Health Service Focus

Listen and learn

The CQC has been determined to listen to the public and NHS staff more, and to ensure their experiences and views inform its inspection reports. NHE spoke to CQC director of engagement Chris Day.

The Care Quality Commission (CQC) has been running ‘listening events’ ahead of its formal inspections for nearly a year, all over England – from Sunderland to Bristol and from Eastbourne to Preston.

Since mid-September 2013, there have been 102 of these events, which came off the back of a strong desire by the health and care regulator to move beyond the formal data and into personal experience and perception.

Chris Day has been director of engagement since the events started (he was previously head of CQC communications for four years).

He told us: “In the past, CQC focused a lot of its inspection work and what we look for on ‘hard intelligence’ – on death notifications, mortality outliers and so on.

“But actually that only answers part of the question about how an organisation is doing. To drive a real granular understanding of how an organisation was working, and what was going well and why and what wasn’t, we wanted to engage more with staff and the public. We wanted a really open and genuine conversation, before we inspected an organisation.”

The CQC holds separate events for staff and for the general public, seeking a “quantifiable sense” of what the issues might be in an organisation before the inspectors go in.

Listening events have sometimes been bespoke events, sometimes involved CQC people pitching up at community events (which it wants to do more of), and also involved online discussions and information-trawls. It plans to do more of this, too, partnering with groups like Mumsnet and Age UK to get specific people’s experiences of a service.

Day said: “It all means that when we go into an organisation, we’ve got a picture of what the public perceive is working well and where the issues might be. There’s a direct correlation between that information and what we eventually look for and find in our inspections. It’s trying to drive change and improvement, and to do that, you’ve got to have a really good understanding of where the issues are. We found that the public engagement piece gives a different dimension to it.

“Often the numbers take you to the ‘what’, the conversations take you to the ‘why’. That’s the real difference.”

The inspection reports have a section explaining what was heard from staff and the public.

Executives and staff at the organisations take this highly-visible feedback seriously, but because it’s primarily about perception and experience, it’s very hard to argue with or dispute.

Clearly some people have specific grievances that might be part of a separate process, both staff and public, but the listening events are about getting the wider experiences too, good as well as bad. Some people have issues stretching back years, but Day said the CQC is most concerned with care as it is now, not as it might once have been.

He said: “You’d always get the people who have an axe to grind, and that could be all you’d hear – but we’ve found that by advertising the events appropriately, and by getting the right local channels, we can get more of the right information.”

NHE suggested that such listening events are a good thing in their own right, as well as useful for service improvement.

Day said: “Yes, but there’s a ‘contract’ that comes with that: ‘I tell you what I know, you need to do something about it’. Part of what we’re doing is recognising it in the report, but also that the report will have some solid actions that we want the organisation to do, and we’ll be back to check up on them.

“It’s important we actively listen and record what we find out, but also that we use those conversations to drive real change in the organisation and hold it to account. We’re not responsible for them making the change, but we are for coming back to ensure it’s clear that we absolutely won’t tolerate inaction.”

NHE will continue to report on the results of specific listening events via our coverage of CQC inspection reports.

Upcoming listening events

• Kettering General Hospital NHS Foundation Trust (2 September 2014)

• Hinchingbrooke Health Care NHS Trust (16 September 2014)

• Sunderland GPs and City Hospitals Sunderland NHS Foundation Trust

   (16 September 2014)

• The Hillingdon Hospitals NHS Foundation Trust (30 September 2014)

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