of the Quality Framework for several reasons:

1. Contract renewal: Our contract was coming to an end, and we felt that the Quality Framework was an excellent way for us to assess our current performance and would help us to gather evidence of effectiveness and impact to inform upcoming contract negotiations. 
2. Continuous improvement: We wanted to pause and reflect on where we were and better understand where we needed to focus our efforts in the future to increase our effectiveness and strengthen our impact.
3. Board involvement: Our Board members had engaged with developing the Quality Framework and had found it helpful and wanted to continue their participation. We also saw this as an opportunity to get Board members re-energised about our work.
4. Benefits to host organisation: Healthwatch Haringey is one of a range of contracts delivered by Public Voice CIC. Board members and staff found the Quality Framework very useful for assessing the effectiveness and impact of our organisation. The parent company or host organisation can use the Quality Framework to evaluate their performance in addition to local Healthwatch. 

Who did you involve, and how long did it take? 

Investing the time and effort in fully completing the Quality Framework was essential to us as we knew it would help us reflect on what we did well and what we needed to improve and, in the longer term, enhance the effectiveness and impact of our work. 

The more time and effort you put in, the more you get out of the process, and the more valuable it is to your Healthwatch. 

Whilst completing the Quality Framework involves the whole team, we felt there needed to be one person leading and coordinating the process – someone who had a good overview of our full range and depth of work.

Our Research and Engagement Manager led the process, coordinated the whole team’s input, and completed the documentation. 

It took us three months to complete the Quality Framework from start to finish in and around our day-to-day work. As we were piloting the Quality Framework process for Healthwatch England, we set a strict deadline for completion. 

How did Healthwatch England support you during this process?

Our Regional Manager, Alvin Kinch, reviewed our Quality Framework submission and provided detailed feedback on how we could improve and strengthen it, sharing ideas and good practice from elsewhere, ensuring we got the most out of the process. 

What changes did you see? 

We set out three areas for improvement for the coming year, with a clear focus on what we would be doing differently to make these improvements happen. From this process, we found several immediate and longer-term benefits. 

Immediate benefits

• Open and honest discussions with our Commissioner
  We used the insight gained from the process to inform our discussions with our Commissioner, highlighting our strengths and being open about areas for development and improvement plans. 
• Stability and security from new contract
  We were awarded the Healthwatch Haringey contract for a new three-year term, with a contract value almost the same as previous years, despite local authority budgets facing cuts. Our contract renewal for three more years gives us a level of security, knowing we have a stable and reliable income stream. 
• Improved teamwork 
  Working as a whole team and collectively reviewing our strengths and weaknesses helped build team relationships, improve communication, and boost team morale. Staff valued taking time out from their daily tasks to pause, reflect and take stock. We now meet monthly to ensure that we have a clear overview of our work, allowing everyone to help shape priorities and work plans for the coming year. 
• Re-engaging our Board
  Our board members are responsible for delivering a broad portfolio of contracts, not just Healthwatch Haringey. Going through the Quality Framework process helped us re-engage board members in our work and helped shape our plans for the coming year. 
• Strengthening our annual report
  The Quality Framework made us focus on the impact of our work. This provided a wealth of information that we could use in our Annual Report highlighting changes and improvements we had helped to deliver to our community. 

Benefits one year on:

One year after completing the Quality Framework, we met with our Healthwatch England Regional Manager to see what impact this had made. We found that we had: 

• Improved how we work with our neighbouring Healthwatch 
  Monthly meetings with the five local Healthwatch in North Central London have been invaluable in improving communication, identifying common themes and challenges, learning from each other and increasing our impact. We’re now working on our first joint project together. 
• Improved how we work with Healthwatch England
  More of our staff are attending events and training put on by Healthwatch England. We’re also engaging more on joint work with Healthwatch England and have learnt a lot through doing this.  
• Renewed our energy and focus on reaching out to our diverse communities
  We’ve focused on building longer-term relationships with more of the diverse communities in Haringey. Over the last year, we’ve developed excellent working relationships with our Turkish and Kurdish communities. We’re now looking at ways we can create similar relationships with Black African communities in Haringey.
• Moved to a more outcomes-based approach to better understand our influence and impact
  We now invest much more time and energy in follow-up after we’ve published a report. We make sure our work leads to tangible improvements and change based on what the public tells us. Through this focus on outcomes, it is much easier to assess and evidence the effectiveness of our work. 
• Improved how we communicate with partners, stakeholders and the public
  We have invested more staff time in Communications over the past year and have become much better at shouting about our successes and informing people of the difference we’re making. 
  
  We regularly update our website with what we’re working on and the outcomes of that work and send a monthly newsletter brimming with content that fully reflects the range and variety of our work. 

Interested?

Find out what the quality framework is and how you can get involved.

Find out more

Who is working together? 

Five local Healthwatch worked with West Yorkshire Health and Care Partnership their local ICS, including: 

• Healthwatch Bradford
• Healthwatch Calderdale
• Healthwatch Kirklees
• Healthwatch Leeds
• Healthwatch Wakefield

What's the population like? 

The ICS serves a population of 2.4 million people and covers a large geographical area with a mixture of rural and urban areas. Within this population, local Healthwatch serve a number of diverse communities.

How are they working together? 

Five local Healthwatch started working together as an informal network in 2018 and have an agreed Memorandum of Understanding (MoU) to determine how best to continue this partnership, when the ICS covered West Yorkshire and Harrogate. The MoU is:

• A commitment of the organisations not to bid for the same work to collaborate rather than compete.
• An emphasis on maintaining their independence.
• An agreement to share local intelligence monthly.
• An agreement to meet every six weeks to coordinate work.

Previously, the five local Healthwatch had a single representative at the Sustainability Transformation Partnership (STP); they have now adopted a distributed leadership team approach when working with the ICS

Their approach for working together is joint and transparent:

• When delivering commissioned projects, the project lead and activities are decided based on specialist skills, volunteers, and capacity. For example, Healthwatch Calderdale took the lead in developing the MoU.
• Support activities are also distributed. For example, Healthwatch Leeds coordinates the West Yorkshire and Harrogate activities such as arranging meetings and setting agendas.

As the involvement required by the ICS has grown, local Healthwatch have requested the ICS to provide a formal financial commitment including funding a role to coordinate Healthwatch work at an ICS level, which is being considered as part of the ICS operating model

What are the enablers of working together?

The local Healthwatch are well integrated within the ICS and place-based partnership level. Many local Healthwatch having long-established relationships and developed profiles of work with the community voluntary social enterprise sector.

Local Healthwatch have a specific role to play within the ICS: influence decision making by informing the ICS with local, place-based intelligence whilst maintaining objectivity.

The local Healthwatch have agreed on several objectives with the ICS, such as gathering information and public feedback on particular areas of interest, and this is reflected upon at the ICS Strategic System Oversight Assurance Group.

• The ICS has tasked the local Healthwatch to focus on health inequalities: to use their networks within diverse communities to engage a wider group of people, including those facing the greatest challenges to accessing health and care.
• The ICS has tasked the local Healthwatch with bringing effective challenge into the ICS, including monthly reports on the issues that matter most to local communities through the Strategic Oversight Assurance Group and West Yorkshire Programmes.

The local Healthwatch are integrated into various ICS workstreams, including the Unpaid Carers workstream, the Planned Care Alliance, and the Harnessing the Power of Communities workstream. They also work closely with the Communication and Engagement Lead at the ICS.

The local Healthwatch share roles participating in the ICS’ key forums, including:

• Healthwatch Wakefield is represented on the System Leadership Executive and the Partnership Board. 
• Healthwatch Leeds are part of the Strategic Oversight Assurance Group. They have a regular agenda item to inform the group of the views of local people.
• At a Place-based Partnership level Healthwatch Leeds lead the citywide work to work as one health and care listening team through the People’s Voices Group. This focuses on putting the voice of people experiencing inequalities at the centre of health and care decision making.
• Local Healthwatch also have representation and key input within their Placebased Partnership structures, including Health and Wellbeing Boards and Health and Care Chief Executive monthly meetings.

Working together to explore young people's use of A&E

The local Healthwatch have taken several key local issues to the ICS System Oversight and Assurance Group, including access to dental services, the impact of moving to digital, experiences of waiting for paused treatment and people’s experiences of joined-up health and care services, for example mental health and primary care.

In terms of commissioned work from the ICS, a current local Healthwatch project explores the use of accident and emergency (A&E) services by people aged 20 to 29. The ICS Urgent and Emergency Care workstream previously identified that this group of people had a high use of A&E services for non-urgent issues. The ICS asked local Healthwatch to gain insight from young people’s use of A&E.

This is a collaboration with each local Healthwatch undertaking engagement and partnership working with their local Trusts. The project is coordinated by Healthwatch Leeds, who are developing this with their young volunteers. Healthwatch Kirklees and Calderdale will then be bringing together the themes across the ICS areas using a specialist analytical tool for the final report.

The approach is working together, focusing on each other’s strengths and always recognising the principle of subsidiarity and that local places have individual experiences that need to be heard.

This case study was produced by the Strategy Unit for Healthwatch England.

Who is working together?

Eight local Healthwatch organisations in North East London are working together with the North East London Integrated Care System (ICS). These are:

•  Healthwatch Hackney 
• Healthwatch City of London
• Healthwatch Tower Hamlets
• Healthwatch Newham
• Healthwatch Waltham Forest
• Healthwatch Barking and Dagenham
• Healthwatch Havering
• Healthwatch Redbridge

Geographically, the ICS covers a large and complex patch. The inner-city boroughs are more ethnically diverse, have higher levels of deprivation and unemployment and higher density populations. Newham borough is the most diverse in the country and Hackney borough has a significant orthodox Jewish community. The outer city boroughs have older populations.

How are they working together?

• The ICS covers seven former Clinical Commissioning Groups (CCGs), which formally merged into one in April 2021. Prior to the development of the ICS, the eight local Healthwatch worked together within their own CCGs, attending the CCG board and the Patient Participation Groups.
• The developing ICS has provided a route for local Healthwatch to work together via an informal network with regular communication over email.
• Local Healthwatch have been working with the North East London People Engagement Working Group which is developing the strategic approach in advance of the ICS being established in April 2022. Representatives attend either the working group or related sub-groups.
• The ICS and all eight local Healthwatch now meet every two months. This regular meeting provides the ICS Chair, Chief Executive, the Communications and Engagement Lead and the local Healthwatch Leads with a forum for dialogue and a space to highlight local issues.
  • The ICS is co-producing six principles for engagement with partners including local Healthwatch. This incorporates the learning from the Co-production Charter which is currently used in City and Hackney.
  • Healthwatch are also supporting the development of the ICS engagement strategy. Healthwatch is viewed as best placed to champion patient voice for the ICS, to understand local issues and connect the ICS to local people and seldom heard groups.
• Local Healthwatch first worked together in response to a tender from the ICS to deliver community insights through a single database across the ICS, particularly in relation to COVID. The eight local Healthwatch combined their data, using a system already in use by some local Healthwatch to provide ICS level insight (see example below).
• Local Healthwatch have also organised themselves into three partnerships around the footprints of the Hospital Trusts so that they are better able to serve their local hospital or Trust:
  • Hackney and City of London for Homerton University Hospital NHS Foundation Trust.
  • Tower Hamlets, Newham and Waltham Forest for Barts Health NHS Trust.
  • Barking and Dagenham, Havering and Redbridge for Barking, Havering and Redbridge University Hospitals NHS Trust.
• Local Healthwatch are invited to the CCG Governing Body meeting and Primary Care Commissioning Committee. Currently local Healthwatch volunteer to join specific ICS boards based on interest and capacity, but this will be reviewed once the ICS finalises the design of their governance and decision making. There is expected to be further agreement of local Healthwatch participation arrangements in ICS governance, for example sub-committees such as ‘quality, safety and improvement’. Healthwatch are actively involved in and expected to have seats within local place/borough partnership boards.
• Healthwatch activities for the ICS are funded through the ICS engagement budget. Specific commissioned ICS projects are distributed amongst the local Healthwatch taking into account the nature of the work and individual Healthwatch priorities and skill sets.

What are the enablers of working together?

• The ICS held an early development session for all system partners including commissioners, providers, community and voluntary sector leads and local Healthwatch to set the ambition and the priorities for the ICS and strengthen relationships between partners.
• The ICS Chair is a strong advocate for Healthwatch and the voluntary and community sector, ensuring that these organisations have a voice within the ICS. In turn, local Healthwatch provide objective and independent data-informed evidence to the ICS.
• Healthwatch acts as ‘the golden thread’ across system partners, including the community and voluntary sector, providing community insights and sharing reports.
• A mutually beneficial relationship between the ICS Corporate Communications team and Healthwatch. For example, Healthwatch provides local intelligence for the ICS Corporate Communications team and the team support local Healthwatch with publicity strategies.
• There is diversity in Healthwatch senior leaders with respect to age, ethnicity background and interests. Regular structured meetings as well as ad hoc meetings ensure a good level of communication between Healthwatch leaders.
• Local Healthwatch are supportive of one another and willingly share data. They are also able to critically reflect on each other’s projects to make improvements.

Example of working together to deliver community insights

Led by Healthwatch Tower Hamlets and with Healthwatch England as a strategic partner, local Healthwatch in North East London are working collaboratively to produce a Community Insights Repository which collates feedback for providers from different sources, such as NHS Choices, Care Opinion, Google reviews, website feedback, surveys and complaints. The system, together with more detailed community insights projects, was funded in 2020 by the ICS for three years and is governed by a joint steering group of local Healthwatch, Healthwatch England and the ICS.

Healthwatch staff can use the Insight System to synthesise feedback on an issue of interest, providing a full picture of that feature of care across boroughs, services and providers in the ICS. Through this system, approximately 161,000 issues have been recorded based on feedback from almost 44,000 people, and 40 insight reports on areas of interest have been produced to date.

Data from the system also allows local Healthwatch to advocate for improvement efforts where it is most required. For example, using the Community Insights System, local Healthwatch identified residents with disabilities in North East London were the most challenged by poor health and care communication during the pandemic. As a result, Healthwatch were able to target research activity towards this population and produce a range of reports, including easy to understand infographic reports.

In addition, teams from across the ICS have made good use of the Community Insights System to further explore local views before commissioning services. For example, ahead of submitting the North East London Long Term Plan strategy, local Healthwatch were commissioned to host two focus groups and complete 250 questionnaires in each borough. They engaged with 2000 people face to face and 1275 patient surveys were completed. This insight was invaluable in the development of the strategy and directly influenced plans. To actively encourage partners to utilise the system, training sessions are being offered on a regular basis.

This case study was produced by the Strategy Unit for Healthwatch England.

Who is working together?

Six local Healthwatch organisations in South East London are working with Our Healthier South East London Integrated Care System (ICS), including:

• Healthwatch Greenwich
• Healthwatch Lewisham
• Healthwatch Southwark
• Healthwatch Lambeth
• Healthwatch Bexley
• Healthwatch Bromley

What's the population like?

The ICS serves a diverse population of approximately two million people with pockets of deprivation sitting side by side with significant pockets of wealth. Age profiles vary widely across the six boroughs - Bromley has the oldest population in London, and Lambeth and Southwark are the most diverse and youngest boroughs. In Greenwich, with a population of 280,000 people, 47.9% are from an ethnically diverse background with a seven-year range in life expectancy from poorest to wealthiest parts of the borough.

How are they working together?

• Six local Clinical Commissioning Groups (CCGs) formally merged in 2020. This provided the impetus for six local Healthwatch who were already working together to consider how best to organise their collective approach and relationship with the new South East London CCG.
• The six local Healthwatch are now represented by a single South East London Healthwatch Director, who has a dedicated leadership role in ensuring that patient voice across South East London is central to decision making within the ICS.
• The South East London CCG currently funds the director role. System partners are confident about continued funding of this role with the formation of the ICS Partnership.
• Local Healthwatch meet every two weeks with a set agenda, including developments within the ICS and other relevant committees shared by the South East London Healthwatch Director. This forum also provides an opportunity for local Healthwatch to feedback on significant concerns collectively.
• Communication and engagement specialists across local Healthwatch meet regularly with the South East London Healthwatch Director. The Director works with the ICS communications and engagement leads to contribute to developing an ICS engagement strategy.
• Local Healthwatch have a joint working agreement and pool resources for relevant projects. They have developed an approach to team working and allocate tasks based on the issue being addressed and area targeted. For example:
  • Southwark and Lambeth partner together to work on local initiatives which involve Guy's and St Thomas’ and King's hospitals.
  • Lewisham and Greenwich work together to support and progress improvements and developments at the Lewisham and Greenwich NHS Trust, for example policy and process on charges for patients not eligible to access free NHS services. o Lewisham have been active members of a GP task and finish group. This is helping to provide input from local users into fast-moving issues like the development of digital tools and proposed GP mergers. 
  • Greenwich took a key role on the mutual aid governance board during the COVID pandemic.

What are the enablers of working together?

• Local Healthwatch have prior experience of working in partnership at a place-based level with local providers, smaller provider collaboratives, and the previous South East London Sustainability and Transformation Partnership.
• The Healthwatch Director has previously worked as a Healthwatch Chief Executive and has a specific leadership and coordination role for local Healthwatch within the ICS.
• The Healthwatch Director is a member of various governance bodies in the CCG/ICS. This includes the Primary Care Commissioning Committee, the Engagement Assurance Committee, the Equality Committee, the Equalities Task Force (which was set up specifically to look at vaccine distribution and COVID inequalities, and is expanding its remit), the Quality and Safety Subcommittee, the Data Usage Committee, the Information Governance Steering Group of the ICS, and the South London COVID-19 Preventing Mental Ill-Health Taskforce.
• Local Healthwatch perceive their work with the ICS to be an extension of their statutory duties. Joint reports are shared and published on all six local Healthwatch websites.
• Following the local Healthwatch joint working protocol, the Healthwatch Director delivers a progress update to the six local Healthwatch and the ICS. This reports activity against the domains set out in the Quality Framework but also captures impact, for example, where the ICS has accepted evidence or recommendations presented by the Healthwatch and agreed an action plan. This means it can be followed up to ensure the ICS is responding appropriately to feedback from users.

Working together to improve access to GP services

Local Healthwatch are working collaboratively, with support from the ICS, to assess access to GP services in South East London. The purpose of this work is to help the ICS dig beneath the surface satisfaction figures provided by the annual GP Patient Survey, and to properly contextualise the current media stories around problems with access to primary care. This means the ICS has an accurate local picture of current experience and an understanding of why people are having these problems.

To provide this insight, each of the six local Healthwatch is responsible for assessing (with agreed parameters) the quality of information regarding access on GP websites. A website audit tool has been developed and shared across the six boroughs to support this task. In addition. each Healthwatch is tailoring a base survey, that was developed in collaboration, to collect people’s experience of accessing GP services. For example, Lambeth is gathering insight at GP practices; Bexley and Southwark are carrying out qualitative research, in addition to the survey; and Lewisham, Bexley and Bromley have added questions to their survey. To date 1,145 people have participated in the survey.

Developing and administering the survey in collaboration has reduced the administrative burden and allowed for the identification of cross cutting emergent themes that are common across the six boroughs. For example, a key theme that has emerged is that online triage and waiting for telephone calls from GPs causes patients to experience confusion and anxiety. The ICS has committed to using the findings from local Healthwatch to inform local plans to improve patient experience of accessing GP services.

This case study was produced by the Strategy Unit for Healthwatch England.

About

Healthwatch Week ran from 9-12 November 2021 and saw staff and volunteers join us online from across England. Find out the key takeaways from each day and access further resources to help you apply what we learned. 

• Day one
• Day two
• Day three
• Day four

Day one

A message from NHS England

The conference got going with a welcome message from NHS England Chief Executive Amanda Pritchard. Amanda spoke about how much the NHS appreciates the work you do to make care better and the vital role Healthwatch can play in helping to overcome the challenges that health and social care services face. 

Our Chair, Sir Robert Francis QC, then talked about how far we had come, with more than two million people supported to share their experience or get advice last year. However, he warned delegates that we still faced challenges that we must overcome to remain relevant. 

Takeaways from other sessions

Putting our values into practice

Most staff believe our brand is critical to our work but do deliver a strong brand we need to embed our values in our work. Tips include:

• Have clear objectives and follow up on work to understand your impact so we can demonstrate our value of 'acting'.
• Train staff to ensure our communications are accessible to help deliver our value of 'including'. 
• Adopt our new brand behaviours when they are launched. 

Healthwatch brand messaging guidance

Collecting demographic data

Lots of factors, like ethnicity and peoples income levels, can affect peoples care. Collecting demographic data is key to understanding the experiences of different sections of the community. When you live in areas that are not as diverse, this information is even more critical. Asking for demographic data is not always straightforward, but there is training to support you. Every little bit of information helps when collecting demographic data and even answering one question is better than answering none. 

How to collect and use demographic data

Using the quality framework

The Quality Framework self-assessment tool has helped many local Healthwatch understand work areas that might need improvement. Lessons from local Healthwatch who have been through the exercise includes the importance of harnessing the different perspectives of board members, staff and volunteers and prioritising actions over time to make them manageable. 

The Quality Framework: How can it help you?

Communicating the difference we make

People must understand the difference their views have made to local services. Tactics to achieve this goal include:

• Make time to track if changes have occurred and plan this into your work.
• Promoting the improvements that have been achieved rather than the tasks that got you there. 
• Describe what you have achieved engagingly and what would have happened if services had not acted on your evidence. 

Demonstrating impact – new resources

Key reflections

Ending the day, our former national director Imelda Redmond reflected on the unique role of Healthwatch.

Day two

Holding services to account

Day two kicked off with a debate about one of our important roles - holding care services to account. Delegates agreed that this works best when we build constructive relationships with health and social care decision-makers, and we can influence decisions before they are made. Many of you think that carrying out this role will be challenging in the new health and care landscape, but we can if we continue building our skills, relationships and working together to be heard. 

Takeaways from other sessions

Making your communications accessible

Accessibility isn't a box-ticking exercise and should be an essential part of our everyday work. To make sure your communications are accessible, there are straightforward steps you can take, like using ALT tags. You can also avoid doing things, like using complex language, to ensure what you say is easy for people to understand. The brand language guide includes an accessibility checklist you can use.

How can we make our information as accessible as possible?

Using data to make a difference

Once you're collecting demographic data, analysing it to understand what it can tell you involves trial, error and exploration. Top tips include using statistical approaches like ratios and pivot tables to see what you uncover and using external data to make comparisons. 

How to collect and use demographic data

How volunteers can help tackle inequalities

In helping to tackle health inequalities, its important to have volunteers drawn from across the diverse communities we serve. Our volunteers can play an essential role by championing equality in our work, raising awareness of the different perspectives some groups have and helping to build relationships with their communities.

Guide to Volunteering

Day three

A message from Government

Minister of State for Health Mr Edward Argar MP welcomed delegates by speaking about our role in the future NHS landscape.

Takeaways from other sessions

Policy breakfast briefing: Social care

The public are unclear on the recent changes to social care and are increasingly concerned about issues like access, eligibility and how to pay for care. There are a lot of issues across the country at the moment with inconsistent care and financial assessments. This can lead to people giving up and not getting the care they need. We can help by focussing on clear advice and highlighting where local needs are not being met.

Advice and information: What is adult social care? 

Supporting volunteers in the new health and social care landscape

The role of volunteers within the new ICS landscape is unclear and only just over a third of delegates were confident that their ICS had volunteering on their agenda. Without a statutory requirement volunteer and patient involvement is likely to be inconsistent across the country. You can help by raising volunteering with your ICS and encouraging a discussion to find out what roles our volunteers can help with.  

Resources to support volunteering

Representation of people and communities through local Healthwatch 

Having a seat at the ICS table is important that Healthwatch demonstrate the value they bring. Bring able provide to provide evidence we collect at an ICS level and build trust through this valuable insight is key. Having Healthwatch representation will also give us the opportunity to hold systems to account for their decisions. Doing this is often a difficult task that uses a lot of resource, so it is important we come together, support and learn from each other. 

Watch the recording of this session on YouTube.

How are Healthwatch and ICS's working together?

Celebrating the difference we make

Day three also saw our annual network awards ceremony, celebrating the difference you've made over the last twelve months. 

Day four

The final day of the conference included a debate about our role in public health and an overview of net steps following Healthwatch Week.  

Takeaways from other sessions

Using our new Healthwatch brand

Consistently using the new Healthwatch tone of voice and personality takes practice but will help you grab people's attention, keep them interested and build trust. Tips to help you write like Healthwatch include:

• Speak to the reader
• Keep copy short, sharp and write in an active tone
• Use plain English and cut unnecessary information
• Write with specific personality points in mind

Brand messaging guidance

Turning evidence into change: Stakeholder influencing

Local Healthwatch are currently spending a lot of time influencing ICSs and it is not yet clear what the impact of this influencing is. However, we also sit on boards and committees such as Health and Wellbeing boards and this can lead to a lot of impact, helping to build relationships with local stakeholders and ensuring the Healthwatch voice is heard.

A guide to running Healthwatch

Working together: CQC, NICE and Healthwatch England

We are all aligned on our strategy to prioritise tackling health inequalities in our work. This gives us the opportunity to collaborate more, particularly in targeting seldom heard communities and making it as easy as possible for these communities to talk to us. Demonstrating the outcomes of our work will be key to demonstrating success in this new strategy – and all three organisations are looking at new ways of ‘closing the loop’ and showing people the impact their feedback has had.  

Watch the recording of this session on YouTube.

CQC and local Healthwatch working together

The Quality Framework is a self-assessment tool you can use to understand where your work is currently effective and where you can make improvements.

Many of you have already used the tool with our support, working with staff and volunteers to review six key domains that apply to every local Healthwatch.

We asked Healthwatch Northumberland to talk us through the process they followed and the learning they think you should know.

Why did you start, and how did you plan the work?

In March 2020, our board decided to complete framework, with the aim of having an action plan in place by the following March. The timescale felt feasible and would give us important insight to help us negotiate our contract renewal and develop our next year’s business plan.

We first thought we’d review all the domains simultaneously, with our staff, volunteers and contract holder.  But, in response to the COVID-19 pandemic, instead of holding one workshop, we had six online meetings to discuss each domain using the prompts provided by the framework. 

Each meeting involved a mix of our internal stakeholders and we enabled those less comfortable with online meetings or large groups to participate.

Who did you involve, and how did you gather your initial evidence?

The process was great because it gave us a chance to involve everyone.

However, to ensure volunteers and staff could fully contribute, we worked hard before the review sessions to make clear the purpose of the Quality Framework and how the assessment would work. This meant we focussed discussions on the review, not the process.

We invited everyone to at least one event, with a mix of staff, board members and volunteers represented. Attendees were allocated by availability or the knowledge they had of the area. Overall, 20 people took part.

It was important to think about people’s different needs. For example:

• For neurodivergent participants, make sure the meetings are not too long (1-1.5 hours),
• Use smaller groups so those who are less confident can take part.

Our chair led all the sessions and wrote up the notes. Our lead officer, who coordinated the project deliberately did not attend to enable the widest discussion.

Each session helped us gather evidence, highlighting examples of existing good work or our future aspirations. We also used the sessions to assess our current performance, giving each domain a red, amber or green (RAG) status. We also circulated the meeting notes so everyone could comment.

Following the meetings, the project coordinator and the chair also reviewed the notes and RAG status for accuracy, discussed the findings and identified themes, issues and any potentially contentious areas.

This review was critical, as it highlighted issues outside our remit or capacity or where work has taken place that the participants might now know about.

How did you build your broader evidence?

Our project coordinator then gathered the further evidence needed for each area of work and produced a summary.

An example of the evidence gathered for the people domain.

• Volunteer and staff role descriptions
• Induction plans and processes
• Code of conduct policy
• Overview of induction training
• Volunteer agreements
• Our strategic plan
• Equality and diversity policy

The project coordinator also drafted a Context and Environment Document by:

• Reviewing internal strategic planning documents, strategies, board reports and minutes, impact records and re-using relevant supporting information from evidence summaries.
• Reviewing external material and strategic documents such as local authority strategic plans, Joint Strategic Needs Assessment and Care Quality Commission reports.

The aim was to produce a ‘pen portrait’ of the context and environment we faced.

An example of the issues we looked at and the length of each section

• 149 words: Our local authority values Healthwatch, understands our role and is committed to at commissioner, officer and elected member levels
• 66 words: Robustness of local health and care services and system
• 1,491 words: Strength of local health and care stakeholder relationships
• 97 words: Local authority attitude to voluntary sector generally
• 61 words: Other local organisations doing engagement in health and care
• 162 words: Number of local providers and commissioners
• 180 words: Geographic and demographic challenges (e.g. levels of deprivation, poverty, health inequalities)
• 147 words: Local partners' attitude to involving people in their work
• 35 words: Value of our core contract and grant
• 44 words: Length of any contracts and grants
• 33 words: Number of full-time equivalent staff funded by your local authority core funding

How did you review the evidence and create your action plan?

We used our annual board planning day to review our evidence and to create an action plan. All our staff and volunteers were invited, as was our local authority.

We first started by looking at our review of the context and environment. We then broke into small groups to look at each domain and review and priories any proposed actions.

An example of how-to prioritise actions over three years:

Do First - things that are so important they need to be done in the first year if the action plan

Do Next - actions that would take longer and could wait for year two

Do Later – longer-term improvements in year three 

Do Not Do – things that are not achievable or are unnecessary

The day resulted in a list of actions, which we then developed into a plan, with information about who would deliver what and when.

Our Board then agreed the plan and asked for progress reports twice a year. We also communicated the plan to our staff and volunteers.

How much resource did the self-assessment take?

Over the five months we took, most of the costs related to the days spent on the project by our chair, project coordinator and volunteer officer.

A breakdown of time spent

• Preparation and briefings by lead officer - one day

• Preparation, review meetings and follow up by board, staff and volunteers - two days

• Review evidence, agree RAG rating, write action plan by lead officer, chair and staff - three days

• Support meeting with Healthwatch England by lead officer - two hours

Can you tell us more about any outcomes?

Since we agreed the plan, we’ve seen some real changes in different areas of work

Collaboration: We are working more closely with neighboring local Healthwatch, sharing resources, doing joint projects, and ensuring we have a strong collective voice in our Integrated Care System.

People: We have identified ways to have better induction for staff and volunteers. A new anonymous feedback survey also means we can monitor staff and volunteer satisfaction.

Engagement, involvement and reach:  We’ve done lots of work, using support from Healthwatch England to make equality, diversity and inclusion a driver of our public engagement work.

Any overall tips you would give to others?

The experience has been useful, good preparation for our contract retender and given us a better focus on key issues. Final overall reflections would include:

• Take a full-team approach
• It’s natural to worry about gaps you may find or feel guilty that you cannot address every issue.
• Encourage people to be challenging and pragmatic but not pedantic
• Build trust, be transparent and support people to take part to remain focussed
• Make use of the support from Healthwatch England.

During Healthwatch Week 

We’ve an exciting line up and some interesting sessions for us all to enjoy – but let’s get others involved too. 

Let’s use the opportunity to raise awareness of the Healthwatch brand across the country by: 

• Highlighting the difference your Healthwatch has made to people and services. #TB to our work on XXXX – hearing from XXX people about the changes they’d like to see. As a result @XXX have listened, acted, and improved care for people in XXX. #Healthwatch2021
• Encouraging people to share their experience and reminding them of the importance of doing so. Services can’t change unless we tell them how. Whether you’re unhappy with the care you've received or have an idea of how to improve care for others, we want to hear from you. It only takes five minutes in our online survey [link] #Healthwatch2021
• Promoting your current/upcoming projects and let people know how they can get involved. #DYK [include a stat]. We want to know how XXX are working for people in [location]. Retweet to help as many people as possible have the opportunity to complete our short online survey [link] #Healthwatch2021

Tips for tweets during your sessions on the day:

• Share what you’ve learnt – is there anything that you’re going to do differently in the future? Share on Twitter so that other services can take on board the idea too.
• Share the work of other Healthwatch – is there a piece of work that you can help bring into the spotlight and encourage others to look into?
• Share inspirational quotes – are there any useful pieces of advice from the keynote sessions that you can share with others? 

It's hard to believe Healthwatch has been in place since nearly a decade, and in Healthwatch Commissioners terms, I feel like a dinosaur as I have been here almost from the beginning!

Over the years, Healthwatch England has worked hard to provide leadership, guidance and support to local Healthwatch and commissioners alike.  This support felt much more visible at  the outset as we all beavered ahead in setting up the Healthwatch function in our respective areas, and over the years, there have been times when as a commissioner, I thought, ‘What is Healthwatch England doing now? What are they working on? What can we help with?’

At an event for Healthwatch Commissioners in July, we collectively agreed to work closer with Healthwatch England to help shape the support provided to local Healthwatch and Commissioners.

As part of this, we decided to set up a Commissioners Reference Group. With this group, we hope to work closely with Healthwatch England to shape and improve guidance and support to local authorities with our statutory duty to commission effective local Healthwatch.

At the event in July, we heard from Healthwatch England colleagues about the things they are currently prioritising, a key one relating to the changes in health structures and the implications this might have on local Healthwatch including:

• The role of local Healthwatch at ICS level
• What capacity and resource might be needed
• How we can capture good practice and highlight challenges to stakeholders and decision-makers.

They’re currently bringing this together into a toolkit, supported by webinars and training for local Healthwatch to help them to influence Integrated Care Systems and add the most value.

As a representative on this board, I’m hoping to support Healthwatch England with planning events, shaping policy, sharing commissioning practice and grappling with some old age conundrums such as ‘demonstrating impact’ and looking at whole structures, systems and processes through an equality, diversity and inclusion lens.

Another important aspect for me will be the responsibility of being an effective ‘representative’.  How other representatives and I bring in the broader perspectives of commissioners and how we ensure we keep them up to speed with some of the key things happening is central to making this work.

We all know how important it is to collaborate, and this Reference Group brings enormous potential. Having a way for us to share what we’re working on, learn from one another and work together on live issues will make a big difference and add strength to the network.

We’re all working to that same end goal; we all have a vested interest in Healthwatch and ensuring everyone gets the health and care they need.

So I want to end by letting you know how I’m feeling right now… I’m feeling hopeful that by working better together we can have a greater impact at a time when it is possibly needed more than ever!

To support data sharing on a regional and national level, we need to make sure the information we collect is consistent with each other and key stakeholders.

You can find out more about our progress on digital transformation and the need for us to have a more significant focus on data standards in our blog.

We know through our conversations with the network, that there is more work to be done to:

• Produce a more standardised way to collect data across Healthwatch so that we can strengthen our collective insight. More similar data sets will be critical as Integrated Care Systems (ICS) moves to a statutory footing, helping to allow for easier comparisons.
• Understand the systems that are in use to collect and store data within the network so that we can build on what's working well.
• Know the barriers to data sharing and help overcome these.

So, what are we doing about it?

To start, we’re going to be contacting a sample of local Healthwatch who do not currently use the CiviCRM to ask a series of questions about your current approach to digital and data sharing.

Having already done this for 12 Healthwatch this approach has shown to be hugely insightful and has shaped our work and plans moving forward.

What will we do with the findings?

Create a standard taxonomy to help with data sharing

We will be revisiting our 'minimum viable taxonomy' in light of the information we've received from local Healthwatch about how data is categorised. Our aim is to help standardise the information while retaining a degree of flexibility at local levels.

We then will look at a solution to aid sharing data in the most straightforward and least resource-intensive way possible back with Healthwatch England to host in one place. It will enable data to be brought together for conclusions on a local, regional and national level.

We want to reassure you that we are currently working with a data consultant to ensure we operate to the highest level of data standards. Data sharing between local Healthwatch as well as with Healthwatch England is part of this work.

Use the insight to aid our decision around supporting the CiviCRM

At the moment, we've committed to supporting the CiviCRM until March 2023. We know that for some local Healthwatch the CiviCRM is not easy to use, and reporting can be complicated. However, before we can decide to move away from the system, we need to understand:

1. Alternative systems that work well within the network so that we can fully assess other viable options
2. The core business needs that an alternative system will need to provide
3. How data will be shared with Healthwatch England if we did not have the CiviCRM

How can I help?

We will try to contact as many of the local Healthwatch who do not currently use the CiviCRM as we can from the end of October.

If you’re contacted, we will be asking you for a couple of hours of your time to demonstrate the systems you use, and ask some additional questions. We will also talk you through our plans in a little more detail with the opportunity to ask questions.

If you haven't been approached by Friday 19 November but would like to participate, please email digital@healthwatch.co.uk.

For those who use the CiviCRM, we will be looking to speak with you in 2022.