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.