News and Comment

No decision about me without me: where next for HealthWatch?

Friday 5 August 2011

Andrew Lansley has just announced the launch of 75 Local HealthWatch pathfinders. On the surface this certainly seems like a strong commitment to embedding the ‘no decision about me without me’ mantra. But not all patient and public involvement (PPI) practitioners are so sure about this new PPI era.


When I first started working on patient and public involvement in the NHS, Community Health Councils represented the voice of patients. They were felt to be of variable quality so were replaced with Patient and Public Involvement Forums, which themselves had a short shelf life and were binned in favour of Local Involvement Networks (LINks). These had the additional powers of being able to hold NHS and social care commissioners to account and refer services to overview and scrutiny committees. The latest PPI incarnation, Local HealthWatch represents the fourth shake up of PPI structures in 10 years. That is some going even for the NHS!

On paper HealthWatch bodies have quite a lot going for them and could be a stronger vehicle for the patient voice than LINks given that they will have a broader range of responsibilities.

But the launch of the pilots has been overshadowed by a row about funding. The Telegraph has reported that analysis by the LINks national body shows that on average local LINks saw their budgets cut by about a quarter, while nine had their funding cut by 50 per cent or more, and only six of 150 saw no change. Perhaps unsurprisingly they are worried about how Local HealthWatch bodies are going to be able to do more when money for PPI is being squeezed.

To ensure that HealthWatch can do their job properly some feel that additional money will be needed and that the funding should be ring-fenced. They are worried that at a time when local authority budgets are under severe pressure, funding HealthWatch will be a low priority. Their suspicions were not helped when the Department of Health withdrew a consultation document saying that Local HealthWatch bodies could be run for as little as £20,000 per year rather than the £100,000 or so spent by LINks.

But the NHS Future Forum disagreed saying that health and well-being boards and overview and scrutiny functions should be able to hold local authorities to account when looking at whether Local HealthWatch is adequately funded. And, if there is no local resolution then the national body HealthWatch England will have a role as an independent arbiter.

How the government reacts to this heated debate will show how committed it really is to putting the patient voice at the heart of the reforms. If the government truly believes in empowering patients it needs to work hard at reassuring those who are understandably jaded and scarred from the 10 years of PPI changes. HealthWatch could be the best PPI development yet, but it feels like it might just have taken a step backward.