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The government risks severing links with valuable volunteers

It was inevitable that a government regarding the empowerment of individuals and communities as its raison d’être would seek to instil a greater public voice into the health service.

The weary members of the public who had already been attempting to instil a greater patient and service user voice in the NHS probably felt it was equally inevitable that the government would seek to destroy the existing local systems through which they operate and impose a baffling new arrangement. They are used to this happening.

Volunteers who have had to cope with the demise of community health councils, the rise and fall of patient and public involvement forums and the birth of local involvement networks now face seeing their bodies “evolve” into HealthWatch.

Repeatedly under Labour, and now under the coalition, ministers have sought to solve the problem of a lack of patient voice in the NHS by removing the one that already existed. The lifespan of organisations has been such that they had rarely found their voice before they disappeared. There was little opportunity for each system’s strengths to be built upon and its flaws ironed out before a new system was imposed.

Few civic minded volunteers could have withstood this baffling sequence of reorganisations. Why bother to win the trust of local volunteers, build up relationships and begin to understand an array of organisations if the rug is going to be pulled from under you? Committed people will have left their role disillusioned, only to be replaced by new volunteers whose enthusiasm swiftly waned.

Andrew Lansley follows the likes of Alan Milburn and Patricia Hewitt in thinking his system will be the best. “For the first time in 40 years, there will be real local democratic accountability and legitimacy in the NHS,” the consultation document into the changes proclaims. Local HealthWatch branches, we are told, will be more independent than LINks by being corporate bodies in their own right and employing their own dedicated staff.

However, HSJ this week reveals growing concern over Mr Lansley’s plans.

There will be no additional money to set up the local bodies. Funding will not be ringfenced and will be routed through councils which might consider HealthWatch to be a low spending priority. Embarrassingly, the Department of Health had to withdraw a consultation document after it appeared to suggest HealthWatch branches could be run for as little as £20,000 a year, compared with the £100,000 spent by LINks.

HealthWatch – which can recommend that the Care Quality Commission investigates services and must be consulted by councils over their health plans – faces doing more than LINks with fewer resources.

Although we are told the transition will be evolutionary, it seems start-up costs can only be paid by removing funds from LINks. In effect the new organisation will feed from the carcass of the old.

Meanwhile, confusion surrounds a Health Bill amendment which demands HealthWatch is “representative” of the local community. Volunteers are usually representative of those members of the community with time on their hands – the retired for instance. Many groups could fall foul of this rule.

The government still has time to show these are mere teething problems and not fundamental flaws. It must show HealthWatch has the teeth to hold local organisations to account and cough up the transition costs. It is not too late to prove an incremental path can be taken to retain local expertise in successful LINks but force change in areas where LINks have performed poorly.

If the government fails to do this the next health secretary will inevitably come along and jettison Mr Lansley’s solution, causing more disillusionment among volunteers and continuing the pattern of local hard work being undermined by reorganisations enforced by the centre.

Readers' comments (4)

  • If the Government has its way we will all be volunteers, that way they get to save a fortune! But seriously though this doesn't bode well for David Cameron's Big Society or am I right in thinking that his big idea may be dead in the water in any case? One of the problems lies in the very success of many of these groups. When they do their job too well (Community Health Councils spring to mind as an example) the Gov can't wait to get rid of them as they show up their failings as well as local health services. They become a thorn in their sides. So guess what we change the system. Ummm, sounds rather familiar doesn't it?

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  • There is an in built dislike for local accountability in the NHS by the DoH. That is why Trust Boards are stuffed with a dad's army of cashiered businessmen(persons) and all round do-gooders. With public health handed to local government under democratic control it will be interesting what roles are played. If HealthWatch is populated by the retired at least they have areal interest in the quality of local health services. the question is who decides who pulls the strings in these new local bodies and will there be professionalism in their management - £20K - probably not.

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  • I may be wrong, but my reading of the paper referring to transition of funds from PALS and ICAS(before it was pulled, due to be reissued on 15th Aug) was £20k minimum transfer of funding NOT the total funding of LHW as it will retain current (crap not ring fenced) levels of LINk funding.

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  • Excellent article; successive SoS have faffed and fiddled around with patient engagement models, and the only effect has been the accelerating demise of of the patient voice in parts of the NHS.

    Lansley is only the latest culprit in this; he has argued that the patient voice is best heard through the direct Dr/Patient interface when planning a referral/admission/care package. Well, up to a point, Lord Cropper. It works (sometimes) for elective care or OP, but doesn't really address the fact that:
    - an enormous number of patients are emergency admissions
    - individuals and communities have a legitimate right to be heard on servives, even if they aren't currently patients or seeking care
    - the dialogue should also be with groups and communities of interest, not just individuals
    - it doesn't address hard to reach and traditionally excluded groups

    I could go on. However, Wales has mainatained and consolidated the statutory role of CHCs; as a model it's a good one. They are a clearly identifiable body with clear stautory roles and rights, and there's a real benefit in that.

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