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How you can effectively measure people’s experiences of health visiting services and improve their care

21st June 2016

Picker logo no strapline cmykA guest blog by Amy Tallett, Associate Director at Picker Institute Europe, shedding light on how people’s feedback can be used to improve services, and why it is so important.


When you consider that delivering anything less than optimum care in any setting can potentially have life-threatening implications, effectively measuring and understanding service user experiences of healthcare becomes a key priority. Or at least, it should.  Particularly in health visiting services, where both the parent / caregiver and the child’s health are at stake.

This is further emphasised in the National Health Visiting Core Service Specification for 2015-16 (NHS England, 2014[1]) which states that the delivery of health visiting services should be informed by user experiences and feedback from families.

In 2015, NHS England commissioned the Picker Institute Europe to develop a toolkit for this very purpose. Consisting of a questionnaire and supporting guidance, the toolkit allows health visiting providers to effectively understand and measure service user experiences. Perhaps more importantly, it is freely available to download and use from the Picker Institute website.

The feedback questionnaire is a key component of the toolkit. It focuses on care quality and asks about specific events that have (or have not) occurred during the care process. It can be widely used to identify where there is room for improvement in care provision.

How the Toolkit was developed

The questionnaire was developed in a way that ensures the feedback generated is robust, actionable, and useful to the care improvement process.  It was developed as follows:

  • Depth interviews with health visiting service users to explore their needs and preferences in terms of service delivery.
  • Survey development based on depth interview findings and an existing health visiting feedback tool.
  • A consultation with stakeholders to seek their views on the survey content. This included feedback from:
    • Health Visiting Professional Leads, Team Leaders and Programme Managers;
    • Heads of Children’s Services;
    • Representatives from Contact a Family and the National Network of Parent/ Carer Forums.
  • Cognitive testing of the survey to check for comprehension and clarity, in addition to exploring views on survey design and format.
  • A full pilot with two health visiting provider organisations (one NHS-based and one local authority provider) to ensure that a postal methodology yielded a successful response rate and actionable data.

The development of the supporting guidance documents were based on the methods successfully implemented in the pilot. These include sampling guidance, survey implementation and data entry instructions, and guidance for analysing, interpreting and reporting on the survey findings.

How the Toolkit can help you

By following the guidance (which includes everything you will need from the questionnaire and covering letters, to sampling and reporting guidance), actionable data can be gathered on a range of health visiting service areas, including; provision of information and advice, access to support, and experience of a recent appointment with the health visiting team (either a home visit or in clinic).

Some results from the pilot (conducted with an NHS and non NHS Local Authority provider) highlighted some interesting service user trends, including:

  • The majority of parents (95%) reported that the health visiting team ‘definitely’ or ‘to some extent’ considered the individual needs of their family when providing information and advice.
  • Most respondents (85%) agreed that health visiting staff were definitely welcoming and friendly in a recent appointment.
  • Only just over half of respondents (58%) definitely received active support and encouragement from the health visiting team with feeding their baby. 13% of parents felt that feeding advice had been inconsistent.
  • Half of respondents (50%) were not fully comfortable discussing emotional issues with health visitors.
  • 13% often or sometimes felt judged or patronised by health visiting staff.
  • One fifth of parents (19%) did not see the health visiting team as often as they would have liked.

Along with other (qualitative and quantitative) feedback mechanisms, the toolkit can be used by health visiting providers to generate insight into the experiences of their service users. Such insight should be used to inform the delivery, design and commissioning of health visiting services. It should also be used to optimise service quality, and the care experiences of the families and children depending on it.

Further Information

This work was conducted by the Picker Institute in 2015. Sheffield Children’s NHS Foundation Trust funded the original survey refinement, and NHS England funded the survey consultation/refinement, pilot and toolkit development. The survey and toolkit are available to health visiting service providers in England to license free of charge from the Picker Institute website until 31st December 2017:

For further information, please email [email protected].


We would like to thank all who took part in the research, including

  • stakeholders in the consultation
  • service users in the questionnaire refinement and pilot stages
  • the health visiting providers that piloted the survey: Croydon Health Services NHS Trust and Swindon Borough Council

[1] NHS England (2014). 2015-16 National Health Visiting Core Service Specification. (accessed 13 January 2016).

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