Tuesday, 19 June 2012

We Need To Talk About HealthWatch ... And ACT!

HealthWatch is in danger of becoming the Cinderella of the NHS troika – and it is YOUR job (and hugely in your interest) to act now to make sure it doesn’t.

For all we hate it because its subvert aim is to marketise health, the Coalition’s NHS is truly elegantly-designed as a three-strand plait.  
However awful it may turn out in practice, it looks good on paper.

CCGs and HWBBs
At the heart of the new NHS, of course, will be the Clinical Commissioning Groups (CCGs), comprised primarily of GPs and clinicians.  These are the groups which will be taking over from the Primary Care Trusts – which will be spending the money and commissioning the NHS services.  They are required to include ‘lay people’ on their board, but a quick glance at the person spec is enough to make you realise that these are not ‘ordinary people’ in our understanding of the term.  I would guess that most will turn out to be retired clinicians.  The CCGs are intended to be very high-powered, very expert groups.

Inter-twining their role with the CCGs, will be the Health and Well-Being Boards (HWBBs).  If the task of the CCGs is to excel, the task of the HWBBs is to keep them grounded in reality, in the medical and social needs of the local people.  The HWBBs will include representatives from the local CCG, but its main body will be comprised of relevant Council officers (e.g. the directors of public health, adult social services, children’s services etc.) and as many Councillors as the Council chooses to place on it.

Local HealthWatch – what it can do for YOU

The third (and most important for us) strand in the plait will be the Local HealthWatch.  Each council area will have one and, for us ordinary people, this is the most exciting part of the process – the part that we will have a say in, and the body which will represent us most directly in the NHS process. 

LHWs, in the government’s scheme of things, are intended to be a development of the NHS Local Involvement Networks (LINks).  The LINKs were set up in 2008 to provide proactive client scrutiny for the local NHS; one of their powers is ‘Enter and View’, and a significant strength is that they are allowed to present anonymous testimony.  Although in many parts of the country, LINks have been badly-publicised and ineffective (and you may even be unaware that you have one at all in your authority), some are run very energetically by an independent Management Committee elected from the membership, with office function supplied by a ‘Host’ provider commissioned by the County Council.

LHW is LINk writ large. 

LHW will be a ‘hub’ of all the different health and care networks and will thus constitute a ‘one-stop-shop’ – a ‘no wrong door’ – gateway of access to the NHS for ordinary people, helping them where possible, or ‘signposting’ them to the appropriate health or care services where necessary.  It will provide NHS complaints advocacy.  It will seek and solicit the needs and views of local people and feed them to the HWBB (on which it will have a seat) and the CCGs, so that those commissioning bodies can use them to inform the commissioning process.

A Role in Scrutiny

Most of all, the LHW will have the power (and the duty) to MONITOR the local NHS – not only its services, but also its processes (i.e. the HWBB and CCG). 
This is the intended primary role of the LHW, and by far the most important.

Most of us have a love-hate relationship with the NHS.
At one level it is our pride and joy – the pinnacle of our Welfare State.  Health Care irrespective of person, and free at the point of need, is a principle British people value, almost as a defining factor in their ‘Britishness’ … and when Americans recently took to criticising our NHS, their comments were decidedly unwelcome!

Having said that, however, we all know that the NHS is a strange Dr Jekyll character – at one moment miraculously bringing back your wife, literally, from the dead … then taking all afternoon to conduct the simplest eye examination.  Talk to anyone about the NHS – especially to those with chronic conditions – and you will hear story after story of an NHS which is alternatively unprofessional, cruel, careless, lazy, profligate, inefficient and downright incompetent.  Worst of all, you will find that most people don’t bother complaining, for fear of victimisation, or because they believe that the medical profession will ‘close ranks’ and that resistance is futile.

In this situation, LHW could be the most valuable and important part of our NHS, not only because it will have the authority proactively to seek out client experience and feed it through to the HWBB and thereby the CCG, but because – through HealthWatch England – it will have ‘teeth’ … HealthWatch England, through the Quality Care Commission (QCC) will have the power to force HWBBs and CCGs to change.

Credit where credit is due; if the LHWs work like we would want them to work, we could end up thanking the Coalition for a truly marvellous piece of legislation (at least in this respect).

Finding out the details
As you read this, your local County or Unitary Authority is busily planning its Local HealthWatch.  Are you aware of what it is doing? Has it consulted with you?

These are the crucial days – the days of creation.  There will be a terrible impulsion at Council level to create an anodyne, compromised HealthWatch – all show and no teeth.

Chase your local Councillors and make sure that they are aware of what is going on, that they keep you informed, and that they are pressurising for an incisive and effective HealthWatch.  Go on your local council website, search for ‘HealthWatch’, and see what is going on.  Locate the scoping document, and demand the commissioning criteria.  Where there is a consultation, get involved and make your views known.

The Local Government Association (LGA) has published a guide: Building Successful HealthWatch Organisations.  Compare the HealthWatch proposed by your local Council to the models described by the LGA.
A good HealthWatch spec, says the LGA, will address nine key criteria – purpose, membership, responsibilities and competencies, functions, governance structures, methods of accountability, outcomes, milestones, and outputs.  How comprehensively does your LHW model prescribe for these areas? 

Two Key Issues
This is not something that can be campaigned nationally, for the government has stated that every LHW will and should be different, to meet differing local needs.  So it will be up to you to find out what is going on locally, and to shout out if what is going on locally is not what is needed locally.

However, I would suggest that there are two issues which are worth especial scrutiny:

First, make sure that MONITORING is at the heart of your LHW.  Is the primary and explicit focus on scrutiny?  Does your Council model stress proactive monitoring as the primary function of its LHW, or has scrutiny got buried in a welter of essentially cosmetic functions?  Does the model define HOW, and how often, the LHW will monitor the quality of local NHS services?  Above all, does it state explicitly that the LHW will monitor the quality of the commissioning process (i.e. the CCG and the Council’s HWBB) as well as simply the quality of the services commissioned?

Secondly, research the proposed membership and governance of your LHW to make sure that there is a democratic element. 
To be fair to your Council, this is not required.  Of the exemplar Councils in the LGA guidance, only two (Derby and Essex) were explicitly moving towards a full-on democratic model.
But – if the LHW is NOT at base a democratic body – how can it ever be wholly representative of the public?  The alternative to a democratic body is a paternalistic quango, ‘consulting’ on its proposals, telling us what is best for us, and then networking as fellow-professionals with the services they are supposed to be monitoring.
Yes of course there will need to be professional input – in most cases, the extended brief of the LHW will be way beyond the often amateurish LINks.  But you should make sure that your Council is insisting that the LHW has a stated strategy for an extensive and active membership, and you should insist that at least a third of members on the Management Board are lay delegates elected from that extensive membership.

This is all something that you will have to do yourself, for your own LHW.  If the new NHS is a thee-fold plait, the LHW must not be allowed to be a weak strand within the model, or the whole structure will function inadequately.

You may find that you have to pursue the issue in the face of downright opposition from your local Council, which would much prefer to construct their LHW to be as pliant and ineffectual as possible.  But you know as well as I that it is in our interest that the Local HealthWatch is as fearlessly invasive and critical as possible.

As John F Kennedy said in his inauguration speech: “Ask not what your country can do for you - ask what you can do for your country” – and this is your time to do something for your local NHS.

1 comment:

  1. Interesting: This weekend healthcare campaigners will gather for a conference on how to fight the Coalition’s newly passed Health Act. http://www.leftfutures.org/2012/06/reclaiming-the-nhs/