Inclusion Gloucestershire quality checking experts by experience

This case study outlines how autistic people and people who have a learning disability, a physical disability or mental health needs, are employed to review services across Gloucestershire.

Gloucestershire County Council

Experts by Experience are a key part of Gloucestershire County Council’s Quality Assurance Programme. The council commissions Inclusion Gloucestershire, a disabled people’s user-led organisation to deliver peer-led quality checks of support or services for adults who access care.

Gloucestershire County Council risk rates services and providers continually using both soft and hard intelligence to determine which services are most appropriate for Inclusion Gloucestershire to engage with and when. 

As an example, intelligence may include (but is not limited to) the number/type of safeguarding referrals raised, active professional involvement at the service, the last Care Quality Commission inspection date, known vacancies in the management team, and time since the last Inclusion Gloucestershire /Quality Assurance review. Between the Quality assessments and Inclusion Gloucestershire assessments, the council aims to visit and assess all service locations within three years.

How the quality checks work

  • The fundamental principle which underpins Inclusion Gloucestershire’s Quality Checking service is that people who use services are the experts on their lives.
  • Inclusion Gloucestershire has an accessible recruitment process to employ people with lived experience to review services. This includes an "easy-read" application and an interview with a person who has lived experience.
  • Recruited staff, known as ‘quality checkers’, receive training and support from Inclusion Gloucestershire co-ordinators before, during and after each review.
  • Gloucestershire County Council commissioners identify services which need to be reviewed.
  • Quality checkers meet with people in their homes or the places where they are supported, including supported living, residential homes and hospitals. Every quality check that is carried out has at its core, the conversation between two people with lived experience.
  • People who use services are invited to take part, but it is their choice as to whether they do or not. Inclusion Gloucestershire asks people to let them know how they would like to take part and tailor the process to their preferences and needs.
  • Quality checkers ask about what’s important to the person they are visiting, using questions which have been developed by people with lived experience. Each visit also includes conversations with staff and a review of the care provider’s documentation to ensure that a fair evidence-based assessment on the quality of the service is provided.
  • The assessment on the quality of the service, with a rating and recommendations to improve the service, is shared with the care provider and commissioner. An accessible version is written for the person supported by the care provider.
  • If Inclusion Gloucestershire become aware of any safeguarding concerns during visits, they notify the manager of the service and ask them to complete referrals to the local authority Safeguarding team. They ask for evidence that the referral has been made and follow up on any learning arising from the safeguarding concerns at any subsequent visit. The Inclusion Gloucestershire team is supported and debriefs are provided for the team members involved to support their wellbeing.
  • Any safeguarding concerns shared with the council’s Quality team, either through Inclusion Gloucestershire or other avenues, are reviewed in close liaison with Gloucestershire County Council, the local safeguarding teams, the Care Quality Commission, allocated professionals, and commissioning colleagues, as appropriate to the scenario. Concerns raised will impact on the risk rating of the provider and future assessment allocation decisions, as well as offer of support and guidance. The council may also take the decision to use their contract escalation pathway if this is felt appropriate.

Impact of the quality checks

Reviews have led to a number of changes to the support or service to improve the person’s life. These changes are wide ranging and have included having their health appointments booked, discussions about their end of life wishes, support with identifying goals and help to make progress towards them. A recent quality check for one person resulted in an increase in choice and control in their home, as restrictions to their kitchen were removed as a result of the quality check.

I think that one of the most important parts of our quality checking process is that, as people with lived experience, we have a genuine empathy with what it is like to receive care and how it feels for you as an individual.  When asking for how people feel concerning their support, it is really positive to be able to share the fact that you have been there, done that and got the t-shirt! Such an understanding really helps the people you are talking to, to feel listened and the fact that you are talking also about how it makes you feel rather than simply asking if the guidelines are being adhered to is crucial to understanding the quality of care being offered to the people who really matter in the process.” 
-A quality checker

It was all very well organised. It is really good to have sections and feedback on areas to look at – to ensure that the people we support are getting the best quality care. What worked particularly well was the friendliness around the people we support. The team made them feel comfortable and listened to the staff around that person.”
-A support provider who recently received a quality check

Gloucestershire County Council send the Care Quality Commission a monthly report showing the gradings across the Inclusion Gloucestershire domains from visit reports published that month.

Inclusion Gloucestershire’s Quality Checking service plays a vital role in assessing and improving the quality of care for individuals who receive support commissioned by Gloucestershire, both in and out of the county. It supports a well-rounded understanding of the current care market and help us identify providers who give excellent care, as well as helping us identify concerns and actions we may need to take as commissioners. The Experts by Experience team are well respected, and their understanding of and relationship with individuals that use services is invaluable.”
-Jess Breeden, from Gloucestershire County Council’s Integrated Adults Commissioning Hub on the value of quality checks

Top tips

  • Positive trusted relationships with local commissioners are critical. They support relationships with everyone involved. Commissioners also promote the importance and impact of quality checks.
  • Quality checks need to be accessible, flexible and supportive, ensuring reasonable adjustments are made for the quality checker and the person whose support provision is being reviewed.
  • Risk assessments should be completed before each review. This is critical to plan the review and to ensure it does not distress the person being visited or the quality checker.
  • It’s helpful to recruit a large team of experts by experience to support with matching the lived experience of the quality checker and individuals receiving care and provide cover where people may have fluctuating health needs.
  • Review questions need to be developed and regularly checked by people with lived experience to ensure they reflect current issues.

Linked resources

Quality checking leaflet: information about what to expect from a quality check


Inclusion Gloucestershire:

Gloucester County Council: