Quality Checkers are experts by experience; they visit the places where services are delivered, and report on user experience in these places. Quality Checkers are themselves adults with learning disabilities who receive support to help them live independently; they audit services provided to support independent living amongst adults with learning disabilities – so they really are experts by experience.
Apart from government exhortation, just how important is it to understand the user experience?
Statutory commissioners, by which I mean local authorities, buy a range of different services to best meet the needs of adults with learning disabilities. They have to balance the amount they spend on adults with learning disabilities with the requirements of all the other groups of people needing support.
The challenge is to deliver the best combination of care for the people who need it, within the resources available. Commissioners (the people who buy the services) who have a lot of experience know that happy people often indicate good quality care. The difficulty is, that with the range of services needed, you can’t always justify something as intangible as “user happiness” when making a decision to buy from this care provider vs that one.
The Care Quality Commission (CQC) has established minimum standards. This means that supported living environments, or support in people's own homes isn't actually dangerous. There are the appropriate fire exits, cleanliness, staff skills mix etc. This is regularly inspected, and enforced. But it doesn't tell us how happy the people are, or whether they feel respected.
In this age of austerity, people might ask whether we can afford to take the user experience into account. One challenge is the sheer cost of measuring user experience – which we’ll go into: the second is whether better user experience is also more expensive, and whether that is a good use of limited resources.
The Quality Checker team, with years of experience and the support of experienced staff at Skills for People, developed a method of measuring the user experience through interviews. A consultancy called Paradigm later worked with Skills for People (amongst others) to develop 11 REACH standards, and these national standards are the ones the Quality Checkers assess against.
The internationally recognised SROI framework is based on seven principles, and the process generally follows six stages. I'm going to discuss the way I engage stakeholders, and the preparation of the report in the next blog, but it's worth touching on the seven principles:
The Quality Checker SROI report benefits considerably because the assessor (me) is independent of Skills for People. Stakeholders felt that they could tell me what it was really like, what's really going on, and of course since I was asking them after the event, they could tell me what had continue to change after the Quality Checkers had left, and who had been the most influenced.
Bringing in experts by experience to verify the user experience really does improve the quality of care that people get. It helps in other ways too; Quality Checkers use a standard set of criteria (Reach standards), and a standard way to assess performance against these criteria (face-to-face interviews); provider services know what they are working towards, and it makes it much easier to improve quality of care.
How does Quality Checkers compare with other ways to improve standards? Quality Checkers seems to be one of the best; it seems to have a big impact on standards and quality of user experience, and is relatively low-cost. Its SROI ratio – the savings that are commissioner or provider could expect make in real cash terms – is around £10 for every £1 invested.
One source of the savings described is the cost of direct care – the amount of support that people need. People feel happier because they’ve talked to ‘someone like them’. They're much less likely to get frustrated that nobody is listening to them, and resort to challenging behaviours. Numbers might be small, but the costs and cost savings are fairly large.
Quality Checker representatives attend working group meetings and add details to the information in the report, which helps both commissioner and provider to take action. The reports are generally presented as “we found this, which means” which is far more valuable than a simple transcript of interviews.
It is worth getting Quality Checker audits
The sensitivity analysis suggested that in the worst possible scenario, the return on investment was just over 8:1 – you will still save (in one part of the care pathway or another) the amount you spend on Quality Checkers and more. In a best possible scenario, the SROI ratio climbs to over 18, which is pretty good value?!
We only managed to agree on a financial equivalent value for some of the benefits. Many of the benefits where we could not assign a financial value were cultural changes, where there may be a financial value over the longer term. So the SROI ratio is an underestimation - you may find you get a lot more
All in all, an investment in the quality checker expert by experience audits has a substantial return to both commissioner and provider, whether the commissioner pays for it in full, the provider pays for it in full, or someone else funds the audit.