Archives for the month of: November, 2013

By Tony Okotie, Chief Executive, Community and Voluntary Action Tameside (which includes Healthwatch Tameside) and a non-executive director of an NHS Provider Trust.

Margaret McLeod raised a number of interesting points about the role of Healthwatch in her recent blog, Public Engagement in the new NHS – where does Healthwatch fit?, and I tend to agree with many of the issues she raises. However, I believe the debate about whose responsibility it is for engagement and dealing with complaints requires further consideration.

Is there anything wrong with every NHS organisation having someone identified as leading the public engagement? We would say it is vitally important. They all have a statutory duty to engage with patients and the public. By just expecting Healthwatch to have the responsibility, they miss this opportunity to work with the public and patients. The NHS has to move to a sense of ‘working with’ rather than ‘doing to’. That said, the different roles of the National Citizens Assembly and Healthwatch England are not clear – it is muddled and confusing.

I think that we also have to be careful about Healthwatch locally becoming ‘the ‘go to’ organisation when the NHS wants to know what people think about services – I think Healthwatch should be one of a number of ‘must look at’ routes to gaining intelligence but not the only one. They are not funded to do the work for NHS organisations – but to add to it from the perspective of a consumer champion. It’s about partnership working, data sharing and triangulation.

It is probably okay for people to have choice in the way they raise concerns or give feedback about services. What’s important is for the data to be used locally, regionally and nationally in a co-ordinated and meaningful way. For me, this is about cascading detail down to a local level (from whatever source) then having mechanisms to escalate trends and significant concerns up to regional and national level. It is the local contextual knowledge that enables raw data to be interpreted and transfigured into meaningful key messages.

We know from our work with Patient Opinion that service improvements are most likely to happen from complaints and comments when they are responded to as close to source as possible. So by ‘centralising’ this work into Healthwatch, you remove the direct link from the patient to the NHS organisation, and hence the imperative for that NHS organisation to ‘own’, and want to learn from, that feedback.

That is not to say NHS organisations can’t or shouldn’t improve the way that they respond to feedback and complaints. The recently published Clwyd Hart report about the NHS Complaints Service clearly highlights that. We have to make it easier for people to complain and NHS organisations have to see complaints as a positive thing, and an opportunity to improve. Simply moving complaints to Healthwatch is overly simplistic and will remove the ownership of the problem from the NHS.


By Tony Okotie, Chief Executive, Community and Voluntary Action Tameside

The first week of November was Living Wage Week and I was fortunate to attend the ‘celebration’ event in Manchester. This brought together a number of living wage employers to recognise their contribution, and to consider what else we could and should do. I am proud to say that Community and Voluntary Action Tameside have adopted the living wage and became accredited at the start of the year.

In amongst the presentations was one which stood out. This was by a cleaner from Salford who talked passionately and genuinely about the positive impact that her employer, Salford Council, adopting the living wage has made on her and her family. I was also shocked to hear that 23 per cent of employees – 600,000 people – are paid LESS than the living wage in the North West alone. Nationally, there are 430 accredited living wage employers and in the North West there are 50, compared to just five a year ago. So, while there is significant growth, and awareness of the living wage, there is still a long way to go. Also, the campaign reported that the retail industry is still a major challenge for this.

All of this started me thinking about what the voluntary sector should do. We talk a lot about the impact of poverty and many organisations are involved in campaigning, which is fantastic. However we are also, collectively, a major employer. The recent State of the Sector research carried out by Sheffield Hallam University concluded that the sector employs 23,600 full time equivalent paid staff across Greater Manchester.

I contacted a number of voluntary organisations, including one high profile organisation, across Greater Manchester involved in ‘community building’. Many chose to avoid the question about whether they paid all of their staff at least the living wage and there were some who admitted that they didn’t. It disappoints me that many of those same organisations who campaign about reducing poverty or work with communities are failing to ‘practice what they preach’ by ensuring that their staff are paid fairly and failing to stand up and be counted in relation to signing the living wage charter.

If we believe in strong communities – and I do – we need to recognise that our staff live in communities themselves. To help build and sustain communities there is an economic element. We as employers have to provide leadership and for me, signing up to the living wage is one way of doing so.

By Margaret McLeod, Health & Social Care Policy Coordinator, Voluntary Sector North West

The aim of the NHS reforms is to put patients and public at the heart of health and care services – and rightly so – but a downside of this is that all the new NHS structures – and there are an awful lot of them – all have public engagement leads. These leads all want to engage with the public but so far it is not clear how the public is meant to engage with them and more mechanisms to engage are under development.

Healthwatch was hailed as the place where the public would be able to take their concerns and issues about health and social care and where they could also influence how services are delivered. It seems to me that the NHS sees Healthwatch as just one way in which the public and patients can raise issues and have influence. In giving Healthwatch to local authorities to set up it has meant that the NHS sees Healthwatch as not being part of the ‘system’ and so it is continuing with its own processes and mechanisms for engagement.  This in my view has somewhat put Healthwatch in a corner as the consumer champion bringing the voice of the public.  It is not seen as the ‘go to’ organisation when the NHS wants to know what people think about services.

The NHS has launched the Friends & Family Test and the Health & Social Care Information Centre (HSCIC) is currently piloting a ‘one front access point’ to the NHS where people will be able to share experiences and report a problem or ask questions. The National Citizens Assembly has now published its latest progress report on its approach to participation. You then add in the public engagement that hospital trusts, NHS trusts, NHS England Area Teams, Strategic Clinical Networks, Clinical Commissioning Groups, Commissioning Support Units, and GP practices also carry out. 

How are the views of the public going to be gathered in sufficient numbers or strength in one place so that changes or holding to account can take place? Local Healthwatch’s role is to feed the information they gather up to Healthwatch England who will then use this information to make reports and raise concerns with NHS England. The aim is to bring about an improvement in health services. The National Citizens Assembly would seem to see itself as having a very similar remit. The proposed ‘one front access point’ currently being trialled by HSCIC would seem to be carrying out a very similar role to the one given to local Healthwatch.

Why set up an independent body – Healthwatch – to carry out these functions and then proceed to set up further structures to carry out what appear to be duplication. It is almost as if government feels that the public should not just have choice about the type of treatment they receive but also the way they can comment or complain about it. The danger is that with a plethora of ways in which people can comment or complain, public concerns will remain as diluted as they have been in the past because there will be no coherent way of coordinating evidence.

The recently published Clwyd Hart report about the NHS Complaints Service:  ‘Putting Patients Back in the Picture’ recommends that complaints advocacy is attached to local Healthwatch with protected funding.  It also says that if local Healthwatch is to be able to work effectively with the NHS and other partners, then it needs to have its funding protected and ring fenced.

It is therefore important that Local Healthwatch develop relationships (and many already are) with trusts, CCG’s and NHS England Area Teams at the very least. However, each local Healthwatch has varying levels of funding and therefore varying levels of capacity so its ability to develop strategic relationships with many of these new NHS structures may be restricted and could mean its ability to influence and inform is also limited.