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BOARD MEETING – WEDNESDAY 18 MAY 2011
CQC ADVISORY GROUPS AND STAKEHOLDER MANAGEMENT –
PROPOSALS FOR REFORM
PURPOSE
1. CQC has a broad range of stakeholder advisory groups, improvement
boards and reference groups with different remits, membership and levels
of impact. Last year’s stakeholder strategy proposed reforming these
groups to deliver better results for both CQC and stakeholders. This paper
sets out proposals to do so, which need to be endorsed by the Board.
2. The strategy presented to the Board last year set out the objectives for this
reform: to help CQC better engage with stakeholders to allow them to
shape and influence our work; to bring together a broad range of informed
perspectives to improve the way we regulate; to establish a regular
dialogue with stakeholders and build positive relationships; and to actively
promote CQC’s work to stakeholders. This paper seeks to create a
structure to allow stakeholders to have more direct and relevant influence
over the way we work and make decisions; and to ensure that our
relationships with them are transparent, representative and effective.
RECOMMENDATION
3. The Board is asked to ENDORSE recommendations to develop a new way
of working with national stakeholders, namely to:
a. Set up a ‘CQC Stakeholder Committee’ to provide advice to
CQC in line with the Health and Social Care Act 2008 (see
Annex 1);
b. Create sub-committees of this Committee as necessary to deal
with specific strategic challenges, either on an ongoing or timelimited basis;
c. Agree to set up ‘external advisory groups’ to seek stakeholder
views on specific pieces of CQC work, representing the broader
range of voices CQC seeks to respond to, reporting into the
RDA or other relevant part of the governance structure (see
Annex 3 for an example);
d. Develop relationships with other priority stakeholder groups
(mental health, learning disability, voluntary sector and others
tbc) via ongoing formal and informal relationship management;
e. Disband the range of advisory and improvement boards and
groups set out in Annex 2 in their current form, and
f. Migrate members of all existing boards etc. on to a CQC
‘stakeholder register’ to allow the Public Affairs team to offer
colleagues an up to date range of nominated stakeholders to
take part in these advisory groups
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BACKGROUND
4. Last year’s stakeholder strategy set out a high level proposal for how CQC
will manage its relationships with key national stakeholders, given reduced
resources. Engagement with individual organisations to support regulatory
activity carried out by regional staff is not affected by these proposals.
5. Our approach to date has tended to bring out frustrations with regulation
through sector-specific engagement. Our aim moving forward is to bring
stakeholders into fora where different views are brought into balance and
where we can seek a rounded perspective that genuinely influences and
improves CQC’s work. This paper sets out the structural approach we
believe will deliver against this aim.
6. Under the Health and Social Care Act 2008, CQC has a statutory duty to
have an advisory committee (Schedule 1, section 6). To date, this role has
been fulfilled solely by the Provider Advisory Group – a group made up of
representatives of NHS, adult social care and independent health care
providers. There is no representation from service users or from new in
scope providers in this group.
7. A variety of other external groups have been set up to offer advice to CQC
with differing governance arrangements and sometimes overlapping
remits. Some are legacies of previous Commissions or were introduced as
a stop gap during merger. A range of these are listed in Annex 2. These
have been maintained without any overall plan as to the best way to
engage with our stakeholders.
8. Feedback from some of these groups and from those who manage them
indicates that, although often a welcome way of engaging with
stakeholders, their ability to involve members with CQC’s work is variable,
leaving both members and CQC staff sometimes frustrated. However, it is
often not clear what the objective of these groups is, at what level they are
supposed to engage with CQC, and nor is it clear whether they have any
positive impact on CQC’s work.
9. Furthermore, as evidenced by last year’s MORI survey, stakeholders often
believe CQC is good at listening but demonstrates little evidence of
changing the way it works as a result. The way these groups work (and
feedback from their members) reinforces this perception. Providing
effective feedback to stakeholders must be an integral part of the way we
work going forward and this needs to be built into terms of reference and
ways of working for all new groups.
10. CQC is undergoing change which has led to a reduced number of staff
available to engage with external stakeholders on policy and strategy
matters. The proposals in this paper seek to recognise the different level of
resources available for stakeholder engagement. More effort needs to be
made to focus our resources on stakeholder engagement that offers the
best potential outcomes.
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GOVERNANCE ROUTES
11. The Board considered and approved proposals along these lines in
October. Consultation has taken place with members of the Provider
Advisory Group, Mental Health Improvement Board, and CQC staff
including the directors of regulatory development and operations. The
paper was also discussed at the Provider Advisory Group on Friday 6 May
and amended as a result of suggestions from group members.
KEY ISSUES
CQC stakeholder committee
12. We propose that the CQC Stakeholder Committee (‘the Committee’)
should be established to give a broader range of representative
stakeholder groups the opportunity to engage with the Board and senior
management of CQC as per last year’s stakeholder strategy. This would
fulfil the requirements of the Act and draw members from key stakeholders
reflecting the broader range of activities carried out by CQC. This model is
recommended to the Board.
13. The Committee would:





Provide advice and information to CQC’s Board and ET about the
implications of the way in which it carries out its functions at a
strategic or policy level
Reflect the changes to the groups within scope of registration over
time, by bringing together representatives of the full range of
regulated sectors, at ‘umbrella’ or alliance level where possible, and
Include representatives of providers, people who use services,
carers, professionals and others to reflect the full range of CQC’s
stakeholders and to seek to balance these stakeholders’ views
across the piece
Be chaired by a Commissioner, supported by the Director of
Strategic Marketing and Communications, with secretariat and other
support provided by the Public Affairs team. The heads of public
affairs and better regulation would be standing members.
Likely have 20 or more members, membership to be initially
proposed by the Policy and Stakeholder staff group within CQC for
the Chair of the Committee’s consideration and approval. The
principles behind membership and selection will be clearly set out in
the terms of reference.
14. Under the Committee’s leadership, and at instigation of the Committee,
Board or ET, the Committee will need to set up subcommittees to look at
specific themes and offer advice on these to CQC. Membership of these
could be drawn from outside the Committee. Formal terms of reference
would be drawn up with advice from the CQC governance team.
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15. Groups with a statutory footing would not be affected by this change, for
example the Mental Health Act Modernisation Advisory Group which was
set up to offer advice on changes to the way CQC carries out its functions
in relation to the Mental Health Act.
16. Terms of reference for this committee and all sub-committees will set out
how these groups will be run in a transparent manner (e.g. with agendas,
papers and minutes published on the internet). Decisions to handle
business on a confidential basis must be carefully considered and should
be an exception rather than the rule. Terms of reference must also set out
principles to ensure stakeholders receive clear feedback on how and
where their views have helped CQC improve the way it works.
External advisory groups
17. All of CQC’s development work should, in line with good project
management principles, have an ‘external advisory group’ to ensure what
is being developed is effective, practical, and that those groups implicated
by the development work are engaged early in the process.
18. Our aim for the future is to ensure that stakeholders from a broader
background are given the opportunity to directly influence CQC’s work
through these project-related advisory groups. This should allow for a
richer exchange of views in direct relation to our work. These groups
should seek to directly engage stakeholders in developing CQC’s
regulatory work, allowing them to shape programmes and make them
more effective.
19. For example, the current Dignity and Nutrition advisory group (see Annex
3) brings together campaign groups, LINks, nursing professionals, other
regulators, providers and the voluntary sector to advise CQC on how to
communicate the outcomes of this inspection programme. They are able to
contribute their own views on the project and address tensions between
their perspectives as a group, rather than offer single-channel views to
CQC through existing working groups. This model is an indicator of how
future advisory groups can be effective (noting that in this case, we were
not able to involve the group in early project development as much as we
would have liked due to challenging timescales – future groups will seek to
get stakeholders involved in development as early as is possible).
20. External advisory groups should report in via the Regulation and Design
Authority (R&DA). The Reviews Oversight Committee will consider views
of external advisory groups for specific reviews and reflect this in
recommendations to the R&DA. This means stakeholder views will be
directly related to CQC projects, embedded within key workstreams, and
will be balanced across different sectors to build better understanding of
the tensions under which the regulator operates.
21. Terms of reference for these advisory groups will set out how they will be
run in a transparent manner when appropriate (e.g. with agendas, papers
and minutes published on the internet). In some cases, the confidential
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nature of project development work will mean taking a decision to work in
a less transparent way but reasons for this must be made explicit. Terms
of reference must also set out principles to ensure stakeholders receive
clear feedback on how and where their views have helped CQC improve
the way it works.
22. To support the development of external advisory groups, the Public Affairs
team will draw up and maintain a ‘CQC stakeholder register’ (including all
members of current boards, groups etc.) with their key interests and
themes noted. We will seek to add to this over time. In cases where a
project is considered to need stakeholder input via an external advisory
group, the Public Affairs team will put forward a proposed list of
stakeholders to the project manager to ensure balanced representation.
The Public Affairs team should also be able to offer a measure of support
to ensure smooth running of these advisory groups, although this is
dependent on demand and may need to be reviewed.
Transition for members of other current Boards, Groups, etc
23. Given these proposals, and given resource constraints, we propose that
the range of standing Improvement Boards etc. are disbanded and that
their members are put onto the CQC stakeholder directory, to be invited to
join external working groups as and when necessary.
24. In recognition of the fact that some of these standing groups do, however,
have a role to play as engagement mechanisms with certain stakeholder
groups, they can be developed into a less resource-intensive ‘stakeholder
forum.’ This should be done as a result of a policy lead’s decision that an
ongoing forum is necessary based on a particular business requirement, or
in explicit recognition of their longer-term importance to CQC of certain
stakeholder groups (e.g. ongoing fora for relationships with mental health,
carers, learning disability, older people’s and voluntary sector groups seem
likely to need to be continued in some way).
25. These groups should be run on a more informal basis than at present and
the explicit aim should be to share updates on developments within CQC,
flag up projects where input may be needed, and listen to views from the
stakeholders who are taking part. The Public Affairs team will be able to
offer support to these in terms of suggesting membership, bringing forward
core CQC messages for dissemination, and advice on effective formats. In
consulting on this paper a range of options were considered feasible, e.g.
using the voluntary sector stakeholder forum model of three breakfast
meetings a year for key partners in this sector [estimated resource: five
working days per annum]. Other routes have been suggested (e.g. annual
information briefings) and will be considered and tested. The Public Affairs
team will work with internal subject matter experts to develop a forward
engagement plan for these groups.
26. Stakeholder forum members will be given clarity that those fora exist
purely to offer updates and share views, and that engagement with CQC in
terms of its ways of working should take place via formal advisory groups.
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It is likely that bodies who actively want to take part in CQC’s work and
who have high relevance to our work will find as many or more avenues for
engagement open to them via the external advisory group model.
Risks
27. We currently engage with a broad range of stakeholders via the range of
groups set out in Annex 1. Although discussions with the improvement
boards has indicated that members are keen for them to be reformed,
some participants will inevitably believe that they are playing a less
significant role in relation to CQC than previously. The process of
reforming groups and seeking input via more focused channels will be
managed through a communications plan.
EQUALITY, DIVERSITY AND HUMAN RIGHTS IMPLICATIONS
28. It is vital that hard-to-reach groups and those that need specialist support
to offer their insights to CQC are fully represented on the stakeholder
register and Stakeholder Committee. Insight from colleagues in
Involvement will be sought to ensure this is the case.
NEXT STEPS
29. If the Board supports these proposals, initial nominations will be drawn up
for membership of the Stakeholder Committee (to be considered by its
Chair and ET), formal proposals for other ‘priority’ groups will be brought to
ET, and communication plans to let stakeholders know about this new
approach will be brought to ET.
30. We should aim to implement this new approach from September;
communications will need to start in late May.
CONCLUSION
31. These proposals are designed to offer an effective solution to our need to
engage better with stakeholders and involve them more closely in the way
we regulate.
Matthew Trainer
Head of public affairs
Molly Corner
Public affairs manager
13/04/2011
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ANNEX 1
Extract from the Health and Social Care Act 2008
Schedule 1, section 6
(1)
The Commission must appoint an advisory committee (“the advisory
committee”) for the purpose of giving advice or information to it
about matters connected with its functions.
(2)
In considering how to exercise its functions, the Commission must
have regard to relevant advice and information given to it by the
advisory committee (whether or not given at its request).
(3)
The Commission may appoint such other committees and subcommittees as it sees fit
(4)
The advisory committee and any committee or sub-committee
appointed under sub-paragraph (3) may consist of or include
persons who are not members of the Commission
(5)
The advisory committee must include persons of prescribed
description
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ANNEX 2
Various advisory groups identified within CQC:
Group
Provider Advisory Group
Proposal
Key members on to Stakeholder Committee
– possible ASC sub committee? Reflect on
stakeholder register.
Social Care Market Review Group
Abolish – replicated elsewhere
Mental Health Improvement Board
Key members on to Stakeholder Committee,
all on to stakeholder register, sector
‘stakeholder forum’?
Carers Improvement Board
Key members on to Stakeholder Committee,
all on to stakeholder register, sector
‘stakeholder forum’?
Older People’s Improvement Board* Representation on Stakeholder Committee –
possible sub committee? Reflect on
stakeholder register.
Learning Disabilities Advisory Board Key members on to Stakeholder Committee,
all on to stakeholder register, sector
‘stakeholder forum’?
Voluntary Sector Forum
Maintain as sector ‘stakeholder forum’
Dementia Reference Group*
Revisit original TOR, further discussion
needed – representation on Stakeholder
Committee, sector ‘stakeholder forum’?
HealthWatch Advisory Board
Maintain within Healthwatch England
HealthWatch Committee
Maintain within Healthwatch England
LINks Advisory Group
Will be disbanded at transition to
HealthWatch England.
Overview and Scrutiny Committees Develop via Involvement – consider
Sounding Board
transition to Healthwatch England; input
relating to regulatory design to remain
Service Users Reference Panel
Develop via Involvement – consider
transition to Healthwatch England, note role
re regulatory design to remain
Equality Voices Group
Develop via Involvement – consider
transition to Healthwatch England; input
relating to regulatory design to remain
Provider Reference Group
Report via Director SMC
Innovation task and finish group
Report via RDA as working group
Mental Health Act Modernisation
Statutory group - retain
Advisory Group
Tranche 4 Registration Reference
Revisit original TOR, further discussion
Panel*
needed – consider T4 external advisory
group
* - there has been a commitment to set up these groups
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ANNEX 3
DIGNITY AND NUTRITION – EXTERNAL ADVISORY GROUP
1. This group supports a high-profile programme of unannounced
inspections in hospitals to look at standards of dignity and nutrition. It is
meeting once a month for up to six months over the course of the
programme and will be disbanded. Its recommendations feed into the
dignity and nutrition project group’s, which in turn reports back into
CQC’s formal governance structures. To note, this group is advising
primarily on the communication of outcomes from the inspection
programme, in order to try to ensure these have a positive impact on
the quality of care.
2. Unlike most current standing groups, the membership draws on a
range of stakeholders relevant to the project (some of whom have a
range of other regular contacts with CQC). In discussion so far, there
has been useful challenge between these stakeholders (e.g.
professional and campaign groups debating standards of nursing
training). Even where agreement is not possible, open debate has
proven influential in terms of how the project is developed and what
CQC plans to do with and say about its findings. Groups members
have had open and honest feedback about where CQC can and cannot
respond to their suggestions.
Providers
 NHS Confederation
Professionals / regulators
 Royal College of Nursing
 Royal College of Physicians
 Nursing and Midwifery Council
Voluntary sector / user groups
 Age UK
 Three LINks representatives
Campaign groups
 Action on Elder Abuse
 Patients’ Association
 Relatives and Residents’ Association
Improvement bodies
 Social Care Institute for Excellence
Other government departments
 Dignity in Care at DH
 Equality and Human Rights Commission
 NPSA
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