Designing Inclusive Feedback and Co-Production for People With Communication Needs and Complex Presentations

February 2, 2026

Many feedback systems unintentionally privilege people who can speak confidently in meetings, read forms, or tolerate formal processes. In adult social care, that creates a serious risk: the people most affected by poor support may be least able to use standard channels. Inclusive practice requires feedback methods that work for different communication styles, distress presentations, and fluctuating capacity. This article explains how service user feedback and co-production can be designed inclusively within quality standards and assurance frameworks so evidence remains robust for commissioners and CQC.

Why inclusion is a quality and safeguarding issue

When feedback methods exclude people, services risk missing early indicators of harm, restrictive practices, or unmet need. People may communicate distress through behaviour, withdrawal, refusal, or physical symptoms rather than complaints. Inclusive feedback is therefore not “nice to have”; it is a core quality and safeguarding mechanism.

Inclusive systems also reduce reliance on family members as the only voice, while still valuing family insight appropriately.

Principles of inclusive feedback design

Inclusive feedback design should follow practical principles:

Multiple channels: do not rely on one method (e.g., survey).
Accessible formats: symbols, pictures, audio, easy read, short prompts.
Right time and place: feedback when people are regulated, not when distressed.
Trusted facilitation: consistent facilitators and predictable structure.
Observation with consent: using lived experience indicators, not assumptions.
Closed loop: show people what changed, in a format they understand.

Operational example 1: Using structured observation to capture feedback for non-verbal people

Context: A person using minimal verbal communication showed increased agitation during personal care. Standard feedback tools did not work, and staff interpreted distress as “non-compliance”.

Support approach: The service designed a consent-based observational feedback method using an agreed set of indicators co-produced with the person’s circle of support (including family and staff who knew them well).

Day-to-day delivery detail: Staff recorded specific indicators (facial tension, withdrawal, vocalisations, refusal behaviours) and the context (time of day, staff member, pace of support, environmental noise). The person was offered choices using objects of reference and consistent gestures. A trusted staff member facilitated a predictable routine and reduced environmental triggers. The person’s preferences were embedded into the care plan in clear, practical steps.

How effectiveness or change was evidenced: Distress indicators reduced, personal care was completed with fewer escalations, and staff confidence improved. The service could evidence that “feedback” was captured through agreed indicators rather than subjective judgement.

Operational example 2: Co-production with people who experience distress and crisis

Context: A person reported feeling “interrogated” in meetings and became distressed when asked direct questions, leading to avoidance of reviews. Staff then lacked feedback and relied on assumptions.

Support approach: The service shifted to trauma-informed co-production, focusing on psychological safety and paced engagement.

Day-to-day delivery detail: Reviews were split into short sessions with clear agendas, led by a consistent facilitator. The person chose where meetings occurred and could pause or stop at any time. Feedback questions were changed from “what’s wrong?” to “what helps you feel safe?” and “what would make tomorrow easier?” Staff used a simple scaling tool (0–5) for key themes (routine, relationships, environment) and logged changes between sessions. Agreements were written in plain language and checked back with the person using their preferred communication method.

How effectiveness or change was evidenced: The person attended reviews consistently, distress reduced, and plans became more personalised. The service evidenced engagement rates, reduced crisis incidents linked to review periods, and improved satisfaction indicators.

Operational example 3: Inclusive feedback driving changes to restrictive practices

Context: A service used restrictions (e.g., locked doors, limits on items) for “safety”, but people with communication needs could not easily express how this felt or propose alternatives.

Support approach: The service introduced a co-produced restriction review tool in accessible format.

Day-to-day delivery detail: Staff used pictures and simple scenarios to explain why a restriction existed and what alternatives might look like. People were supported to express preferences via choices, symbols, or supported conversation. Reviews included “what matters to you?” and “what feels unfair?” prompts. Where capacity was unclear, staff documented best-interest decision making alongside evidence of the person’s known wishes and feelings. Reviews were time-limited and revisited monthly.

How effectiveness or change was evidenced: Restrictions reduced or became more proportionate, with improved documentation and fewer incidents of conflict. People demonstrated greater engagement and reduced frustration, evidenced through feedback indicators and incident trends.

Making inclusion defensible: records, governance, and assurance

Inclusive feedback must be documented clearly so it stands up to scrutiny. Providers should be able to show:

Why a method was chosen for the individual.
How consent and capacity considerations were addressed.
What indicators were agreed and what they mean.
How the person’s voice shaped actions and reviews.
How the service confirmed that change worked.

This ensures inclusive feedback does not become “interpretation”, but remains a legitimate evidence source.

Commissioner expectation: equitable access and demonstrable responsiveness

Commissioner expectation: Commissioners expect providers to demonstrate equitable access to feedback and involvement, including for people with complex needs. They will look for:

Accessible methods and advocacy-informed practice where appropriate.
Evidence that services can respond to early concerns before escalation.
Clear documentation linking involvement to improved outcomes and safety.

Regulator expectation: person-centred, safe, and well-led practice

Regulator / inspector expectation (CQC): Inspectors assess whether people can raise concerns, influence their support, and experience safe, respectful care. They will test whether providers can demonstrate involvement for people who do not use standard channels, and whether restrictive practices are reviewed with genuine regard to the person’s rights and experience.