Lets get my cards on the table.
First, I think investment in mechanisms to help citizens hold local commissioners to account is a GOOD THING.
Second, efforts that we have made so far to do this – Community Health Councils, Commission for Patient and Public Involvement in Health and LINks have all been a bit wet. In all the turbulence since the election the voice of LINks – the key agency for getting the citizens voice heard has been almost completely absent from the debate about the future of the NHS, the role of public health, the impact of policy on health inequalities – etc etc.
I don’t want to decry the achievements of LINks – in the DH annual report for 2009/10 there are interesting examples of success – not least some evidence of successful service change and of savings achieved.
As we move towards October 2012 and the implementation of Healthwatch we need to make sure that the debate about its contribution is powerful, lively and public. Will the proposals put forward by DH allow local authorities to build on the successes of LINks and move to more powerful engagement with citizens? We certainly need it to.
I suspect I will return to this issue – but for this posting I am just going to consider the money – as this is the subject of the very narrow “consultation on allocation options for distribution of additional funding to local authorities for Healthwatch etc” that the Department of Health is currently running until the 24th of October.
The consultation seems to me to have two purposes one explicit and the other implicit. It explicitly puts forward for comment two methods of calculating funding for Healthwatch, NHS Complaints Advocacy and PCT Deprivation of Liberty Safeguards. It also brings together these three areas in one consultation – implicitly raising the question about whether these functions could be commissioned from one organisation.
To be honest I am not really interested in which of the two models that DH puts forward for calculating local allocations is the right one – they both reach roughly the same figures – and I don’t think that is where we should be spending our energy.
We have to be thinking about what Healthwatch is tasked to do and what it needs to do to achieve this – the money follows.
Some figures from the consultation
Existing LINk funding £27m
Signposting funding taken from PALs £19.3m
Additional Choice Money £.5m/1m/1.5m per year from 2012 onwards.
Some start up money £3.5m – first year only
I am not going to talk here about other funds which are also included in the consultation (DOLS, IMHA etc)
The funding equates to roughly £47m a year. In the absence of any clarity about what a good model looks like DH have presented us with the two formulae in the consultation. While superficially this appears objective and evidence based I don’t think it is good enough. This is because the models that DH use for calculating investment in Healthwatch bear little relation to the challenges we face which include:
- a new health system which will require very strong local organisations holding Clinical Commissioning Groups to account
- greater focus on providers to ensure that they do not reduce quality as they try to cope with government spending reductions.
- the need for an even stronger focus on wicked areas such as health inequalities
- the need for strong advocacy at a national level to hold the government to account for their drive to marketisation
If government ambition is to be met and if health and well being services are to be protected and improved we will require Healthwatch to deliver a well informed and active citizenry who are engaged to a degree that we have not seen before.
So, lets compare the proposed funding against a model that has been running since 1939 – Citizens Advice. I am using this for two reasons – First, because the government has said that Healthwatch should become more like a “Citizens Advice Bureau for health and social care” (DH consultation – Liberating the NHS Local Democratic Legitimacy in Health) and secondly I know a bit about it having been involved in CA at a local and national level for some time.
Local Citizens Advice Bureau funding in 2009/10 was £179m with a further £62m going directly to the national organisation. In that year Citizens Advice organisations helped over 2 million people – this compares to 192,000 seen by LINks in 2009/10. (Note that in addition to Citizens Advice there is also a large network of independent advice centres who are affiliates of Advice UK). Of the 28,000 or so staff employed by Citizens Advice about 75% are volunteers – who have access to high quality training and development support.
In simplistic terms the Citizens Advice network provides two services – helping individuals with their problems – welfare rights, debt advice, signposting, advocacy AND analysing the 1:1 support it gives – to inform its social policy campaigning nationally and locally.
There are of course no figures on performance for Healthwatch – yet. My argument is that Citizens Advice data – on cost and service start to gives us some clues about how we could develop a stronger model for looking at cost.
A stronger model for resourcing Healthwatch?
First – are we expecting Healthwatch to provide a similar service in terms of population coverage to Citizens Advice – if so, then why is Healthwatch funding only just over 20% that of Citizens Advice? Is this because it will be seeing fewer people? what it does is less complex? It has less of a role as a social policy champion?
Second – is it realistic to expect Healthwatch to offer a similar range and quality of service to Citizens Advice? If so then it is worth considering the CA service model which has elements that include:
- an integrated approach to service that ranges from national web based advice and phone advice lines to local face to face provision
- a national membership system which provides quality assurance, training, access to specialist advice etc
- a standardised IT system that allows data to be aggregated and quality assured at a national and local level
- a powerful independent national policy function that can speak strongly and independently about government policy
Third – if we accept that the above makes sense are the current proposals about investment sensible? For example it seems strange to develop and consult on the funding allocation at a local level without considering the resource implications for the whole system – what will CQC provide and how much will it cost?
So – as we move towards the commissioning of Healthwatch – I remain concerned. I think that DH offers us a financial model that is based on data that has weak links to the new role of Healthwatch, does not include adequate clarity about the role and functioning of national Healthwatch and does not seem to build on existing experience and practice of agencies who have been working in this field for a considerable period of time.
What do you think?