What do people think about local Healthwatch and why?

At the moment we (Leeds Beckett University) are doing some work for Healthwatch England developing ways in which local Healthwatch and their stakeholders can understand how effective a local Healthwatch is.

It is challenging to come to a view about the effectiveness of a small organisation with a very big remit whose impacts are often long term and therefore hard to measure.

One of the tools we are testing is to gather views of a wide range of local stakeholder organisations through a 360º process using the Healthwatch England Quality Statements (we developed these earlier in the year in partnership with local Healthwatch) to produce an analysis which is then considered at a facilitated workshop.

Gathering and analysing a wider stakeholder view should help contract managers (who are usually middle managers) have a more effective relationship with local Healthwatch.

What is clear is that the opinions of all stakeholders are shaped by the context they work in. Here are some thoughts:

It depends on where you sit

Organisational stakeholder’s perceptions are to some degree influenced by the position and role that they occupy, for example:

• Managers of services may have experienced local Healthwatch through being subject to an investigation or having sight of a report that may relate to their service. So, they will have a good and detailed knowledge of that specific interaction but may not be aware of the broader range of services that local Healthwatch provide or the other roles they perform at a more strategic level. It is also the case that a service that has been investigated by local Healthwatch will have to account for any criticisms they may receive to senior figures in their own organisation – this may feel uncomfortable.

• Leaders such as Cabinet Members, Directors and members of Governing bodies generally have a different experience of local Healthwatch. They are more likely to be aware of the broader scope of Local Healthwatch activities and may have a more personal relationship with local Healthwatch senior officers and board members through formal and informal strategic meetings.

• Different sectors perspectives vary. For example it could be argued that health providers have a view that is focused on the services that they are funded to provide. Local Authorities and NHS providers are large organisations and it is unlikely that all staff will have a shared understanding of a small organisation like Local Healthwatch, while a CCG with fewer staff and a broad health scope may have a more rounded view of local Healthwatch – but within the context of NHS commissioning.

It depends how you talk

There is evidence that the way that large organisations such as local authorities and NHS bodies are organised means that there is an emphasis on understanding the world primarily through analysis of quantitative data (demographic and performance) and evidence from research.

This is not the way in which citizens and communities operate where much more emphasis is placed on personal experience and the stories that describe them. Local Healthwatch operates in between these two constituencies, part of its added value is reflected in its ability to bring the public ‘into the room’ in a way that is understood and accepted by these large organisations.

Remember the history

Local Authorities and many health providers can often trace a continuous history going back over 100 years. It is very easy in the highly pressured environment of health and care to forget that local Healthwatch are actually very small and new organisations. Their effectiveness relies heavily on relationships, with the public and with stakeholder organisations. Local Healthwatch have been in existence for less than three years, they are still developing their expertise and their relationships with citizens and communities.

Moving Forward

So, any analysis of effectiveness cannot just rely on a totting up ratings and opinions – these are important – but there also has to be some account taken of the context that respondents are working within and it needs to be understood that the effectiveness of a local Healthwatch while ultimately its responsibility can be improved by bigger players in the system helping; actions could include:

• Including an explanation of the Healthwatch role in all induction for new staff
• Briefing middle managers on the role and current activities of their local Healthwatch
• Agreeing what good practice should be when working with local Healthwatch on an investigation

What do you think?

With thanks to Healthwatch Dorset and Leicester, the local authorities of Poole, Bournemouth and Dorset and of course, Jennie Chapman