The question - why buy Quality Checkers?

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?

The situation – a portfolio of services

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.

CQC minimum standards

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.

So does User Experience make a difference to cost?

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.

Quality Checkers

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 Method used to prepare the SROI report for Quality Checkers

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:

• involve stakeholders – asking people what they think
• understand what changes – check with them that I understood them, and check that I understood what changes
• value the things that matter – how much? how many? what does it change?
• only include what is material – don't count it if it comes from something else; where possible, use a monetary value, or give it a financial equivalent value. If this is impossible, then don’t try too hard
• do not over-claim – only count things once (!)
• be transparent – how did we reach this conclusion and who agrees with it?
• verify the result – if it's an estimate, also estimate the smallest likely amount, and the largest likely amount

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.

Answers - why buy Quality Checkers?

Quality Checkers is Value for Money

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.

Quality Checkers means people feel "listened to" - they don't get frustrated

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 reports are presented in context so action can be taken

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.

This Means

It is worth getting Quality Checker audits

Quality Checker audits will help you

• understand the quality of service
• hold suppliers to account and drive through service improvement

Each £ invested saves you (the commissioner + supplier) £11.41

• part of the savings represent a reduced amount of the commissioner needs to pay; the commissioner is responsible for paying a certain level depending on the category of support that the service user needs. If the service user develops less challenging behaviours, then the commissioner will not be obliged to pay higher support costs
• part of the savings are direct savings to providers, for example reduced staff sickness/ absence, better staff retention, and more appropriate spend on facilities
• some of the provider savings can be passed directly back to the commissioner; this might be where a better price is offered
• of course there are many benefits where we couldn't assign an approximate financial value. If you could assign a financial equivalent value to these, in the SROI ratio would be much higher

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?!

There are other, less tangible benefits

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

Here are some examples:

• providers of care may not listen to commissioners' demands for improvement, but will listen to structured feedback from service users
• changes the culture to one of innovation instead of "this is the way we have always done things"
• ideas of how to measure user experience in other areas of care
• developing more Quality Checker teams and getting Adults with Learning Disabilities into employment
• people receiving support, and their families, were happier (we did not attempt to assign a value to “happiness” since we felt the academic published values were optimistic)
• staff were more flexible, more inspired "this is what we signed up to do"
• can lead to more business (as quality improves and the word gets out)

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.

The icon on the left is the link to the full SROI Quality Checker Report - it will open as an 80 page PDF.  Sections are also provided below to make it easier to digest:

• Assurance Statement
• Executive Summary
• Acknowledgements
• Who are the Quality Checkers, and who uses them?
• Scope of this evaluation
• What did we find? Outcomes and Evidence
• Impact - What difference did it make?
• Social Return Calculation - how much was it worth? Including Sensitivity Analysis
• Audit Trail - why did we do what we did? and Documents Referred to