​Internal Review

Introduction and Background

There are a number of challenges facing health and social care which cannot be addressed by the NHS alone. We must work with our partners, stakeholders and residents to develop innovative and sustainable solutions to these challenges. Involving people and communities in service design, development and transformation is an important part of this.

As an NHS organisation Croydon CCG is accountable to the public, communities and patients that it serves and is rightly subject to public scrutiny. We welcome this scrutiny as a way for us to continually improve our engagement and equalities work. As part of this improvement process, in 2018 the CCG began an annual process of internally reviewing its engagement function. The process includes our One Croydon stakeholders and is discussed at the local Croydon Communication and Engagement group as part of an internal assurance process. 

The CCG's Public, Patient and Community Engagement and Involvement function is assessed by NHE England and Improvement national Patient and Public Participation team annually as part of the NHS Oversight Framework. The Patient and Community Engagement Indicator contains 5 domains, each containing several indicators, which is used to assess all CCGs engagement duties as part of the Improvement and Assessment framework (IAF).

This annual assessment will remain in place after the CCGs merger in April 2020 and, insofar as we are aware, will follow a similar process and timeline, although the responsibility for completion will shift to Southwest London CCG.

Since the introduction of the Patient and Community Engagement Indicator NHS Croydon CCG has been rated Green overall. In 2018 the engagement function was rated as outstanding in 2 domains and good in the remaining 3. In 2019, four domains were rated as outstanding, while the feedback and evaluation domain was rated as requiring improvement (with a score of 1/3 against 3/3 across the other domains).

Feedback from NHS England and Improvement indicated that areas of weakness in domain D (Feedback and Evaluation) focused on two criteria:

  1. The CCG reviews its involvement activity, including how effective it has been, and takes action in response to what it has learnt.
  2. The CCG seeks the views of patients and the public, and their representatives, about their approach to public involvement.

Alongside this assessment both the CCG and CHS have a public commitment to:

  • Promoting equality and diversity
  • Ensuring that all commissioned and contracted services deliver better outcomes for our population as a whole and those with protected characteristics.
  • Making sure Croydon have empowered, engaged and included staff

In this internal review we have used the NHS England and Improvement IAF framework to check that our engagement and involvement function is following positive practice. Using the IAF framework also allows us to map our year on year improvement.

This review focuses on NHS England and Improvement 2018-19 IAF assessment which highlighted the need for improvements in Domain D, Feedback and Evaluation.  It also includes some other indicators across other domains where suggestions for improvement were highlighted by the external assessor.

The audit also focused on training and support for patient and public voice partners and commissioners, as a previous internal review indicated that, while the CCG was assessed as good in this area we wanted to do more.

Objectives & Scope

To undertake a review of the CCG's compliance against NHS England's statutory guidance: Patient and Public Participation in Commissioning Health and Care (April 2017) and revised guidance: NHS Oversight Framework Patient and Community Engagement Indicator Assessment 2019/20.

The review concentrates on NHS England's assessment domain highlighted to the CCG as areas which require improvement in July 2019 upon receipt of the assessors detailed feedback in August 2019.  This included domains; B (one indicator) C (three indicators) and D (four indicators). These indicators cover these topics:

Domain B: Annual Reporting: Accesibility and appeal

Domain C: Day-to-Day: Information is available in a range of formats; Information is presented in plain English; There is support to staff and patient representatives around Involvement.

Domain D: Feedback and Evaluate: The CCG seeks views on its engagement approach; The CCG reviews its engagement activity and takes action from the learning; Public facing communications is accessible; Feedback is communicated using creative and diverse methods.

Management Summary

Croydon CCG were able to provide and demonstrate evidence of good working practice and compliance with the tested NHS England domains, where we had previously been assessed as outstanding and we are confident that we have continued to meet positive practice across four of the five domains. Particularly around; explaining public involvement in commissioning plans, assessing, planning and taking action to involve patients and the public, showing clear evidence that we considers equalities and health inequalities when planning and implementing our approach to public involvement and that demographic monitoring is in place for public involvement and is used to inform improvements well as sound structures in place within the community to feedback the impact of patient and the public participation.

However, our review does reveal that we need to improve the way we involve patients, the public and stakeholders in assuring and improving our approach to patient and public engagement and how we feedback on the difference it has made.

The table below demonstrates the findings of the CCGs internal review and actions the CCG has taken to improve its practice against the IAF indicators.

Self-assessment post review

Domain Rating ABCDE
 GovernanceAnnual Reporting Day-to-Day Practice Feedback and Evaluation Equalities and Health Inequalities
NHS EnglandOutstanding OutstandingOutstandingRequires Improvement Outstanding
Croydon CCG   Improving  


Audit Findings

Domain/IndicatorNHSE & I Comments (2018-19)Audit findings/actions
B. Annual Reporting  

Is accessible and appealing (see page 8-9 of the Annual Reporting Guidance)


Criterion met. The 20 page Summary version of the Annual Report is colourful and uses photos, and has an appealing cover.  The document would benefit from having a statement about being provided in different formats upon request; and perhaps the use of some infographics.  

A statement on how the CCG can provide information in different formats has been added to the CCG website. The Communications and Engagement team will also ensure that this statement is included in all printed/written materials including mailouts to our health network members.


Southwest London Health and Care Partnership are supporting the Engagement team with video and infographic materials.

c. Day-to-Day Reporting   
Information about how to get involved is available in a range of formats (online, paper, telephone, social media etc) and easy to access

Criterion met. Consider including a postal address for people to write in to. Some other CCGs have also been explicit that information can be made available either in braille or in audio: if these are also an option, add this to the current information that has been provided.


The CCGs Freepost Engagement postal address has been added to the website.


A statement on how the CCG can provide information in different formats has been added to the CCG website.

Public documents are written in plain English and produced in appropriate formats for the community


Criterion met.  The CCG has produced a community friendly version of its annual report; and also considered other ways of sharing information (such an infographics and videos).  In terms of the website, the CCG might want to consider including an image/icon of where there are key documents that can be downloaded to make them more visible/obvious.  In future evidence, it would also be useful to see example(s) of easy-read documents.


The CCG will merge with the 5 other Southwest London CCGs in April 2020 so the current website will be archived and replaced by a southwest London CCG website. The suggestion to add an icon to access key documents has been forwarded to the designers.


New Easy Read materials will be uploaded onto the website alongside other versions.

The CCG provides support for staff and members of the public and their representative on public involvement.


Criterion met.  The CCG has produced a 22 page engagement guide for staff to use, although it would also be useful to know how this is promoted to staff.  The CCG has provided a presentation they use with commissioners.  It would be useful to know what other training is provided to staff and how regularly.  The CCG have provided information about induction, training and support for volunteers, and have included a lay member role profile on the website.  Some examples of training would be helpful.


Engagement is part of the induction rotation for all new commissioning staff where they are provided with a hard copy and internal link to the engagement guide document.


A lunch and learn sessions was held for staff in 2018 and will be repeated in spring 2020.


All staff have access to hard copy bite size guides from NHSE/I. A link is to the NHSE/I Get Involved hub is cascaded to all staff.


We will run a training session '10 steps to even better engagement' as part of the NHSE / I roll out 'Train the Trainers'.


PPV partners are encouraged and supported to attend the 2 day PPV training funded by NHSE/I and delivered by WSA Community Consultants.

D. Feedback and Evaluation   

The CCG seeks the views of patients and the public, and their representatives, about their approach to public involvement.


Criterion not met. The people listed in link 1 and the Service User Group in link 2 would be just the people to involve in a review - along with others - to discuss if the checklist and framework and other approaches have been successful, and if not what changes the CCG should make.


Since October 2019 the One Croydon Service User involvement group have been involved in reviewing the CCGs Engagement framework and suggesting changes as a standing item.


The SWL Patient and Public Engagement Steering Group (which includes 3 Croydon representatives) have been instrumental in developing a Southwest London wide Engagement framework which will be implemented in April 2020.

The CCG reviews its involvement activity, including how effective it has been, and takes action in response to what it has learnt.


Criterion not met. Link 1 is not about the CCG reviewing its engagement; links 2 and 3 are about practice, while the CCG reviewing its engagement approach would be an audit of how many CCG staff use the checklist and framework as part of a review of the CCG's engagement activity, identifying what if any improvements can be made and then making those improvements.The CCG have implemented this annual review process. We have also adopted the Southwest London Engagement Evaluation checklist (LINK) which the Engagement team complete with commissioners and PPV partners post Engagement to evaluate the work and make recommendations for future Engagement work.

Feedback is  communicated using creative and diverse methods.

Clear evidence of the difference that public involvement has made to commissioning, decision making and/or services.

The CCG seeks the views of patients and the public, and their representatives, about their approach to public involvement.

The CCG has met this criteria.  Looking ahead, the CCG could share more feedback through the use of infographics across social media (Facebook, Twitter, Instagram etc), newsletters, and the development of case-studies where public feedback has had an impact on services etc.  The CCG might also want to consider what community events (including those that are equality based) that it could piggy-back, to further share feedback.


The CCG has improved the way we use Twitter as a feedback tool and introduced a monthly newsletter for our PPV partners which highlights work undertaken as well as opportunities to participate in our work and training opportunities.


The CCG Engagement team has continued to develop good relationships within the community and regularly attend community meetings, for example, the Asian Resource Centre monthly coffee mornings and local Children's Centre sessions.


Key Topic Audit Findings and Summary

Domain D

Feedback and Evaluate

The CCG's website holds a variety of feedback examples from patients and the public under the Engaging Communities tab. We also have a You Said We Did (are doing) tab which will need updating regularly to ensure it is current. The CCG also mails out directly to our Health Network and Community and Voluntary Sector with regular updates and the results of Engagement.

Additionally the CCG use the multi-agency Communications and Engagement group to share information on how public involvement has supported CCG decision making and the impact of any involvement. However, the review found that social media was not currently used widely to provide feedback to patients and the public post engagement events.

Through public and public engagement reports, the CCG were able to demonstrate how there has been a review of involvement, but not necessarily how effective it has been. The review confirmed that there are no formal methods to assess the effectiveness of specific engagement activities. The CCG is now actively planning ways to seeking patients' and publics' views on their approach to involvement, for example as a standing item at the One Croydon Service User Group, as a method of gaining assurance on effectiveness and adapt methods where appropriate.