Directorate for Adults, Health and Wellbeing : Briefing Paper

From: / Hazel Summers, Head of Commissioning
Contact: / Tel: 0161 234 3824, Email:
Date: / 1st February 2012
Subject: / Options for Healthwatch

Purpose of Paper:

  • To scope the key requirements on the local authority arising from the transition from Local Involvement Networks (LINks) to Local HealthWatch Organisations, as proposed within the Health and Social Care Bill 2011 and associated guidance and the role within the Health and Wellbeing Board.
  • To identify options for local implementation / procurement.
  • To present proposals to take this work forward in partnership with agreed stakeholders within the required timescale.

HealthWatch - a summary:

The government vision for the NHS seeks to put patients and the public first; the principle is based onshared decision-making; learns from people’s experiences of using services and listens to patients and the public in the commissioning and provision of services for local communities.

In line with this vision the current Health and Social Care Bill seeks to strengthen the collective voice of patients, users of care services and the public through the establishment of HealthWatch England and Local HealthWatch organisations in each county council and unitary local authority area.

Section 191 of the Bill sets out the responsibility on the local authority to establish Health & Wellbeing Boards; Local HealthWatch must be represented on the Board by one person appointed by the HealthWatch Organisation. No specific role/ duties are allocated, other than the general responsibility to link to consumers and provide a consumer voice.

Under Section 189 (preparation of JSNAs) and Section 190 (preparation of joint health & wellbeing strategies) the local authority and partner Clinical Commissioning Groups have a duty to involve Local HealthWatch.

The HealthWatch brief extends across all services provided as part of the National Health Service in England, for all ages. However in respect of social care DoH guidance restricts the brief to adult care services for people over 18. However, it is evidently important that key links are made with Childrens Services and the Childrens Board especially when considering transition. The original legislation makes reference to “social services functions as prescribed within the meaning as in the Local Authority Social Services Act 1970”. This may also mean that other services in respect of children may come within the remit. We are waiting for further national guidance. The Council will ensure that representation is made from all stakeholders including minority groups to meet its responsibilities with regard to equality and diversity.

The statement of intent positions HealthWatch as the independent consumer champion for the public, locally and nationally in order to promote better outcomes in health for all and in social care for adults. Local HealthWatch will achieve this through three layers of activity.

1. The provision of support to individuals by:

  • Being highly visible and accountable in the community, known about, understood and trusted by local people as a source of information and support.
  • Supporting people to access information and make informed choices about their health and care and treatment options available to them.
  • Empowering and facilitating people to speak out, including through NHS complaints advocacy.

2. The presentation of consumer views by:

  • Providing strong, independent, local consumer voice on views and experiences to help bring about better health and social care outcomes
  • Monitoring local health and care services and make recommendations to commissioners and providers of services about things that could or should be improved.
  • Providing authoritative, credible and influential representation on Health & Wellbeing Boards, Commissioning Groups and other providers of services, to help shape and improve services.
  • Proactively researching information about local health, care and public health services, contributing to the local JSNA and health & wellbeing strategy.

3. Organising appropriately to local requirements by:

  • Operating in a way that encourages and facilitates participation from all individuals and stakeholders who wish to be involved, in a transparent way with clear accountable governance which anchors the organisation within the community.
  • Actively engaging and involving people that need help to be able to contribute, underpinned by principles of equality and diversity.
  • Understanding local voluntary, community & patient participation groups.
  • Having excellent relationships with commissioners and provider services and acting as an informed and critical friend to both.
  • Understanding local needs, national health & social care policy and the capacity to engage and applying this as a member of the Health & Wellbeing Board
  • Developing a well led organisation open to self assessment, scrutiny, and continuous improvement.

Key dates:

HealthWatch implementation has been delayed until 1/4/2013. This provides more time to work up the "Manchester HealthWatch Model" as more guidance emerges; HealthWatch England will be established in October 2012.

Key finance issues:

  • There is some funding in 2012 /13 to support development of HealthWatch (£3.2million across England). and is allocated via the local government formula.
  • For the current spending review period up to 2014/15, LINks and HealthWatch funding is no longer ring fenced but is contained within the DCLG Formula Grant, the Council has identified £80,000 pa which funds the existing LINk arrangements.
  • The DH is consulting on the funding transfer arrangement that will apply in respect of the transfer of signposting arrangements from Patient Advice and Liaison Service.
  • The DH is also consulting on funding arrangements in respect of the transfer of NHS complaints advocacy, this will be determined in the autumn funding settlement 2012/13.

Transition from LINks to HealthWatch:

A HealthWatch Programme Board and Advisory Group has been put in place at national level with sub-groups and action learning sets containing strong representation from LINk members. All documentation stresses the need for evolution from LINks to HealthWatch and the retention of skills, learning and the goodwill of volunteers.

A number of local authorities and LINks are pathfinders in the HealthWatch Pathfinder Programme to test out various aspects of HealthWatch operation, engagement strategies, service standards and governance models e.g. Oldham is exploring HealthWatch’s potential role as a gateway to local advocacy services and will not report before April 2012.

The legislation reinforcesthe right and responsibility of local authorities to determine their own local HealthWatch arrangements according to local requirements, to ensure effectiveness and to secure best value.Local authorities will have powers via the Secretary of State to dissolve and replace a local HealthWatch organisation if it is not operating effectively.

Legislative Framework:

Under the Health and Social Care Bill previous legislation which required local authorities to establish Local Involvement Networks (LINks) will be amended to require the establishment of Local HealthWatch organisations and introduces the new duties detailed above.

Legislation will also establish HealthWatch England as the national independent consumer champion, operating within the structure of the Care Quality Commission (CQC). It will provide support and advice for local HealthWatch organisations.

HealthWatch England will be represented on the board of the CQC and will advise the Secretary of State for Health, the NHS Commissioning Board, Monitor, and the CQC about concerns raised by local HealthWatch organisations. Regional CQC staff will establish liaison arrangements with local HealthWatch.

At this stage there is a great deal of uncertainty across local authorities as to the appropriate governance structure forLocal HealthWatch organisations. The Bill will empower the Secretary of State to issue guidance as to membership, but uncertainty remains around government intentions re guidance compared with local determination.

Schedule 15 of the Bill states that a local HealthWatch is a “body corporate” and independent of the Crown. It may appoint employees, enter into agreements, acquire property, cooperate with public authorities and generally do anything that is expedient/ necessary in the exercise of its function. This may include raising additional funds. However, there are various views on the interpretation of this clause and specific form of corporate status Local HealthWatch organisations should adopt. We are currently seeking local legal advice from Legal services.

The local authority is required to put in place arrangements to establish this “body corporate”, and whilst the function requires a substantial degree of independence from the local authority it has continuing responsibility to ensure that the organisation operates effectively and provides value for money.

Should the local authority be dissatisfied, it has power alongside HealthWatch England to apply to the Secretary of State to dissolve a Local HealthWatch organisation. This is a complex governance / constitutional relationship which will require some precise legal interpretation if further statutory guidance is not forthcoming.

Option Shaping - messages from other local authorities and sub regional seminars:

All local authorities represented at the Greater Manchester HealthWatch Commissioning Seminar are in a similar position and areexploring the way forward through policy expectations and financial realities in the absence of any certain central guidance. CQC representatives have suggested that further guidance may emerge in January2012.

HealthWatch will be set up by the local authority but must be an independent organisation to avoid conflicts of interest andmust be reflective of the diverse community it serves. Previously the approach has been a procurement modelwhere the Link has been hosted by an external organisation, which avoided any specific corporate identity issues. Furthermore,Guidance to date has proposed that Local HealthWatch should be developed with LINks and the wider Voluntary and Community Sector (VCS).

Healthwatch should have a strategic role with representation on the Health and Wellbeing Board; it should be strong, open and accountable with good mechanisms in place to ensure it is a two way process between Local HW, the community it serves, and the Health & Wellbeing Board. Healthwatch should also play an important part within the development of the Joint Strategic Needs Assessment (JSNA). Many areas now have a Transition Group involving stakeholders and the key message is that if this is not already in place it is important to get this up and running. Locally, it was felt important that the budget reductions to the current LINk were not blurred with the establishment of a transition group.

Finally, there was some agreement that there may be benefits from joint procurement of back office functions and particularly NHS advocacy (which is currently sub-regional via ICAS).

Research from the Pathfinders and through the regional seminars has shown that thekey issues are:

Body Corporate – the legal entity

To date none of the authorities have chosen a specific model as an independent Legalentity; in reality this would probably mean a board of directors / trustees which is quite different from LINks. The functions of LINk will transfer into the new organisation but not any current LINk governance arrangements

Patient Advice and Liaison Services (PALS)

The key question is what element of PALS will transfer to Local HealthWatch; this will need to be worked out at a local level between the local authority and the Trust or other body that it currently sit in.

TUPE

The national view is that any TUPE of NHS staff would have to follow the national NHS Framework but arrangements would be based on local needs. Whereas, other staff, such as from the current LINk organisation, may also be subject to TUPE arrangements

Community Engagement

It is recommended that we should now beraising awareness of HealthWatch to ensure that wehave good community engagement to identify the kind of HealthWatch people want and also how they want to be able to engage with it. Furthermore, we also need to make sure thatall equalities groups are engaged in its development.

Most authorities are taking consultations forward in conjunction with their local LINk, with some looking to manage the critical tensions within these statutory responsibilities via the corporate core, at arms length from the lead service directorate. However, it was recognised that each local authority will shape its own local HealthWatch arrangements to reflect local influences. However, given the amount of provision which crosses local authority boundaries it is evident that cooperation will be required across HealthWatch organisations.

Developing the Manchester HealthWatch Model

Both national and local influences point to the need to develop a “Manchester HealthWatch model” which reflects local circumstances.The following issues / challenges should inform the model and need to be developed within wider consultation.

The model should reflect the commitment to an integrated whole system approach to health and social care planning and delivery. However, HealthWatch must be delivered at an economic cost which balances the importance of the HealthWatch function against the priorities set by the Council and the acute financial pressures on direct health / social care service provision. Best value will have to be sought against a limited budget and built into the shared vision and specification from the outset.

The service can be broken down into its key functions and different options considered for each element as follows:

1. The presentation of consumer views

In securing best value, Manchester HealthWatch could be positioned as a Hub, in order to engage with established patient forums, specific disability /condition groups, equality groups and community and ethnic organisations, rather than duplicating them. Such organisations have a wealth of experience as regards the consumer experience of heath and social care services. The Hub could gather the views of these groups and then present those views through the Health and Wellbeing Board

Furthermore, MCC and NHS could look to secure added value from HealthWatch investment, utilising HealthWatch as a proactive part of the “duty to involve” and consultation programmes.

HealthWatch should be creative and inspirational in capturing the imagination of individuals who want to get involved in influencing the development of the health / social care services and to improve access. Volunteering routes could be developed through “Manchester volunteers” to make a contribution to the agenda through, for example, administrative, advice and research roles.

Relationships should be built with academic / research institutions as sources of information and support. External funding and partnership opportunities should also be explored in order to develop the HealthWatch work programme.

As a member of the Health and Wellbeing Board HealthWatch must share a vision for health improvement, capable of negotiating challenging times within which difficult decisions will have to be made.The shared vision should not compromise HealthWatch’s role as a credible, independent, accessible health and social care consumer champion.

2. The provision of support to individuals:

a) Signposting to Services

The Health and Wellbeing Board should look for ways to reinforce “visibility and access” at economic cost e.g. HealthWatch might be co - located within the re configured MCC Customer Service facility, emphasising the centrality of health care access and information for Manchester residents.

b) Complaints/ advocacy.

There is potential to undertake a joint commissioning/ procurement exercise with Greater Manchester Authorities for this service; this is currently provided by ICAS over the North West. Access to this would be via the HealthWatch Hub.

Shaping the “Manchester way” forward:

Given the parameters the options at this stage appears to come down to where the line is drawn between:-

  1. A locally negotiated “Organic route” to growing a HealthWatch Organisation which then takes responsibility for its own development and negotiation of budget /support arrangements with the local authority, or
  1. A “Procurement route” where, similar to the “LINk Host” role, a provider is contracted to develop and support the organisation. This could include consortia arrangements which involve a range of organisations to meet the needs of diverse communities.

Both routes could encompass the HealthWatch Hub model whereby existing patient /service user groups would be key stakeholders and undertake delegated activities within the overall coordination of the HealthWatch Hub.

Both routes would need an inclusive, consultative approach which enabled an independent Local HealthWatch organisation to emerge, with informed but unpaid consumer leadership providing executive direction to a small employed HealthWatch Development / Support Team.

The Organic route is more complex in governance terms and will demand more officer time or external consultant guidance. The Essex Pathfinder Model (see Appendix 1) provides an example of how this might be taken forward by utilising a local authority governance process to appoint an interim HealthWatch Steering Group; Kent has a similar approach. The Organic route may provide more focus and control around core requirements with a more hands on role for the local authority.

The Procurement route simplifies the task to a specification and procurement transaction and immediately creates the independent distance from the local authority which is implicit in the “critical friend” role.

However, the choice of a host or strategic development partner is crucial. This model has had mixed results in respect of LINks, there is limited choice of such organisations. It risks exposure to alternative agendas and uncertainty as to where control and direction rests.

The Strategic Director AHW met with the Chair and representatives of the LINk to discuss Healthwatch developments, interim arrangements until 2013 and the need to continue to support and value the contribution of the LINk volunteers. It was agreed that a copy of the final draft of this paper would be circulated to the LINk.

Consultation

It is important to consult with key stakeholders regarding the keys aims and values of the “Manchester HealthWatch Model” and these two options (plus any others that emerge). Thiscould form the basis of a 12 week consultation exercise which would take us up to April 2012. The results of the consultation and any guidance could then feedback into relevant decision-making processes at the Health and Wellbeing Board.