Service user and carer involvement

It provides our view on service user and care involvement, including our regulatory requirements, and what we commonly see in programme delivery.

This information should be considered by education providers when developing new and existing programmes, linked to this area.

Our threshold requirements

Summary reflections 

Service user and carer involvement is most effective when it is considered as a key part of institution or division strategy, meaning it is properly integrated into various aspects of programmes and the way the institution or division functions. It is generally at its weakest when it is seen as a supplementary initiative added to programmes.

Education providers with a more ‘hands off’ academic approach, for example those delivering portfolio-based routes, or programmes where learners were more independent, need to work harder to integrate service users and carers into their provision.

Within more traditional higher education institution provision, there is often a broad range of involvement, from basic non-structured involvement, which is sometimes tokenistic, to service users thoroughly integrated into multiple aspects of programmes in a strategic way.

The COVID-19 pandemic should no longer be seen as a barrier to good service user and carer involvement.

Education provider approaches 

For many education providers, established central groups are drawn upon by programmes to provide specific involvement within education provider frameworks, with service users and carers involved in:

• a wide range of learner-facing areas, such as in admissions, delivery of content, assessments, and fitness to practise panels;
• governance, ranging from advisory groups to integration of service users and carers within a wide range of groups with differing functions;
• quality improvement, such as design and development of programmes, and the production of policies – again involvement is wide ranging from single point consultation through to co-production; and
• less frequently, service users and carers are involved in research.

We consider the following as good practice:

• internal lead roles responsible for developing service user and carer involvement strategy, with service users and carers, and co-ordinator roles to manage involvement and logistics;
• measuring success embedded into reporting;
• payment for service users and carers, above and beyond expenses, which is seen by some service users as essential, rather than ‘good practice’;
• support for service users and carers in the form of training and preparation for sessions, practical support for attendance, and risk assessments where required;
• contingency planning if things go wrong, such as unexpected unavailability for a learner session;
• wellbeing considerations for learners, service users and carers built into learner sessions; and
• feedback from service users, carers and others being acted on to further embed involvement, with good communication of changes made in response to feedback.

There are external frameworks, standards and organisations to inform service user and carer involvement, such as:

• the requirements of other regulators;
• professional body expectations; and
• regional groups, which represent service user and carer interests in geographic areas.

Current sector focus and challenges 

There are common pitfalls in to involving service users and carers, as follows:

• reliance on a small number of individuals;
• too narrow a range of experiences within service user groups;
• ill-defined staff responsibilities to support, integrate, and optimise service user and carer involvement;
• uncoordinated approaches to involvement, which are not underpinned by clear objectives, a service user strategy, or the required resources to support; and
• impact of involvement not being evaluated in a structured way.

Some of these pitfalls can contribute to sustainability issues. When good practices reside with individuals, (service users  or staff, rather than through policies and structures, practices and momentum is lost when people move on. There is also a linked challenge in balancing service users and carers who are able to contribute (with the support and level of institutional understanding needed to do this), and over-institutionalisation which can affect the ability of an individual to contribute to topics with the service user and carer perspective.

Recruitment and retention can be an issue for education providers, and this is sometimes seen as an explanation for small groups or narrow ranges of experiences, rather than a problem to be solved to improve service user and care involvement.

Some education providers use simulation as an example of service user involvement. Although service user input into the development of simulation is service user involvement, the continued use of materials and technology produced with service user input is not in itself service user involvement.

Areas commonly explored further through our assessments 

We commonly referred this area to be considered in future assessments when service user and care involvement was under development or changing.  

Proportion of performance review assessments with quality activities / referrals