Healthwatch England

One of the outcomes from the Government white paper Equity and Excellence: Liberating the NHS (July 2010), is to attempt to "strengthen the collective voice of patients and the public". The Health and Social Care Bill, currently going through Parliament, makes provisions for the establishment of Healthwatch, to be a new independent consumer champion and a statutory part of the Care Quality Commission (CQC). CQC say they are clear that Healthwatch should be a separate arm of the regulator. It must be close enough to CQC to influence regulation and share information, but retain enough independence to be a strong consumer voice, constantly challenging on behalf of local people..

Subject to Parliamentary approval Healthwatch will be set up at two levels: Healthwatch England in October 2012 and local Healthwatch to be introduced from April 2013. Royal Assent (when the Bill becomes an Act) is expected by May 2012. To follow the progress of the legislation, go to the Parliamentary website:

Lord Howe, Parliamentary Under Secretary of State for Quality says in the introduction to the The Department of Health Healthwatch transition plan:

· "Our plans for Healthwatch will provide people with a single point of contact. They can put people in touch with the right advocacy organisation, or help them find information about the choices they have; they can support people to speak out and they can give those who want to get more involved the opportunity to do so".

The Department of Health vision and expectation of local Healthwatch:

The Government's view is to create "a strong local infrastructure" that will enhance the role of local authorities in promoting choice and complaints advocacy, through the Healthwatch arrangements they commission". Healthwatch role is to:

• Present views, shaping and monitoring health and care services
• provide the strong, independent, local, consumer voice on views and experiences to help bring about better health and social care outcomes;
• monitor local health and care services and make recommendations to commissioners and providers about things that could or should be improved;
• be authoritative, credible, and influential with commissioners and providers of services, to help shape those services, and help them to improve;
• contribute their information about local health, care and public health services to the Joint Strategic Needs Assessment process and the health and well-being strategy.

Supporting Individuals

• be highly visible and accountable in the local community, known about, understood and trusted by local people as a source of information and support;
• signpost people or help them to access information thus helping them exercise choice;
• empower and facilitate people to speak out, including through NHS complaints advocacy.

Organisational behaviour

• operate in a way that encourages and facilitates participation from all who want to be involved, including acting in a transparent way
• actively engage and involve people that need help to be able to contribute, underpinned by principles of equality and diversity
• have a good understanding of local voluntary and community groups, other patient and public groups, like Patient Participation Groups and foundation trust membership and how they complement each other. This will enable local Healthwatch groups to work through and with local organisations to understand and present the views of local people, and effectively signpost people to information and advice
• have excellent relationships with commissioners and providers, acting as a critical friend, informed about the experiences, needs and aspirations of local communities
• have the capacity to use health, social care and public health information and to help others to do so
• have an in-depth understanding of the issues facing the local community, and apply this as a member of the local health and well-being board
• be a well-led and well-managed organisation, including being open to scrutiny (for example through self-assessment and peer review), seeking continuous improvement
• have a high level of knowledge and expertise in health and social care policy and implementation, including keeping up to date with developments for example in personalisation.

At national level - Healthwatch England:

• Healthwatch England will provide leadership, advice and support to local Healthwatch.
• Healthwatch England will provide advice to the Health and Social Care Information Centre on the information which would be of most use to patients to facilitate their choices about their care
• Healthwatch England will provide advice to the NHS Commissioning Board, Monitor and the Secretary of State and
• Based on information received from local Healthwatch and other sources, Healthwatch England will have powers to propose CQC investigations of poor services.

In a nutshell this is what Government are proposing:

• The role of LINks will evolve to become local Healthwatch which will have an expanded range of functions. The service will be commissioned by local authorities. There is no automatic rite of passage for the LINK to become a local Healthwatch organisation; local authorities have freedom to choose who they want to commission the service from and what they consider to be best for their area. (There is no central government directive on this process)
• From April 2013 local authorities will take on responsibility for commissioning local NHS complaints advocacy services for people requiring support to make a complaint. Although Healthwatch is about health and social care services, the complaints advocacy will only be about health services.  Complaints advocacy can be commissioned by the local authority  from Healthwatch or any independent advocacy organisation. 
• The DH will make additional funding available to local authorities to support the set up of local Healthwatch
• Local Healthwatch will have a seat on the local authority health and well-being board, to ensure consumer voice is integral to decision-making
• Chair of Healthwatch England to be appointed April 2012
• From April 2013 PALS (Patient Advice and Liaison service) and ICAS (Independent complaints advocacy service) will no longer exist in their current form.  Many of their functions will move to local Healthwatch  (NHS complaints advocacy and signposting to health and social care related services)

The role of independent advocacy

Disadvantaged groups of people are frequently left out of debate and their ability to exercise choice and control is often lost in an unequal system where the needs of the strongest are heard and the weakest ignored.

The intention of independent advocacy is to see and hear the human side of people and not just the clinical side that looks at what others believe to be the best solution or treatment in any given situation. Advocacy support is vital to ensure there is patient engagement if many vulnerable people are to get the choice and control in decision making to which they are entitled. Their voices need to be heard so that they receive services that they need not just as patients but as people.

It has always been the intention of advocacy services to enable each individual to have maximum choice and maximum control in the way their lives are managed. For many with profound learning disabilities, autism, dementia or those experiencing mental ill health, control is not always possible without an advocate to stand by their side and ensure that they are listened to. It is very difficult for them to hold services to account when they rely on those very services for their existence. One only needs to look at the recent account of Winterbourn View in Bristol to see how often services and their regulators fail to keep those very people safe from harm.

The overall purpose of Healthwatch is to give people more say in how care and health services are monitored and delivered. There is concern that at this time of funding cuts local authorities may mistakenly believe that there is a system in place to support people to speak up about the services they receive and therefore the long standing need for independent advocacy will no longer be there because Healthwatch has taken up that role 

Throughout the Government white paper Equity and Excellence: Liberating the NHS (July 2010), Advocacy is mentioned but there is sometimes confusion over the meaning of the word 'advocacy' and 'independent advocacy'. It is important that during this time of changing legislation and planning for the future, that those making the plans consult with the independent advocacy sector to ensure that 'advocacy' is understood in its' fullest meaning. Unless advocacy organisations take on some of the responsibility to ensure that this consultation takes place, then the advances made to date in the provision of independent advocacy could be lost.

The Department of Health Healthwatch transition plan, concentrates on what can be set out now, while the legislation putting things in place goes through the Parliamentary process, before Healthwatch England begins to operate and before other parts of the NHS, social care and public health systems have changed.

Despite the regular references to advocacy in the white paper Equity and Excellence: Liberating the NHS (July 2010), the Department of Health Healthwatch transition plan makes no mention of working with locally based advocacy organisations. It would therefore appear that it will be up to advocacy organisations to make the connections and lead on the partnership working if advocacy is to remain an independent voice for those who seek to access it. This should be sooner rather than later before Healthwatch becomes established as that independent voice, and independent advocacy is deemed to be no longer needed.

It is vital that we ensure that independent advocacy is included as an integral part of the new health and social care bill and that those producing future plans understand how they can build on what works, so that groups of people are not left without a voice and with services that are unable to be as responsive as they need to be.

22nd February 2012