We have discussed on this blog before about the benefits of moving about and becoming part of a wider local government family, and by living this ideal I recently came across something which has not really crossed my radar too closely until now. On a semi-regular meet up with a colleague from another borough, I discovered the weird and wonderful world that is Healthwatch.
What’s that you say? You’ve never heard of Healthwatch before? Well, you certainly wouldn’t be alone. This idea is part of the Health and Social Care Bill which is currently working its tortuous and controversial way through the system, and aims to replace LINks, or Local Involvement Networks. What’s that you say? You’ve never heard of them either?
LINks have been around now for a good few years, and have aimed to help local people have more of a say about the quality of healthcare in their area. They are networks of people, usually hosted by a separate organisation and based around the involvement of volunteers. Healthwatch apparently looks set to take these responsibilities and add some others into the mix, adding a little more teeth and a few extra pennies into the mix for good measure.
These may be very good intentions, but what hope is there really when so few people even know of its existence?
Making a complaint about a company is relatively easy; you either do it on the spot by speaking with the staff, or you wait until later and write something down to send in. Most companies have some sort of complaints or feedback department, and will take your ‘constructive criticism’ on board and issue you with a reply and perhaps a voucher so you can return to somewhere you obviously didn’t like to see if they’ve made things better.
If you’ve got a comment or concern about health care, the plan is to create these local healthwatch organisations as your one stop shop to do just this. But what are the odds of it actually doing anything, other than replicating some of the many things that have been attempted in the past?
Providing simple feedback about healthcare services appears to be pretty complicated. Do you write to the local patient council, a GP patient liaison group, a service user group, your LINk (assuming you know what that is), PCT PALS, ICAS, Health and Wellbeing boards, the Council, the NHS Foundation Trust, NHS Choices, Patient Opinion, your local councillor, your local MP or just any journalist who will listen? And that’s not to even consider the range of third sector organisations who attempt to perform similar roles themselves.
Even when you get to the most appropriate organisation or group, the types of things you can get involved with vary wildly. Some simply want you to passively leave comments and thoughts, whilst others will merrily sign you up to perform inspections and investigations to your hearts content. Some are reactive, forming their workplans around the issues which come up over the course of a year, whilst others are more proactive and set out their targets in one, two or even three year plans.
If local healthwatch goes any way towards simplifying any or all of this, then it will be worth some of the effort and upheaval. By all reports however, it’s not exactly a smooth road to delivery. In order to prepare for healthwatches coming into being (originally scheduled for September but now put back to April 2013), a number of ‘Pathfinder Healthwatches’ have been established, which in effect are the current LINks in all but name who all aim to share their good (and hopefully bad) practice and lessons learnt in the meantime. However, funding to support this which they had been expecting didn’t materialise, leaving many looking at a chunk of extra work on top of their ‘normal’ roles and nothing to help make it happen. There is also a lot of uncertainty around regarding the future of these LINks – after all, what’s to stop a major company or simply a rival third sector organisation from bidding – and perhaps succeeding in becoming the new healthwatch? What would this mean for all those who have invested time in getting to this stage, both volunteers and staff? And where LINks aren’t working well (there are a few which aren’t where they would hope to be) is this a bad thing?
If these healthwatches are to have any chance of working then they have a long road ahead of them. They have the potential to massively streamline the way in which local people will be able to shape health and social care services in their area, but only if they are the primary way in which this is done. Every additional group in existence which performs a similar role dilutes the potential impact which a strong healthwatch could have, and dilutes the currently weak brand behind it. A healthwatch currently has a simple advantage over its predecessor in that most people would be able to work out what it aimed to do, even if they didn’t know: a healthwatch aims to keep an eye on health issues. Try asking someone out of the loop what they think a LINk does (you can even explain what LINk stands for if you are feeling generous) and I doubt a single person would make the intuitive leap to mention health.
The healthwatch programme needs a huge national push, even if each local healthwatch will operate slightly differently. There needs to be some central campaigning so that when people see the healthwatch brand somewhere, they have an idea of what it is all about. There needs to be simple, plain english descriptions about the powers – and just as importantly the limitations – of a healthwatch, again so that people understand what they can expect to achieve. And many of the other routes for submitting feedback need to start feeding into this one source, rather than creating micropockets of feedback only used by those who know where to look.
So far, all of this has focussed on the healthwatch, and through them the NHS. So why on earth are we writing about this here? Well, the funding for all of this is being run from the Department of Health through local government, who will then need to commission a healthwatch to deliver this service. There is currently some debate over whether councils will be commissioning an organisation to deliver a service, or are commissioning the services themselves (in which case why are they being commissioned externally when they could be delivered internally?), but generally speaking there are contracts being planned which will require a corporate body to be established to become a local healthwatch and deliver on a number of pre-agreed goals.
With public health moving into the Council in the future, this will throw up a wonderful issue around true independence. Will a healthwatch, who receive their funding from a local authority, really feel empowered to then tell that local authority that they aren’t actually doing a good enough job? Will the fact that these will be delivered by external organisations see them sugar coating their responses to garner a more amicable and friendly relationship in the hope of staying in the funders good books? And will local councils really have the fortitude to recommission these organisations, even if they don’t like what they are being told?
From what little I can tell, this entire piece of work – and I would by no means want to underestimate just how big a piece of work this actually is – is a constantly shifting beast which seems to create two new questions for every one that is answered. Current LINks are doing everything in their power (understandably so) to either position themselves positively to become a new healthwatch or to fight the system so that there will be no competition at all, whilst councils are all looking around at each other with little in the way of any strong, unequivocal and consistent guidance being given to them.
If these healthwatch organisations are to be in place by April next year, then the planning needs to begin in earnest now. To wait for too much longer will risk seeing nothing delivered at all, and the proliferation of feedback routes continuing (and perhaps continuing to grow).
All in all, this confusion is not creating a very healthy situation. Someone should watch it to make sure it doesn’t get worse.
Tusk tusk, you forgot to mention Health Scrutiny, which is also trying to work out how it fits into the Healthwatch programme. Actually some of the issues you talk about concerning the public knowing about Healthwatch are issues that Scrutiny has and continues to face since it began. How many residents understand what scrutiny does, actually how many Officers and Councillors understand it? Based on the last 10 years of scrutiny, Healthwatch have a lot of work ahead of it. By the way, good point made, the LINks are not going to automatically become Healthwatch.
It might also be worth pointing out that both LINk and HealthWatch have a broader remit than just health – they also cover social care services.
There are still so many unanswered questions about what HealthWatch will be able to do, will be expected to do and will be funded to do. The problem maybe is that these questions may never be answered and in the spirit of localism there will be a hugh amount of flexibility locally. That is difficult to get our heads round but not insurmountable. The major concern though is that this will soon become ‘Pickles’ localism instead of actual localism. In other words government will say you can do whatever you want locally but if we don’t like the choices you make we will come out swinging.
Working on the development of HealthWatch has, for me, highlighted many unanswered questions. It is anticipated that HealthWatch will be able to hold contracts and employ people. For current LINks to do this it would require a great change in the culture of the organisation and a quick development of the skills of members.
You do highlight the complete lack of guidance of how these bodies will come into being. If they are to be “procured” then there is a question of exactly who in any area is suitable to provide this sort of service. I doubt many of the current LINks would get through a procurement process merely through having no track record as corporate bodies.
I believe there is a preferred option of working with local groups to grow a locally responsive social enterprise to perform this function. Unfortunately this will take time and without guidance from the centre it is something that local authorities are reluctant to begin.
I think there is a lot of good in the idea and I don’t think it is an accident that the structure and functions mimic the old Community Health Councils. What we need is some clarification on what it is we can do locally rather than vague platitudes about local determination.