Local Healthwatch – Setting Priorities – how systematic can we be?
I am involved in 3 local Healthwatch and as they get going one of the first things to think about is the process of setting priorities.
At the moment there are two things I am thinking about.
The first is how to select the priorities of today?
I think that one of the biggest challenges is getting the balance right between the memberships views and other views of priorities. An approach that gives too much weight to building a workplan based purely on the views of its membership runs the risk of setting priorities that do not reflect some of the real underlying concerns that need to be addressed within a health and wellbeing system.
It also lets the Healthwatch organisation off the hook – allowing it to say ‘this is what our members said were concerns’ and therefore not taking sufficient responsibility for addressing important system level concerns that the membership did not raise.
I think that there are three key areas that a local Healthwatch needs to consider and it is the way in which it manages these that then help shape local Healthwatch Priorities.
These three areas are summarised in the diagram below:
The Official Line – What key public documents say
I think the first place to go are the reports produced by public organisations. I am still feeling my way here but would suggest that this should include:
- The Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy
- Quality Accounts
- Local Accounts
- Relevant CQC Reports
- What other documents would you add?
There is a limit to how many documents a small organisation can read but I think that the above list are probably the essential ones. The key issue is to consider these seperately from any official consultation process. Together these documents represent the official shared narrative of priorities and quality in a place. This is not of course the same as a true narrative!
The Unofficial Line – what the professionals say
Many managers and directors in key organisations will have a clear professional view of system level challenges and failures. A lot of them will be working hard to champion improvement and will be finding it slow or worse. Some will be keen to share their concerns informally – in the hope that some external pressure or interest will help them drive work forward. A gentle process of informal dialogue with a range of key managers will help test ideas about where to probe, investigate and test.
Voice – what the public say
This is clearly crucial. I think that one of the challenges is how to use this important democratic mandate to greatest effect. Listening to the views of the Healthwatch membership and special interest groups is not enough. This has to be about building a mandate through dialogue with these groups. I think this will mean taking a risk and presenting an analysis based on the official, unofficial and voice information and being willing to debate this and amend it with the membership – producing a set of priorities through this process.
The second issue I am concerned with is how to strengthen the democratic voice in the future?
In many cases Healthwatch has inherited quite weak processes from the outgoing LINK (I know not all!). I do think that now is the time to recognise this and it is reasonable to focus some energy in year one on working with key stakeholders to establish processes to improve public engagement processes for the future. It is in local Healthwatch’s interest to ensure that the system as a whole puts energy into raising its game with regard to public engagement as a priority in year one.
What might this look like?
In year one this might mean convening a cross sectoral group involving the PPI leads from the CCG(s), Local Authority, NHS Trusts and big care service player to consider how public voice plays in across their organisations and the local system.
For example:
What is the balance between:
- Membership
- Complaints
- Consultation – individual and collective
- Representation – from membership/patient fora/governers and none exec directors
- Co-production – from focus groups to volunteering
- Feedback – how does this happen?
What support is available for the public (patients, people using care services, carers, the public as a whole, people who experience discrimination) to engage and participate for example:
- Information provision
- Training
- Interpretation
- Community Development Support
A shared view about deficits and ambition would help lay the foundation for a system that places a greater emphasis on public involvement in priority setting in future years.
What do you think?
This is such a critical issue. Having been previously a member of 2 Community Health Councils (CHC’s) in Liverpool and Sheffield, the creation of local Healthwatch organisations could be an opportunity to germinate the idea of local ownership of healthcare services.
Since the creation of NHS Trusts, and then Foundation Trusts, the links of accountability have all but disappeared. When the old Health Authorities (which weren’t exemplars of democracy) had a TUC representative and local authority representatives, and the local CHC sat at the table with a voice (if not a vote) then there was a feeling that there was some local accountability……
Having sat in Foundation Trust Board rooms, the role of ‘FT Governors’ has clearly created a smokescreen of accountability.
If Healthwatch is going to make an impact, it needs to be bolstered with local elected Councillors, patient groups and healthcare trade unions – anyone interested in achieving the best standards in healthcare delivery.
I share your concerns and have become so battle-weary with the scrap-it start again (but still making the same mistakes). We are 2 years into ‘transition into Healthwatch’ and ‘shadow organisations’ – and frankly, a lot of LHW organisations (in their many guises) are nowt’ but LINKs with a seat on the Health & Wellbeing Boards. So what… ….well, I guess at least those LHW are actually doing something – unlike my LHW.
I don’t share your trust in the LAs however. Unless kept at arms length many (not all) ‘local elected councillors’ and the LAs (sometimes in control of certain LHWs) often become the barrier to improving healthcare – but perhaps that is my local bias.
We do need HW (or something like it), but as independent, consistent and well-formed as possible. If LHW is the ‘consumer champion’ then it has to be better than what went before it at the very least (and the article above is right to throw some questions into the pot about this) but what we actually have is a hotchpotch of groups that may or may not be around in a few years time, and crucially, they may or may not be functioning ‘properly’ until next year when advocacy and complaint functions are expected of them.
Hi Rob – really valid points – I am not sure whether it is tactically appropriate at this stage for local Healthwatch to be deliberately making space for trade unions (and save our NHS?) – they are at an early stage of development…however, I would hope that a range of stakeholder groups like trade unions and others will be looking at local Healthwatch and encouraging their members and key activists to engage with it.
…I forgot to say – great graphic – a stylish solution to poor-power-pointed-pixels!