Ross Griffiths explores how HealthWatch bodies have the opportunity to support local health economies and their scope for innovation in delivering care.
Local HealthWatch bodies, the successors to LINk introduced under the Health and Social Care Act 2012 are beginning to emerge from the mist. This is long overdue, following a great deal of confusion and indecision. It is now clear that they will be independent legal entities, and not something prescribed in statute.
For obvious reasons the government does not want to clutter the decks with more statutory bodies, with their associated accountable officers, public governance, audit and appointments. There is also a desire for less central “command and control” of local services, and a belief that it is right to strengthen the local democratic legitimacy of the health and social care system.
So allowing local solutions to take shape is rather more appropriate, and is also consistent with a desire to encourage local authorities to listen to their communities and work with their public, voluntary and community sector partners. So what will these new bodies do?
The Health and Social Care Act requires that a local authority makes arrangements for a local HealthWatch to carry out a number of activities: promoting and supporting the involvement of people in commissioning, provision and scrutiny; enabling people to monitor and review local care services; obtaining views regarding needs and experience of care services and making these known to recommend improvements; providing advice and information about access and choices; apprising HealthWatch England of standards and potential improvements; recommending reviews and investigations and generally assisting HealthWatch England.
Much of the above is envisaged to be by contribution to the joint strategic needs assessment which will be one of its most important tasks.
However, it also has the opportunity to undertake a range of discretionary activities to support the local health economy, and even within its basic functions there is plenty of room for innovative thinking.
The major challenge at the heart of health and social care reform is how to move from a consumerist approach to the draw-down of services to more of a citizen-based approach: how do I and my family/neighbourhood access services we need in a way that helps to control cost, and manage demand? How can the NHS capture the opportunities created by the expert patient, the informal carer, and the service-user who wants to use services more efficiently and help the limited funds to go further?
Local HealthWatch bodies could have a part to play here, thereby taking on a much more significant role than simply being the successor to LINks. If structured appropriately they could start to play a more substantial role linking the commissioning and providing community to the user community, being of real and substantive help to emerging clinical commissioning groups in their challenging new role. There is the opportunity for a much more inspiring and exciting vision – but what shape will Local HealthWatch bodies take?
It will be the responsibility of the local authority to consider how their local body might best be constructed to get the benefits desired. The purpose and function of local HealthWatch described above suggests that the local body should be embedded in the communities that are served by the local authority and the local health economy, and so the ownership and governance arrangements should reflect this. A legal entity that engages the community, that has the trust and confidence of the community but that is also independent of both commissioners and providers is more likely to be able to successfully express the views of that community than one that is within the control of the commissioning and providing community.
Community engagement is one of the major concerns of emerging CCGs, while improving accountability and democratic legitimacy lie at the heart of both open public services and Equity and Excellence in the NHS. Local HealthWatch bodies could be an important tool in achieving both of these objectives, and also act as a means for communities to express their own needs through the joint strategic needs assessment. This could be instrumental in building confidence that the decisions made by CCGs are more likely to have the benefit of community support. If structured well, they could also improve engagement with those parts of the community that statutory bodies sometimes consider hard to reach.
The best chance of achieving these aims is to ensure that the community genuinely has a voice in the service, helping service users to shape their own healthcare for now and the future. A form of co-operative or mutual entity may be one of the answers.