How service user watchdog plans to make impact on poor practice

As of last month, service users have a national statutory champion for their interests in the health and social care system in the shape of Healthwatch England. Set up by the Health and Social Care Act 2012, its remit is to fight service users’ corner in the corridors of power while also supporting a network of local Healthwatch groups to hold services to account in their areas.

Its governing committee includes people with experience of disability campaigning, charity leadership and local government. At its helm is Anna Bradley, whose background combines consumer rights work – she formerly worked for Which? and was chief executive of the National Consumer Council – with regulation, past roles including being chair of the General Optical Council.

She says her expectations for Healthwatch England are high, particularly in terms of how far it will be listened to by the health and social care establishment. She points to statutory provisions obliging councils, government, the NHS Commissioning Board and the Care Quality Commission to respond in writing to its advice.

‘Sector leaders will have to listen to us’

“The big systems regulators and government have to listen to us; not that they have to do what we say but they have an onus to respond to us and that will be in the public domain and that gives us the power that hasn’t been there in the past,” she says.

The messages that Healthwatch England will be relaying, through its annual report to Parliament and other reports on specific issues, will be based on its analysis of service users’ experience of health and social care services. This will be drawn from two sources: local Healthwatch groups, which will be up and running by April 2013, replacing local involvement networks (Links), and existing organisations that perform similar scrutiny, such as charities for specific client groups.

Spotting trends

“Local Healthwatch groups will collect and collate evidence from the community and the wider public to support them in their role in advising commissioners and providers. We will draw heavily on that information at a national level and will be spotting themes and the significant trends and developments we will want to raise at a national level.”

This will be the job of the analysts within Healthwatch England’s staff of about 30 people. Bradley says that Healthwatch’s reports will be strongly evidence based and it will focus on a few priorities, to avoid spreading itself too thinly. In determining priorities, Bradley says the committee will focus on the needs of the most vulnerable, such as people with dementia or others who lack mental capacity to make decisions about their care.

Focus on most vulnerable

“An organisation like Healthwatch would not be doing its job unless it was focused on the most vulnerable and those least able to articulate their needs,” she says. “How we go about doing that will be one of the first things the committee will want to consider and agree.

“Not only do we have a duty to focus on the most vulnerable but if we get it right for them we should be able to get it right for everyone.”

As well as receiving intelligence from local Healthwatch groups, Healthwatch England will also support them in their work. Bradley stresses this is not a “command and control role” – local Healthwatch groups will be commissioned by councils, not Healthwatch England – but a “support and guidance” function.

Support for local Healthwatch groups

“It will be critical for us to do that role well,” she says. One area that emerging Healthwatch groups have asked for advice on is their power to ‘enter and view’ health and social care premises, to gather feedback from service users on quality.

“We have been speaking to some of those Links who have been particularly active in that area to share their expertise.”

Independence question

Perhaps the biggest question facing Healthwatch is its independence. It is defined as a statutory committee of the CQC, which has set up Healthwatch England and provides its central services, such as finance and human resources.

Moreover, the CQC’s chief executive, currently David Behan, is Healthwatch England’s “accounting officer”, making him responsible for its use of resources, a role which includes an ultimate power to veto Healthwatch expenditure plans if he considers them inappropriate.

However, Bradley, who sits on the CQC board as part of her role and is appointed directly by the health secretary, is adamant that the patient champion will be fully independent from the regulator.

Accountable to Parliament

“We will be accountable to Parliament not the CQC,” she says. “We will work with the CQC as strategic partners. Guarding that independence will be a very important aspect of my job and the committee’s job.”

A set of arrangements have been developed to safeguard the independence of Healthwatch England, whose budget – £3m in 2012-13 – is determined by the DH. Healthwatch will have full editorial independence over its publications, its committee will set priorities, and the chair will appoint the committee, ensuring a majority are not CQC commissioners, and oversee the work of Healthwatch England’s director, its senior officer.

Any disputes between the CQC and Healthwatch should be resolved through “open and frank discussion”, with the DH responsible for resolving any intractable issues that occur.

Care scandals

Healthwatch England has come into being following two big care scandals – the abuse of people with learning disabilities by staff at Winterbourne View, and the poor care that led to unnecessary deaths at Stafford Hospital.

Bradley says it is “dangerous” to assume that action could have been taken sooner in these cases had Healthwatch and its local network been in place.

However, she adds: “The strength of the local networks and the national arrangements should mean that if a local Healthwatch has raised something and not been able to gain local traction there will be several ways in which they can raise it. That will mean we should be able to address that type of issue faster than would have previously been the case.”

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