Local Healthwatch: progress and promise Authors Helen Gilburt Phoebe Dunn Catherine Foot This report was commissioned by the Department of Health. However, it is based on independent research conducted by The King’s Fund and the conclusions reached are those of the authors. Contents Executive summary 1. Introduction 2. Methods 3. Findings A. Providing information and advice to people about accessing services B. Gathering intelligence on people’s views and experiences of health and social care services C. Influencing the provision and commissioning of health and social care services D. Factors influencing the effectiveness of local Healthwatch 4. What makes an effective local Healthwatch? 5. Conclusions 6. Recommendations Acknowledgements We are grateful to everyone who took the time to respond to our survey, take part in an interview or otherwise participate in our case studies. The Department of Health, Healthwatch England and the Local Government Association provided welcome advice and support. Colleagues at The King’s Fund – Laura Bennett, Allison Trimble and Becky Seale – also provided valuable help and advice. 2 Executive summary Established following the Health and Social Care Act 2012, local Healthwatch organisations are the local consumer champion for patients, service users and the public, covering both health and social care. Local authorities have a statutory duty to commission a local Healthwatch organisation, which in turn has a set of statutory activities to undertake, such as gathering local views and making these known to providers and commissioners, monitoring and scrutinising the quality of provision of local services, and a seat on the local health and wellbeing board. This report was commissioned by the Department of Health to examine the progress that had been made in the first 18-21 months of local Healthwatch and to identify the positive steps that could be taken across the system to enable a high-performing and effective local Healthwatch network. Broadly, local Healthwatch organisations are positive about the progress they are making, with particularly positive assessments of progress in gathering people’s views and influencing providers and commissioners. Local Healthwatch organisations are in the process of shifting from setting up the organisation and developing local relationships to developing effective processes for carrying out their activities, and then in some cases beginning to achieve impact in terms of changes to services. Local Healthwatch organisations vary widely in how they are organised, how they conduct their activities and how effective they are in carrying out their statutory activities. Their activities are wide-ranging but their capacity is often very limited and so, in this context, local Healthwatch will only ever be effective through prioritising their focus and working effectively in partnership with others. Our case study sites highlighted a number of key factors that influence the effectiveness of local Healthwatch organisations. Some of the challenges that local Healthwatch face could be addressed through greater support, advice and shared learning on how to operate effectively. Good local accountability for governance and ways of operating (eg, related to the effective leadership of the organisations, how conflicts of interest are managed, and how the public are involved in activities) is essential to ensure the legitimacy and credibility of local Healthwatch organisations. Local Healthwatch organisations rely on building relationships with other local stakeholders in order to build legitimacy, influence and create impact. Their effectiveness in doing this is in part mediated by the receptiveness of local stakeholders to the involvement of local Healthwatch and to the value of public involvement more widely. 3 Fundamentally, the role that local Healthwatch are expected to play in the health and social care system is a demanding one, with great potential for improving how responsive and inclusive the system is of local people’s concerns and priorities, but also great challenges in defining a distinct local role and balancing being an independent voice with being part of decision- making processes as one of the local system leaders. As local Healthwatch organisations continue to mature and develop, addressing both the practical and these more deep-seated challenges will be crucial to maximising their effectiveness and impact. 4 1. Introduction Established following the Health and Social Care Act 2012, local Healthwatch organisations replaced Local Involvement Networks (LINks) to become ‘the local consumer champion for patients, service users and the public’, covering both health and social care. Local Healthwatch organisations now cover every upper tier local authority in England (152) and have been in operation since 1 April 2013. Local authorities have a statutory duty to commission a local Healthwatch organisation, and local Healthwatch in turn are contracted to undertake a series of statutory activities as set out in legislation, which defines their role. A number of these activities are similar to and carried over from LINks, such as gathering local views and making these known to providers and commissioners. Other functions, however, provide local Healthwatch with a more extensive role in influencing provision through local decision-making processes, reflected in their seat on the local health and wellbeing board. Local Healthwatch organisations are required to be social enterprises, though there is no prescribed model under which they are required to function. In practice, this flexibility has resulted in a number of different models being employed, including community interest companies (CIC) and charities. Several organisations were originally hosted by other voluntary and community sector organisations with an expectation that local Healthwatch would eventually become an independent organisation in its own right. It was intended that in setting up local Healthwatch, these new organisations would build on any existing LINks’ successes but, in addition, would address some of the previous system’s weaknesses, with a greater focus on being representative of local communities, building profile through a common brand and identity, and moving towards greater transparency and accountability. Local authorities have a statutory duty to contract with a local Healthwatch organisation (rather than commissioning a ‘service’ as is perhaps the more usual approach for local government), and for re-commissioning if deemed necessary. The statutory activities of local Healthwatch provide mechanisms for them to escalate issues directly to Healthwatch England as appropriate (or, where justified, directly to the Care Quality Commission). Local Healthwatch organisations are also required to share information with and support the national remit of Healthwatch England. Although local Healthwatch organisations are accountable to a commissioner with the relevant local authority, emphasising 5 their role in meeting local needs and priorities, Healthwatch England has a role in developing the potential of the network by providing local Healthwatch organisations with support, guidance and advice. Healthwatch England, the Department of Health and the Local Government Association have produced a number of guidance documents to support the set- up and development of local Healthwatch. These guidance documents have largely focused on purpose and function, with more recent documents providing a mechanism for local Healthwatch organisations to assess their own progress and outcomes. Although each local Healthwatch organisation is required to publish an annual report and Healthwatch England has conducted its own surveys of local Healthwatch organisations, there seems to be little publicly available, aggregated intelligence available on the extent to which local Healthwatch organisations are carrying out their statutory activities, the diversity of their practice or, importantly, their effectiveness in influencing services as the independent voice of the public. About this report We were commissioned by the Department of Health to conduct a piece of research that would examine the progress that had been made in the first 18-21 months of local Healthwatch and identify the positive steps that could be taken across the system to ensure a high-performing and effective local Healthwatch network. This report first sets out the methodology we used and then presents our findings in four sections, looking at the different activities of local Healthwatch and at the factors that underpin their effectiveness. From our own research, and drawing on evidence in the wider literature, we set out some of the key elements of an effective local Healthwatch. After some brief conclusions, we then present recommendations for ways to help maximise the impact and effectiveness of local Healthwatch organisations as they continue to develop. 6 2. Methods We conducted our research between September 2014 and February 2015, using a mixed-methods approach combining national surveys with six in-depth local case studies and interviews with national stakeholders. We did not gather views from the general public or other community groups about local Healthwatch organisations because of the relatively early stage of Healthwatch’s development. In the longer term, however, as local Healthwatch organisations become more established and have conducted more work, it will be very important to understand how they are viewed by the