On March 8th I attended a meeting in Gloucester organized by Gloucestershire LINk for its members, intended to provide a national and local perspective on the transition from LINk to local Healthwatch. Unfortunately one of the main speakers couldn’t get to the meeting, so there was a rather disorganized start to the event.
The missing speaker, Trish Stokoe, works for the South West Development Centre, an offshoot of the soon-to-be-abolished strategic health authority (SHA), NHS South West. She is Transition Lead for LINks, whatever that means, as when LINks make the transition to local Healthwatch the SHA will have disappeared, and both LINks and local Healthwatch are in any case local authority responsibilities, not SHA responsibilities. In her absence no one explained what the SHA has to do with any of it.
Barbara Marshall, who chairs the LINk, filled in on the national perspective rather sketchily and hesitantly.
A recent amendment to the Health and Social Care Bill means that local Healthwatch organizations will have to be social enterprises, in a rather special sense defined by the Bill. The term “social enterprise” does not appear to be defined in law elsewhere, and it loosely means “not for profit”. This was not explained to the meeting, though, and there were only mystifying references to the requirement for Healthwatch to be a corporate body.
Using the term “corporate body” without explanation makes some people think that LINks are being privatized, and plays to the politically motivated fear-mongering around the Bill. I thought it disappointing that this issue was not presented with greater clarity.
There were some wide-ranging questions from the floor, including two from carers who have concerns about whether carers will be forgotten in all the changes. In reply it was pointed out that carers are specifically included, although as I write now I do not actually see that provision in the Bill in relation to Healthwatch. (I do see it in relation to commissioning.)
Fiona Jones, transition lead for Gloucestershire County Council, spoke to the local perspective. The County Council really does have responsibility for commissioning Healthwatch, so she does have a real job. She was accompanied by two colleagues who said nothing.
The project plan includes consultation until the end of April, after which the Council will go ahead with its plans. A web page on the Council site is promised, but it does not yet exist.
Various organizations will tender for the Healthwatch contract in Gloucestershire, and the winner will be known by the end of 2012. After that, LINk will wind down as preparations intensify for Healthwatch to begin its work on April 1st 2013. No reassurance was given that Healthwatch Gloucestershire’s governing body will be democratically elected.
The discussion was somewhat derailed by the speaker’s announcement that Healthwatch Gloucestershire might not be a single organization but many, under a Healthwatch “brand”. This misinformation confused the audience, and there were several questions about its implications. The word “brand” was taken as a further hint that privatization is what’s intended.
It’s not clear where this daft idea came from. The position was explained by Baroness Northover in the House of Lords as follows:
Only one local healthwatch will be permitted for each local authority area. Each local authority will be able to make only one contract. If the local healthwatch wishes to subcontract some of its functions it can do so if the local authority permits, but the functions would still remain the responsibility of the local healthwatch.
There was further speculation from the speaker on social care for children, which is currently outside the scope of Healthwatch, but which she claimed might be included. There is no good way to tell whether there is any truth in this, or whether it’s just another daft idea.
Vision and principles
A group discussion on Healthwatch Gloucestershire’s vision and principles further showed up showed the Council’s current plans. The excuse given was that this was just an exercise at an early stage, to gather information about what people think, but even so the lack of thought given to the proposals was striking.
The proposed vision for Healthwatch Gloucestershire was:
Local HealthWatch will be the voice of service users —using their views and experiences to influence the planning and delivery of health and social care.
It’s difficult to know where to start with that. Healthwatch Gloucestershire probably won’t be called “Local HealthWatch”. It won’t be the only voice. It won’t only represent people who are already service users. It won’t just influence planning (like a LINk) but be a full member of the planning body. It won’t directly influence delivery at all. The entire statement is a complete mess.
Furthermore, what is the Council doing defining the vision in the first place? The Government’s intention appears to be that Healthwatch will be perfectly capable of defining its own vision.
The proposed principles were just as bad. Indeed, only one of them could be said to be a principle at all:
Be inclusive — anyone can have their say.
The others were all functions, not principles. Now, when it comes to functions the Council does legitimately have a say, because it has to commission Healthwatch Gloucestershire under contract to comply with the provisions of the Health and Social Care Bill. The early signs are that the Council intends to go further and use the contract terms or other working arrangements to limit Healthwatch Gloucestershire’s freedom of action. In the Health and Social Care Bill there are no specific safeguards aginst this, but that doesn’t mean there are no safeguards…
Keep our NHS public
A LINk member at the meeting said she represented Keep our NHS public, or maybe she represented Stroud Against The Cuts, it wasn’t very clear. Indeed, it’s not very clear to what extent these really are separate orgainizations, or whether they are just fronts for a very small number of political activists. Anyway, she asked a question about the powers that the Health and Wellbeing Board will have, and she made reference to the recent High Court victory against a decision by NHS Gloucestershire which the Court held it had not made properly. The reply she was given was that there had been consultation on the decision, but she disagreed, saying:
As a LINk member I haven’t seen [any] consultation.
I agree with her on that, even though I disagree with her on pretty much everything else. I haven’t seen any consultation on it either. The LINk is bad at promoting public involvement on these matters, and particularly bad at promoting the public’s views on any controversial matters at all.
It went from bad to worse at the end of the meeting, when this member was apparently told she couldn’t give out leaflets promoting her views. She stood outside to distribute them. But the purpose of a LINk is to promote people’s views, and this purpose is defined in law. The Local Government and Public Involvement in Health Act 2007 s221(2)(a) says that a LINk is for:
promoting, and supporting, the involvement of people in the commissioning, provision and scrutiny of local care services;
When a LINk instead suppresses the involvement of people in the commissioning (in this case) of local care services, something has gone badly wrong. Moreover, we had all just taken part in a group exercise to discuss the principle, “Be inclusive — anyone can have their say.” Extraordinary.
This brings me back to the point about safeguards I made above. The Council’s simultaneously high-handed and foolish preparations for Healthwatch Gloucestershire, as exemplified by this meeting, suggest that Healthwatch Gloucestershire won’t work, that it won’t promote and represent people’s views inclusively and fairly. It looks as if there are no safeguards against this.
But the existence and successes of organizations like Stroud Against The Cuts, Keep Our NHS Public, Cure the NHS and others like them are the safeguard. Councils that get their local Healthwatch wrong will find themselves in the High Court just as NHS Gloucestershire did. Lawyers will profit. Councillors will lose their seats. Everyone will be reminded of the old Chinese curse:
May you live in interesting times.