Embedding Service User Feedback Into Governance, Audit and Board Assurance
Service user feedback often sits at the edge of governance rather than at its centre. Providers may gather surveys, meeting notes, and complaints data, but struggle to show how lived experience informs decision-making at senior and board level. To be credible, feedback must travel through governance structures, influence priorities, and shape assurance. This article explains how service user feedback and co-production can be embedded into quality standards and assurance frameworks so it strengthens audits, board oversight, and regulatory confidence.
Why feedback must sit within governance, not alongside it
When feedback is treated as a separate activity, it becomes vulnerable to inconsistency and drift. Governance provides the structure that ensures:
- Feedback themes are prioritised based on risk and impact.
- Actions are tracked, reviewed, and escalated when ineffective.
- Leaders can demonstrate learning, not just listening.
Embedding feedback into governance also reduces reliance on anecdotal reassurance during inspections or contract reviews.
Where feedback should appear in governance structures
Effective providers intentionally place feedback at multiple governance points:
- Operational quality meetings: theme identification and immediate action.
- Safeguarding and risk forums: feedback linked to harm, restriction, or distress.
- Audit and assurance cycles: testing whether actions improved outcomes.
- Senior leadership teams: trend analysis and strategic priorities.
- Board reports: lived experience as an assurance source, not an appendix.
Operational example 1: Feedback driving audit priorities
Context: Service users consistently reported feeling rushed during personal care. Managers logged the feedback but treated it as an isolated issue rather than a systemic concern.
Support approach: Leaders reframed the feedback as a potential quality and dignity risk and used it to shape the internal audit programme.
Day-to-day delivery detail: An audit tool was designed to test whether care was delivered at the person’s pace, whether rotas allowed sufficient time, and whether staff recorded consent and communication appropriately. Auditors spoke directly with people using accessible questions and reviewed care notes for consistency. Findings were presented alongside feedback quotes to retain the lived experience.
How effectiveness or change was evidenced: The audit identified time pressures on specific shifts, leading to rota redesign and skill mix changes. Follow-up audits and feedback showed improved satisfaction and fewer dignity-related concerns. Governance minutes evidenced decision-making and review.
Operational example 2: Feedback informing risk and safeguarding oversight
Context: Several people said they felt “controlled” by house rules, but no formal safeguarding concerns had been raised.
Support approach: The service treated the feedback as an early indicator of potential restrictive practice risk.
Day-to-day delivery detail: Feedback themes were tabled at the safeguarding and risk meeting. Leaders cross-referenced comments with incident data, restriction registers, and behaviour support plans. A time-limited review programme was introduced, with co-produced alternatives tested and documented. Staff received guidance on proportionality and least restrictive practice.
How effectiveness or change was evidenced: Restrictions reduced without increased incidents, and people reported feeling more respected. The risk register was updated, and board reports showed how feedback informed risk mitigation.
Operational example 3: Board-level assurance using lived experience
Context: Board reports focused heavily on metrics but struggled to demonstrate what life was actually like for people using services.
Support approach: The board requested a standing “lived experience assurance” section.
Day-to-day delivery detail: Reports included themed feedback summaries, representative quotes (anonymised), outcome indicators, and actions taken. Boards were trained to ask assurance questions such as “How do we know this change worked?” and “What would people say if we asked them today?” Non-executive directors occasionally joined visits with clear boundaries and consent.
How effectiveness or change was evidenced: Board challenge improved, actions were clearer, and leaders could articulate the link between feedback, strategy, and quality improvement.
Making feedback auditable and defensible
For feedback to stand up to scrutiny, providers should ensure:
- Clear terms of reference showing where feedback is reviewed.
- Consistent templates linking feedback, actions, and outcomes.
- Evidence of escalation when issues persist.
- Audit trails demonstrating review and learning over time.
Commissioner expectation: assurance, not reassurance
Commissioner expectation: Commissioners expect feedback to be embedded into governance and used to assure quality and value. They look for evidence that leaders understand themes, respond proportionately, and monitor effectiveness rather than offering anecdotal reassurance.
Regulator expectation: well-led, learning organisations
Regulator / inspector expectation (CQC): Inspectors assess whether services are well led, open to learning, and responsive. Boards and senior leaders must be able to explain how feedback informs oversight, risk management, and continuous improvement.