What are Healthwatch England up to?

I am writing this blog in a personal capacity – these are my views.

I recently attended a working group convened by Healthwatch England (HWE) – that is  developing actions that could lead to HWE making a case for taking over commissioning responsibilities for local Healthwatch from local authorities.

According to HWE this shift stems from discussions with local government, local healthwatch and a report they commissioned from the independent consultancy Kaleidoscope – unfortunately this report does not appear to be publicly available.

This extract from the papers of the Healthwatch England Board held in May 2024 states:

My reading of the Kaleidoscope report does not make me think that their primary recommendation was to transfer commissioning responsibilities. This was one of the options they put forward. From conversations I have had with local government colleagues and with some local Healthwatch there does not seem to be a desire for commissioning to be transferred to HWE – I accept that there may be some local Healthwatch who have this view.

Why the transfer of commissioning?

The rationale for this seems to stem from concerns that we are all familiar with:

• Variation in the quality of local Healthwatch
• Variation in the level of funding for local Healthwatch
• Cuts in funding to local Healthwatch
• Conflict of interest between local authority commissioners and local Healthwatch
• The complexity of the Patient and Public Voice system

I have no problem with any of the above issues – they all exist. Indeed they exist in other organisations which are commissioned nationally such as the NHS! However, variation is not always negative – there are positives too. There are excellent local Healthwatch and many local authorities have done their best to support and protect local Healthwatch in the teeth of vicious central government cuts to local government.

With regard to conflict of interest – moving commissioning of local Healthwatch to a single rather weak national organisation which is very close to government appears to carry the potential for even greater conflict of interest?

Problems

Experience – HWE has no experience of commissioning at all. The idea that they can somehow pick up on this complex agenda, managing contracts, performance management etc feels naive and reckless. Many local authorities are actually rather good at this!

Money – local authorities bear the cost of commissioning local Healthwatch – if HWE were to take up commissioning funding for this would have to be found from somewhere?

Politics – this is really not the time to be crying “wolf” about local Healthwatch performance and local government performance with a new government just getting its head around functions and looking to save money! There are many examples of positive commissioning and good practice which should be built on rather than dismantling the whole system and resetting with an organisation with no track record of commissioning.

ICB/S – floating around in these proposals is a notion that commissioning can be done more cost effectively and efficiently at Integrated Care System level. If this is real, it completely misses the point about the democratic role of local government and place. Again, many local authorities and local Healthwatch are actually rather good at working with the complicated relationships in a place – they are part of it!

NHS – Its as sure as eggs is eggs that government will reorganise the NHS commissioning structures and ICS will change or disappear. This is not the foundation to build on – it is local authorities that are permanent and responsible for local democratic systems.

Focus should be on Healthwatch England 

While it is tempting to think that the problems that exist can be solved simply by changing who commissions – this is wrong.

I think more can be gained by reviewing how HWE works. What has not worked? Where it should be focus? For example learning from the LGA Peer Challenge and the NHS Confederation Member Forums and developing much better knowledge exchange between peers.

Further, I think that HWE should be putting more energy into developing a systematic plan to influencing NHS and DHSC strategy development to ensure that the pivotal role that local Healthwatch can play is clear and mandated in all  local health and care systems. Greater recognition of the potential role that local Healthwatch can play would help to address the confusing array of Patient/Public Voice activities locally.

What do you think?