Your story: How the quality framework helped us

The Quality Framework tool helps you work out the strengths and weaknesses of your service. Healthwatch Northumberland walk us through how they used it and the lessons they learned.

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.

What are the six domains the framework looks at?

  1. Leadership and decision-making
  2. People
  3. Sustainability and resilience
  4. Collaboration
  5. Engagement, involvement and reach
  6. Influence and impact.

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.


When determining the timescale, ask yourself:

  • Should we look at all domains at once or prioritise them?
  • What’s our workload, and how much capacity do we have?
  • When do we need the results?

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.


  • Make sure people understand the purpose and process before you meet
  • Ensure you have considered the skills and knowledge of participants, as well as their accessibility needs
  • Provide leadership, be transparent and inclusive and ensure you have enough resources to do the work
  • Review the output for accuracy.

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


  • Collating evidence took two-three hours for each domain
  • The quality framework provides a template spreadsheet
  • You can use the same evidence across different domains
  • Label evidence so you know what it is and which domain it relates to (For example, use the domain number e.g. D1.XXXX)

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.

Learning at this stage

  • Focus on the most important actions and phase delivery to avoid overextending yourself
  • Brief people so they understand the background and how to use the prioritisation tools
  • Use the action plan template provided but also think about how you will make your final product accessible in terms of language and format.
  • Plan how you will monitor and communicate progress in meaningful but proportionate way, avoiding overusing resources.

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.


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

Find out more