We need to demonstrate diversity and inclusion in all of our work. To understand different approaches, we funded two local Healthwatch to work closely with others across the network, share their model and provide support to help their colleagues replicate or adapt those successful methods.   

In this article, we'll tell you about Healthwatch Essex's Learning Disability Ambassador scheme, the 2021 pilot where other local Healthwatch got together to discuss the approach and how you can do the same in your own Healthwatch.  

About the Learning Disability Ambassador Scheme 

Working with their local hospital, Healthwatch Essex recruited and trained 14 volunteers with learning disabilities to undertake visits to the hospital and identify improvements. This includes reviewing signage, accessible information, and the language used. 

Ambassadors also met with Healthwatch Essex staff and the hospital's patient experience manager to discuss issues affecting them and others in their network and attend focus groups and steering group meetings. They contributed to case studies and social media campaigns led by Dan Potts, Healthwatch Essex engagement manager, to showcase the difference they are making.

We spoke to Dan, and he shared his top tips for involving volunteers with learning disabilities.  

Map your stakeholders first  

These might include charity organisations, hospitals, local councils, health care professionals or other agencies working in a similar field. 

Use your stakeholders to help with recruitment

Recruitment is easier once you have a stakeholder map. Make a flyer or leaflet to share virtually and face to face in shops and community settings. During your recruitment, include an informal interview face to face or online to enable you to understand the needs of the individual and what you can do for them during their role. 

Keep recruitment simple and accessible

Include an informal interview face to face or online to understand the needs of the individual and what you can do for them during their role. Remember, it is not always about what the volunteer can do to help your organisation but more about how you can add value to their future.  

Make sure you have everything you need in Easy Read  

Ensuring information is accessible is vital to including disabled people in our work, but it also benefits everyone. You should make sure your crucial volunteer documents are available in Easy Read.  

If you want to create Easy Read documents:  

• Limit text – keep it very simple and don’t use any jargon.  

• Use clear images – either illustrations or pictures of real people, objects and places.  

• Do not overthink it – if you are asking for someone’s address, you do not always have to use a postcode symbol.  

• Attend a training course (Healthwatch England provides these) or find a local provider to help you produce Easy Read formats.  

Our Easy Read role description, application form, volunteer agreement, declaration of interest and volunteer handbook are all available below as downloads which you are welcome to use.  

Work as a team and be patient

Co-production works best when people with lived experience form a working group alongside health and care professionals to influence how services are designed, commissioned and delivered. Make sure you manage your volunteers’ experience. These are huge organisations, and it can take time and a lot of patience to influence and change services.  

Get your engagement method right 

Remember that all voices should be heard and that each project may need a different approach. It may be a survey, focus group, one-to-one conversations or social media campaign but remember to be flexible in meeting the needs of your volunteers.   

Carry out volunteer well-being checks  

The well-being of your volunteers is so important. Check-ins are a great way to keep up to date with how they are feeling and give them time and space to share any concerns they may have. These can be by phone or face-to-face. Remember, well-being checks are not always about mental health and well-being. It could be something they have seen or witnessed that they feel they need to bring up with you, or it could be that they are struggling with their physical health and need to take some time off. This will help you support and retain your volunteers.  

We asked Dan for his reflections on a small group of local Healthwatch coming together to discuss his approach and what they all learned. 

• Being able to share good practice between local Healthwatch was brilliant as everyone is so different, and you can learn from each other. 

• There was a high level of engagement and sharing from the group, and everyone was committed, which made it easy to facilitate. 

• Everyone appreciated the supporting resources and documents, particularly the Easy Read forms, role descriptions and handbook.  

• Six Healthwatch had made progress which they were happy to give updates on in the second session. 

What have local Healthwatch done as a result? 

• Recruited learning disability ambassadors. 

• Ran a learning disability steering group meeting. 

• Worked on digital transformation and addressed learning disability access to Zoom and Teams.

• Set up a learning disability health check programme.

About this guide

This guide is an introduction to qualitative research. It includes:

• What qualitative research is. 
• Different types of qualitative research you can use.
• How to develop a discussion guide.
• Things to consider when carrying out interviews and group discussions. 
• Example discussion guides. 

What is community research? 

Community research involves working with communities - speaking to people, identifying key issues, and seeing where change or practical solutions can be achieved. 

The research is action-focused and participatory, meaning communities are at the heart of this approach from beginning to end. 

Working this way means local Healthwatch can bring resources, time, and effort to support, listen, and build skills.  It can help communities to bring their views and voice to the fore and explain what health and social care issues are important to them. 

Together, we can work creatively - building skills with individual community researchers or supporting community groups to do their own research. 

Community research is important because it is: 

• Community-led throughout and focused on issues of concern 

• Action focused – achieving results for the community themselves 

• Reaches people whose voices are underrepresented 

• Builds confidence and recognises skills, knowledge and expertise in communities

• Reimburses community members for their time and input 

• Can start to address inequalities in access and resource 

• About the process as well as the result 

• Moves away from extractive research approaches 

• Supporting communities is a continuous ongoing dialogue: it can influence health and care providers to build responsive and culturally appropriate  services for underrepresented communities, based on equity, trust and access.

How do we do it? 

Healthwatch works with communities in many ways. Through open discussions we can support communities to identify how best to raise what is important to them in health and care and to get their voices heard. This two-way process takes time to build relationships, trust and dialogue. It is not a shortcut approach. 

In 2021 Healthwatch Oxfordshire supported two community researchers under a Community Participatory Action Research (CPAR) programme. This support was initiated and funded by Health Education England South-East and developed in collaboration with the Office for Health Improvement and Disparities, the Scottish Community Development Centre and NHS England and Improvement.

Healthwatch Oxfordshire developed two models of community research

Model one: Supporting community action researchers on their chosen topic 

People from a community who want to focus on an issue of importance to them can work with Healthwatch as community researchers. We support them in highlighting the important concerns in their community. We are alongside them to provide support, build skills, help research planning, and provide resources for this to happen. We help the researchers and communities to share what they have heard directly with the health and care system. 

In this model, the community chooses the issue, the research methods, and how the research will be used. This process takes time and strongly focuses on participation and change, identifying areas for practical action.  

Model two: Working with community researchers on specific issues 

In this model, Healthwatch can work with community researchers on a specific piece of research. The focus topic is defined up front, either from the community or in response to pressing issues or themes.  

This is a shorter-term commitment and focuses on enabling voices to be heard by the health and care system. We provide support and training to community members to build research skills and highlight areas for change to decision-makers.  

Whilst the community researcher builds skills, there is less focus on wider community participation within the research process. 

Step-by-step guide.  

NB flexibility and adaptation are required! 

Action research cycle through five steps – Plan, Observe, Act, Disseminate, Reflect. 

Step one: Plan  

Lay foundations (Healthwatch led): 

• Set up internal Healthwatch procedures first 

• Establish scope, timeline and budget for the project 

• Agree on reimbursement process for community members' time in group sessions, including transparency around responsibility for tax/benefits declarations etc.  

• Provide equipment and staff support as needed  

• Provide dedicated staff time for support and mentoring 

• Recruit community researchers via local links (E.g. from a community of interest, place, culture)  

• Provide training, induction, mentoring and support for community researchers  

Community plan (community researcher-led) 

• Support researchers to identify the community of focus  

• Support researchers to identify project theme/problem/question/issue in collaboration with the community 

• Build bridges and dialogue between researchers, community and local health and care services 

Step two: Observe (community researcher-led) 

• Develop research methods, approach and plan with the community 

• Promote any events through community networks and social media 

• Gather information, listen and involve communities – make sure research is inclusive, culturally appropriate and accessible and remove barriers to participation 

• Use creative methods to reach people and hear their voice  

• Focus on process, challenges and solutions 

Step three: Act (community researcher-led) 

• Based on what you hear, decide the way forward and identify action points 

• With the community, determine what practical changes are needed; where, how and by whom? 

• Decide on how you will tell the story. 

Step four: Disseminate (Healthwatch with researcher and community) 

• Help community researchers and community members share insights and lessons, e.g. to health and care providers, Health and Wellbeing Board  

• Facilitate round table discussions, community events etc. 

• Make sure health and care providers report back to the community and highlight what has happened as a result. 

Step five: Reflect 

• Change may not be immediate and make take years. Follow impact over time  

• Keep the community updated about progress and changes  

• Keep learning and developing with communities’ input: use lessons to inform the improvement of this approach for

Community action research is part of a family of participatory approaches, e.g. Community Participatory Action Research (CPAR), Action Research, and Community-led research. To learn more:  

Resources and helpful guides: 

Healthwatch Oxfordshire's community researchers explainer film

Scottish Community Development Association

Centric community research hub

Literature review community research

Healthwatch Oxfordshire are happy to share insights into their experience working with community researchers. Please get in touch with them by email at hello@healthwatchoxfordshire.co.uk or calling 01865 520520. You can see examples of this work on their website.  

Costs (based on model one, up to nine months)

• Training (three days @ £11/hour): £231
• Research (100 hours @ £11/hour): £1,100
• Support (10 hours @ £11/hour): £110
• Presentations (10 hours @ £11/hour): £110
• Phone: Nine months @ £15/month: £135
• Travel: Reimbursement/mileage @45p/mile: £100
• Events: 2 @ £200: £400

Total/community researcher: £2,065

Community research is: 

• A process as much as an outcome 

• Time-consuming 

• It takes commitment, skill, risk and an iterative learning approach 

• Rewarding for both community and Healthwatch 

• Highlights issues, perspectives and concerns of seldom heard communities on their own terms and led by them 

• Action-based and focused on change 

• A way of working with communities based on respect, partnership and value 

What community research is not:

• A quick fix 
• Easy 
• Tokenistic
•  A clear-cut ‘toolkit’ approach 
• A guaranteed product, outcome or ‘success’ 
• Without risk 
• Appropriate in all circumstances

What are the challenges?

• Doesn’t stick to ‘office hours’ -challenges boundaries  

• Researchers vary in skills and confidence and may need different levels of support 

• Researchers and community members have busy lives, often juggling jobs and family, so they have little time 

• Needs ongoing problem solving, e.g. challenges with boundaries, GDPR and confidentiality 

• May not be free of community ‘politics’ 

• Needs understanding how to support beyond the research to protect/ navigate researcher and community in dialogue with health and care system and subsequent demands 

• Organisational and service change is slow and takes time, leaving communities frustrated. Make sure to focus on real changes that people can see 

Updated Framework

We have refreshed the domains of the Quality Framework and added in more detail covering equality, diversity and inclusion along with more information on working with Integrated Care Systems. 

The new Framework is available to complete via Smart Survey, to make it quicker and easier for you to complete.  

How it can help?

• Understand where your work is currently effective and where you can make improvements
• Informs local authorities on how to commission and monitor an effective Healthwatch
• Enables Healthwatch England to identify where further help is needed by individual Healthwatch and how we can improve the support and training we provide.

Quality Framework domains

1. Leadership and Decision Making: This looks at the importance of having clear goals and a rationale for your work. It also looks at the strength of your leadership and governance, both of which are key to successfully navigating a complex environment whilst maintaining independence and accountability.
2. People:  This recognises the importance of staff and volunteers. It can help you understand whether your board, staff and volunteers have the right knowledge, skills and support to deliver an effective, consistent service.
3. Sustainability and Resilience: This focuses on a business model that enables you to plan and operate effectively, as well as adapting to the changing needs of communities.
4. Collaboration: This recognises the value of working in partnership, and of learning from other Healthwatch.
5. Engagement, Involvement and Reach: This focuses on our main statutory activities. It looks at how you go about reaching out to all sections of your community, gathering people’s views, providing advice and information, and involving people in your work.
6. Influence and Impact: This focuses on our purpose by looking at the difference you make by ensuring those in charge of health and care services hear and act on people's views. 

Using the Quality Framework

Why not sign up to use the Quality Framework? If you get involved, we will offer you 1-2-1 support and talk through any guidance or training needs you have as a result of completing the Framework.

If you have already started working through the previous Excel spreadsheet, we will continue to offer you support to complete the Framework this way, however we recommend people starting out use the simplified Smart Survey version. 

Please get in touch with Delana Lawson if you are interested in learning more.

The five-year forward plan will be reviewed and revised annually and reflect joint strategic needs assessments and local health and wellbeing strategies. 

We have produced a series of briefings on some of the issues we’ve heard about most.

Integrated care strategies provide an excellent opportunity to fulfill one of Healthwatch’s core functions to make “reports and recommendations about how local care services could or ought to be improved.”

What has changed?

Although the creation of integrated care systems (ICSs) through the Health and Care Act has often been presented as a significant change, in reality – for many local Healthwatch – the main difference will be the scale at which they need to consider the plans.

Healthwatch has considerable experience in influencing the development of plans at the local authority and clinical commissioning group levels so that you will use the same techniques but in a more complex landscape.

How to use these briefings?

We have selected some of the issues that you may want to raise for inclusion in your integrated care strategy, identifying some of the tools that you may be able to use:

• Accessible Information Standard
• Elective care
• Maternity and maternal mental health
• Mental Health
• Primary Care 

It will be easier to influence if there is common ground between what the ICP is looking at and what you are trying to achieve. If the system already recognises that an issue needs to be a priority, you can present your case to help the ICP to decide how best to tackle the problem rather than as an additional burden.

The approach we have taken is to consider what may be necessary for the ICP to consider, including at the national, regional and local levels. If you can use the same evidence to back up your case, you can maximise that common ground and be seen as supporting the ICP in achieving its goal.

The NHS Long Term Plan is still an important document, even if we don’t hear about it as much as we did. NHS England will be producing a refreshed version of the plan later in the year, but in the meantime, it is still worth bearing in mind the expectations in the current plan. 

The briefings are a good starting place, with ICPs looking at national priorities and targets – and considering the implications for their area. 

National and local performance data will help you decide whether your area is doing better or worse (or just average) and whether you can use that as a lever to get an issue on the agenda.

We’ve also looked at progress, generally at a national level. The ICP will likely look at progress locally to see how it compares with the national picture.

There is a risk that integrated care strategies focus too much on numbers. So we’d recommend using your insight into people’s experiences to enable the ICP to consider the full potential of what it is proposing. Other partners may also have helpful insight, particularly about marginalised communities, so consider getting the broadest range possible. 

About this course

This course will give you an understanding of using Smart Survey analysis tools:

• An overview of Smart Survey
• Understanding its functions to analyse your data
• Interpreting the data you collect

It will take you about an hour to an hour and a half to complete this course if you decide to do it in one go, which we do recommend for the best learner experience. However, you can pause and return to it later if you need to. 

You will be able to download a certificate once you have successfully completed the course.

Who is this course for?

This course is designed for staff with some existing analysis skills who want to use Smart Survey to collect and interpret survey data. 

What will you learn?

This course will help you to understand: 

• How you can use Smart Survey in your research  
• How you can use the various functions and analysis tools in Smart Survey to help you in your work 
• How you can analyse both text and numerical data in Smart  Survey 
• How you can produce reports that display results from a sub-group of your survey respondents  
• How you can create and customise charts to visually represent your data   
• How are tools in Smart Survey different from the traditional methods of analysing data, such as in Microsoft Excel 

What is the Theory of Change?

There are many tools for understanding how organisations make a difference. One widely used by the non-profit sector is called ‘Theory of Change’. 

Your Theory of Change for an individual project or area of work describes a sequence of events or outcomes that you expect to lead to your desired long-term outcomes.

Producing a Theory of Change before starting a new piece of work can help you consider how likely you are to achieve positive changes. It can help you identify anything you might do differently to maximise the likelihood of success and make the best use of your resources. 

Usually, a Theory of Change is produced at a very early stage of planning a piece of work; before the more detailed project plan. 

We regularly provide workshops about using a Theory of Change approach. We can consider providing an online session for your team. Contact jon.turner@healthwatch.co.uk for more information. 

Template to create your own 

Based on a model provided by Healthwatch Islington, we’ve developed a template that you can use to produce your own Theory of Change in an easy format. 

It’s best used after you have attended a workshop. However, the template now includes instructions to remind you about each of the stages. It can help you to understand the process even if you haven't yet been to a workshop. 

The template uses Microsoft Excel. To view and use it properly, you will need to open it using a desktop version of Excel rather than an online or Office 365 version. 

After you’ve opened the document, go first to the tab that says ‘Overall Summary – read first.’ 

What is a taxonomy?

The taxonomy are the fields of data you collect in your feedback from the public. They consist of two main types:

• The key fields we want you to share with us
• Other optional fields, including a wider selection of demographics

Why is this taxonomy important? 

This new taxonomy has been built based on you feedback as we want it to meet your needs as well as ours. 

Ensuring that your taxonomy meets ours is essential for you to be able to meet the legal requirement to share your data with us. 

Find out whether you need to make any changes to your existing taxonomy with our simple guide that clearly sets out the fields you need to be collecting. 

About this guidance

This guidance is for new users of Smart Survey - a standard survey, questionnaire and feedback tool. In this guide we cover:

• Creating surveys
• Adding and editing questions
• Controlling responses
• Distributing your survey
• Viewing and analysing submitted feedback

Got a question?

Please email digital@healthwatch.co.uk for further information or questions.

You can also take a look at Smart Survey's own guidance and resources.

Sign-up to Smart Survey

We're offering every local Healthwatch a licence for SmartSurvey for one year. It will cost you absolutely nothing and will give you access to survey templates, data analysis tools, and the ability to collaborate with other local Healthwatch and Healthwatch England. 

Find out more

About

The agreement is designed for working together in an Integrated Care System but can be adapted for local Healthwatch working together on other issues.

How to use this template

You should customise the template to meet the needs of your group of local Healthwatch who are working in partnership.  To do this, you’ll need to refer to the ICS collaboration toolkit and the data protection guidance. 

You’ll need to consider the following: 

• Whether a lead organisation is necessary: this might be needed if funding comes from the ICS for projects. 
• Who is going to deal with safeguarding issues that arise, particularly from joint research or engagement projects?
• Who is going to be responsible for dealing with any data subject access requests for jointly gathered data?
• Who will be responsible for taking action on any data breaches for jointly gathered data?

• How long will the data sharing agreement will run for? You may need to take into account the length of Healthwatch contracts to do this. 

Where part of the template is highlighted in yellow, you will need to customise the content to the needs of your group of Healthwatch.

Other actions

Do a data protection impact assessment

Each local Healthwatch will need to undertake a Data Protection Impact Assessment for sharing data across an ICS area to consider the impact of doing so, and what mitigations might need to be taken. 

Read the guidance

Update your online privacy notice

Your online privacy notice needs to be updated to include the fact that you’ll be sharing data with other local Healthwatch, what data you are sharing and with which local Healthwatch. You’ll also need to ensure that you include information on data retention periods for shared data and data gathered in joint projects. Our privacy notice template contains a relevant section for you to include.

Download the template