In preparation for HealthWatch England and the local HealthWatches coming into being in October 2012, the Care Quality Commission (CQC) has created an online community of interested people to share their views on the new organizations.
The CQC is involved because HealthWatch England will be a committee of the CQC and not a separate body. The local HealthWatches in each local authority area, however, will all be separate bodies.
Unfortunately the software used to implement the online community lacks basic features like user names, signatures, biographies, avatars, links to personal blogs, news feeds etc. The designer didn’t understand the difference between a forum and a topic. There’s no obvious way to find your own contributions again to see whether anyone has replied. It’s dismal.
There are vast numbers of online communities in existence, of course, for all kinds of purposes, making it very quick, easy and cheap to create a new online community with sophisticated support for members’ activities. Unfortunately the CQC had too much public money to spend. Instead of creating a quick, easy, cheap and sophisticated online community, it hired a firm of international marketing consultants, Nunwood, to create a slow, difficult, expensive and shoddy one.
The result is, for members, rather like being in the cult 1960’s TV series, The Prisoner. We are known by numbers rather than names, and a mysterious HealthWatch Team requires us to perform secret tasks in order to extract information from us. I’m number 85. I’m hoping there will be a conference in Portmeirion so that we can get into our roles properly.
As far as I know, absolutely anyone can join the online community. The CQC’s HealthWatch page tells you how. You get to fill in a little survey, and then they send you details of how to log in. In my case they forgot to send the details and I chased them by telephoning 0845 372 0103.
Task 53 is to review a paper on HealthWatch independence. If there really are 53 tasks, I am only able to see four of them. The other 49 must be too secret for me, I suppose.
Oddly, you don’t have to log in as a member of the community in order to download the paper. I assume this is the result of technical incompetence and the intention is that it’s only for members of the community, so I won’t publish the link.
Who wrote the paper? It doesn’t say. The paper quotes no sources, includes no references, gives no examples, analyses no scenarios and offers no alternatives.
Whoever wrote it didn’t start from what HealthWatch is and how it fits into the overall plans for ‘Liberating the NHS’. It seems possible that whoever wrote it doesn’t know what HealthWatch is and how it fits in. The paper paints a confused picture of a HealthWatch whose independence is mainly a kind of Orwellian doublethink, or in modern terminology, spin. Here’s a flavour of it:
Both locally and nationally, it will be important for HW to be impartial. It should not be in the pocket of a particular interest group. It should be free to make judgements about care without undue influence from external bodies. But this should not mean it is unconnected to the wider health and social care system, nor that it will never have a distinct point of view. Locally and nationally, it is important that HealthWatch is connected, that it makes the right contacts across the system so that it can make efficient referrals and influence effectively.
So HealthWatch must remain impartial and have a distinct point of view at the same time, not be in the pocket of a particular interest group but at the same time make the right contacts, make judgements without undue influence but at the same time be connected and influence effectively. Taken as a whole, this is saying precisely nothing. The paper is a hoax.
To complete the task and get my tick in the box, I submitted this response. The numbers in square brackets are paragraph numbers in the paper:
1. Do you agree with the approach set out in the paper?
The approach set out in the paper is confused and impractical. I do not agree with it.
One of the confusions is over local HealthWatch’s impartiality. It cannot be impartial and also take a view . As soon as it takes a view, it will have become partial. It cannot be “constructive and balanced”  and also free to speak “without fear or favour” . As soon as it speaks out on an issue of any importance or urgency, it will have lost its constructiveness and balance, and as soon as it puts forward any constructive and balanced view, it will have entered into local NHS politics.
Another confusion is over funding. According to the paper, HealthWatch “should not be in the pocket of a particular interest group”  and yet also “directly accountable to the local authority for how well they spend public money” . It cannot be both at the same time. A local authority is an interest group, and “in the pocket” is an embarrassingly accurate turn of phrase under the circumstances.
It is significant that whoever wrote the paper imagines “a private company or a charity are independent” . Private companies (unlike plc’s) are entirely dependent on the whims of their owners, and many charities are entirely dependent on national or local government contracts, engaging in no significant activity outside the terms of those contracts. The risk is that local HealthWatch might be no more independent than a private company wholly owned by the local authority, or a charity whose only income is from a local authority contract.
A third confusion is over HealthWatch’s scope. The paper suggests that HealthWatch is constrained not to exceed certain limits, and it can only act “within its statutory powers” . At the same it is constrained not to fall short of certain limits, and it will be held to account if it is “not fulfilling its remit” . It cannot be constrained not to exceed and constrained not to fall short and be independent all at the same time.
2. Is there anything you would add to maintain the independence of Local HealthWatch?
The strongest guarantor of local HealthWatch’s independence will be local public opinion. If local HealthWatch fails to convince the local public that it is doing a good job, then it will be vulnerable to interference from the local authority, the CQC and others. If, on the other hand, it becomes seen as the consumer champion in a real sense, then it will have a basis for resisting such interference.
3. Is there anything you would add to maintain the independence of HealthWatch England?
HealthWatch England is unlikely to be independent as long as it remains merely a subcommittee of a troubled quango. The crunch will come when a local HealthWatch upholds the views of local people in opposition to the CQC’s national policy, and then we’ll all see whose side HealthWatch England is on.
4. What is the main thing both Local HealthWacth [sic] and HealthWatch England should do to establish their independence?
The main thing to do to establish independence is to remain focussed on the principles that underlie the ‘Liberating the NHS’ plans, and not to be distracted by a narrow CQC or local authority agenda. It is notable that this paper makes no reference whatsoever to those underlying principles.