Closing the door on the LINk….

We are one week into the world of Local Healthwatch, so it seems like a good time to pause and reflect …

Last month I was invited to talk at a Westminster Briefing in London about the lessons that I had learned working for a rural LINk. It was a fab way to spend what was officially my last day working for the LINk – and it gave me the chance to give my views to a delightful and interested audience while knowing that the chance of getting myself fired was very slim indeed. (You can read a summary of my talk which has been published today on the Westminster Briefing website.)

I came up with seven lessons that we’d learnt as a rural LINk:

  1. The scale of the work is enormous:
    Over £1 billion of public money is spent on health and social care every year in Somerset.
  2. Demands placed on volunteers are huge:
    Are we really expecting volunteers to thoroughly and effectively monitor and scrutinise over £1 billion in services every year?
  3. Lay people need lay language:
    Believe me, patients have no interest in your authorisation pipeline.
  4. There is not a ready-made PPI army out there:
    There are a few amazing people who are able and willing to commit their time and talents to involvement and scrutiny work. But there are not armies of them. Yes, the hedgehog sanctuary has lots of volunteers – but health scrutiny is not cute and fun. We need more honesty about this.
  5. Third sector organisations lack resources to get involved:
    Third sector organisations have knowledge, grass roots awareness and an understanding of what is happening on the ground. But it is not easy for them to just ‘brain dump’ onto LINks or Local Healthwatch. This requires resources – and charities are struggling just to stay afloat with their own core business. They don’t have the time or staff to do anyone else’s work for free.
  6. The public want a professional service:
    There are very few volunteers will are willing to project manage, collect data, analyse complex information, manage volunteers and have an oversight of health and social care – and all for free. This all needs proper resourcing.
  7. Funding mustn’t be a dark art:
    Funding for LINks – and for Healthwatch – is not ring-fenced. Funding of around 50% of the allocation was not uncommon for LINks, and similar levels of funding have already been seen to be happening to some Local Healthwatch bodies as well. However, the organisations that understand the funding allocations are often those who are the recipients of the contracts – and are therefore in a jolly tricky position when it comes to challenging funding decisions. But while local authorities are being squeezed to the point where they may be unable to provide the services that Healthwatch bodies are supposed to scrutinise, this funding issue is going to be enormously difficult to resolve.

Another article was published today about Local Healthwatch that I also enjoyed reading: Patient Voice? by Martin Rathfield of the Socialiast Health Association. Of Local Healthwatch, Martin concludes:

Each successive iteration of the PPI structure ends up more timid than the one before it, and this appears to be the going down the same road.

His article is well worth a read, particularly for his observations about Foundation Trust scrutiny and the role of Governors.

So, today’s bedtime reading:

All comments welcome!


LINk Legacy Document – who should you send it to?

Since blogging on the LINk Legacy Document, I’ve been asked where LINks should send their Legacy Documents.

The Department of Health has told me that these documents are ‘primarily to inform local conversations’ – and in short, there is no one nationally who is collecting these. This seems a bit of a shame, as there must be lots of excellent work that is being gathered into these documents.

Anyway, here’s my list of people that I think could be on your Legacy Doc circulation list:

  • Your LINk commissioner
  • Your Local Healthwatch Commissioner
  • Your Healthwatch provider
  • PCT (outgoing!)
  • CCG (incoming!)
  • CQC contacts
  • Foundation Trusts
  • Independent Health Providers
  • Chair of your Health & Wellbeing Board (Maybe the whole Health & Wellbeing Board)
  • Councillor with oversight of Local Healthwatch contract
  • Your LINk mailing list
  • Your ‘LINk friends’ – FT Governors and others who have worked closely with you etc.
  • Local community groups and organisations that have an interest in Healthwatch

Let me know if you think there’s anyone else that I’ve missed!

It would also be worth publishing online in the following locations:

You can also use lots of your Legacy info in your Annual Report, which you should also upload to the Healthwatch England Information Hub in due course.

If you have any other ideas, let me know!

P.S. A great piece of LINk Legacy Work from Luton LINk

Debbie Roberts who has worked with the Luton LINk published this fab piece of work on the LINks Exchange website, which I love. She said: “In Luton one of the [Legacy] conversations was captured using graphic facilitation. Attached is the image of the wall map. Its size was around 3.5m x 1.5m and it had a strong impact on the people in the conversation and was a great tool to share messages with others.”

Luton LINk Legacy picture

Luton LINk Legacy picture – click for larger image

I love an infographic and if I was Luton Healthwatch, I would decorate the Healthwatch office using this as wallpaper. 🙂


Local Healthwatch Funding Allocations and the Francis Challenge

With six weeks to go until Local Healthwatch is launched….

Recommendation 146 of the Francis Report raises a challenge for Local Authorities about the funding of Local Healthwatch:

146. Finance and oversight of Local Healthwatch
Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch, while requiring the latter to account to it for its stewardship of the money. Transparent respect for the independence of Local Healthwatch should not be allowed to inhibit a responsible local authority – or Healthwatch England as appropriate – intervening.

There has been a bit of debate on the blogosphere about what this recommendation means exactly. It isn’t enormously clear, and in today’s difficult financial climate, it seems unlikely and unrealistic that every local authority is going to pass on a somewhat undefined and non-ringfenced budget for their Local Healthwatch programme. But that does appear to be the challenge that Francis is putting forwards.

What is your local authority spending on Local Healthwatch?

In order to work out what your local authority has been allocated for Local Healthwatch, you need two bits of information: your LINks funding plus your Local Healthwatch funding. Here’s how you work it out*:

  1. LINks funding will be carried forward as the baseline for local Healthwatch funding. To find this figure for your area, look at this letter and find your local area for 2010-11.
  2. From April 2013-April 2014, the Department of Health will also make funding available for the ‘additional functions’ of Local Healthwatch.  To find this figure for your area, look at this document and do a search for your Local Authority area.

Now do your sums: add up (1) the LINk allocation plus (2) the Local Healthwatch Allocation and find your answer.  This figure is the indicative funding available for Local Healthwatch in your area.

Then you can do a little sum to work out what percentage of this allocation your local authority has actually allocated to Local Healthwatch (i.e. the value of the Local Healthwatch contract).

Other funding things that might confuse you:

There are additional funding ‘pots’ that some areas may be taking into account, but don’t let these confuse you! Essentially, they are:

  1. the start-up funding for Local Healthwatches (an additional amount of money provided by the Department of Health which is to fund the set up of Local Healthwatch) and;
  2. the ICAS (Independent Complaints Advocacy Service) funding. The ICAS funding and function ceases to be commissioned nationally in April and will be commissioned locally instead.  In some areas, this funding pot has been rolled into the Local Healthwatch specification and funding, but in other areas it has not. Bear this in mind when you are doing your sums.

Useful links:

What to do with this data:

  • Do your sums and work out what your Local Authority is spending on Local Healthwatch. What percentage of their funding allocation are they spending? Does your LINk consider this to be adequate? If not, then before it packs up its typewriter, your LINk might want to think about bringing these figures to the attention of your local Scrutiny committee.

* P.S.
I’m not entirely sure that the above sources of funding information are up-to-date – but they are all I could find. The documents seem very slippery and the funding allocations hard to pinpoint – and obviously, they are not ringfenced. But if anyone has any more information, do let us know and I will correct or amend the above info!


LINk Legacy Document – here’s ours

It’s almost time for the LINks to wrap up their good work and pass the parcel on to Local Healthwatch.

Lots of local Healthwatches will be managed by new organisations, new staff and new volunteers – so we need to make sure that the knowledge and learning of the LINks is passed on.  One of the ways is with a Legacy Document – which the LGA recommends is written by each LINk as a parting gift to the incoming Healthwatch.

We’ve just finished writing ours in Somerset, and it’s now out for comment to the wider LINk and general public. So we thought we’d share this with you, in case you are still chewing your pencil and looking for some inspiration.

We couldn’t find any simple templates out there so we put this together with the aim of transferring as much of our knowledge as possible to the new organisation.

>> Download Somerset LINk Draft Legacy document

(It’s quite large – 5MB, so you will need to wait a minute or two for it to load)

Somerset LINk Legacy Document

Somerset LINk Legacy Document

Contents:

We structured the document in two parts: looking back at the LINk, and looking forward to Healthwatch:

Part 1 TELLING THE STORY OF THE SOMERSET LINK

  • What is the LINk Legacy Document?
  • Background
    What is Somerset like?
    Health and Social care in Somerset
  • LINk Lesson 1: Engagement
    How did we engage with the community?
    How did we engage with the third sector?
    How did we engage with stakeholders?
    Who are our stakeholders in health?
  • LINk Lesson 2: Communication
    Who was interested in the LINk?
  • LINk Lesson 3: Working with Volunteers
  • LINk Lesson 4: Our LINk Activity
    Our Projects: Research
    LINk Activity
    Enter & View
  • LINk Lesson 5: Equality & Diversity

PART 2: LOOKING FORWARD TO HEALTHWATCH SOMERSET

  • Ideas for Healthwatch Somerset
    Our Legacy Survey
  • Challenges: Our Risk Register
  • LINk Library
    List of key stakeholders
    Key Dates 2013
  • Thank you
    Appendix 1: Extracts from The Francis Report

Another useful document:

What to do with this data:

Hopefully it will be of some use or inspiration if you are still scribbling away at your Legacy Document.

(If you want this Legacy Document in Word, I’d be happy to send it to you – just email me at lucy.nicholls@helpandcare.org.uk.)


The Francis Report and LINks/Healthwatch

The “Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis” – aka ‘the Francis Report’ – was published last week.

If you work in health, or patient involvement, then you must at the very least read the Executive Summary. It is very readable and concise and I’d recommend you print off a copy for bedtime reading and scribble on it.

I’m publishing on this blog the particular points that I think that LINks/Healthwatches need to read, digest, ponder and respond to. I think they are really important (and in fact, I’ve copied these paragraphs and put them in our LINk Legacy Document to be passed on to Healthwatch Somerset).

N.B. For the full chapter looking at patient involvement, you need to read Chapter 6 of Volume 1 of the full report.

Extracts from The Executive Summary:

The voice of the local community

  • 1.17 It is a significant part of the Stafford story that patients and relatives felt excluded from effective participation in the patients’ care. The concept of patient and public involvement in health service provision starts and should be at its most effective at the front line.
  • 1.18 Analysis of the patient surveys of the Trust conducted by the HCC and the Picker Institute shows that they contained disturbing indicators that all was not well from long before the intervention of the HCC.
  • 1.19 Community Health Councils (CHCs) were almost invariably compared favourably in the evidence with the structures which succeeded them. It is now quite clear that what replaced them, two attempts at reorganisation in 10 years, failed to produce an improved voice for patients and the public, but achieved the opposite. The relatively representative and professional nature of CHCs was replaced by a system of small, virtually self-selected volunteer groups which were free to represent their own views without having to harvest and communicate the views of others. Neither of the systems which followed was likely to develop the means or the authority to provide an effective channel of communication through which the healthcare system could benefit from the enormous resource of patient and public experience waiting to be exploited.
  • 1.20 Patient and Public Involvement Forums (PPIFs) relied on a variably effective, locally provided infrastructure. The system gave rise to an inherent conflict between the host, which was intended to provide a support service but in practice was required to lead with proposals and initiatives offered to lay members, and members of the forum, who were likely to have no prior relevant experience and to be qualified only by reason of previous contact with the hospital to be scrutinised.
  • 1.21 In the case of the Trust’s PPIF, the evidence shows quite clearly the failure of this form of patient and public involvement to achieve anything but mutual acrimony between members and between members and the host. A preoccupation with constitutional and procedural matters and a degree of diffidence towards the Trust prevented much progress.
  • 1.22 If anything, local Involvement Networks (LINks) were an even greater failure. The, albeit unrealised, potential for consistency represented by the Commission for Patient and Public Involvement in Health (CPPIH) was removed, leaving each local authority to devise its own working arrangements. Not surprisingly, in Stafford the squabbling that had been such a feature of the previous system continued and no constructive work was achieved at all.
  • 1.23 Thus, the public of Stafford were left with no effective voice – other than CURE – throughout the worst crisis any district general hospital in the NHS can ever have known.
  • 1.24 Under the new reforms, local healthwatch is intended to be the local consumer voice with a key role in influencing local commissioning decisions through representation on the local Health and Well-being Board. They will be expected to build on existing LINks functions. The responsibility for establishing Local Healthwatch will rest with the local authorities in the same way as it had for LINks. As is the position with LINks, the DH does not intend to prescribe an operational model, leaving this to local discretion. It does not prejudice local involvement in
  • the development and maintenance of the local healthcare system for there to be consistency throughout the country in the basic structure of the organisation designed to promote and provide the channel for local involvement. Without such a framework, there is a danger of repetition of the arguments which so debilitated Staffordshire LINks.
  • 1.25 The local authority scrutiny committees did not detect or appreciate the significance of any signs suggesting serious deficiencies at the Trust. The evidence before the Inquiry exposed a number of weaknesses in the concept of scrutiny, which may mean that it will be an unreliable detector of concerns, however capable and conscientious committee members may be.
  • 1.26 Local MPs received feedback and concerns about the Trust. However, these were largely just passed on to others without follow up or analysis of their cumulative implications. MPs are accountable to their electorate, but they are not necessarily experts in healthcare and are certainly not regulators. They might wish to consider how to increase their sensitivity with regard to the detection of local problems in healthcare.
  • 1.27 There are a wide range of routes through which patients and the public can feed comments into health services and hold them to account. However, in the case of Stafford, these routes have been largely ineffective and received little support or guidance.
  • 1.28 Local opinion is not most effectively collected, analysed and deployed by untrained members of the public without professional resources available to them, but the means used should always be informed by the needs of the public and patients. Most areas will have many health interest groups with a wealth of experience and expertise available to them, and it is necessary that any body seeking to collect and deploy local opinion should avail itself of, but not be led by, what groups offer.

Extract from the Table of Recommendations:

  • Patient, public and local scrutiny
    145 Structure of Local Healthwatch There should be a consistent basic structure for Local Healthwatch throughout the country, in accordance with the principles set out in Chapter 6: Patient and public local involvement and scrutiny.
  • 146 Finance and oversight of Local Healthwatch
    Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch, while requiring the latter to account to it for its stewardship of the money. Transparent respect for the independence of Local Healthwatch should not be allowed to inhibit a responsible local authority – or Healthwatch England as appropriate – intervening.
  • 147 Coordination of local public scrutiny bodies
    Guidance should be given to promote the coordination and cooperation between Local Healthwatch, Health and Wellbeing Boards, and local government scrutiny committees.
  • 148 Training
    The complexities of the health service are such that proper training must be available to the leadership of Local Healthwatch as well as, when the occasion arises, expert advice.
  • 149 Expert assistance
    Scrutiny committees should be provided with appropriate support to enable them to carry out their scrutiny role, including easily accessible guidance and benchmarks.
  • 150 Inspection powers
    Scrutiny committees should have powers to inspect providers, rather than relying on local patient involvement structures to carry out this role, or should actively work with those structures to trigger and follow up inspections where appropriate, rather than receiving reports without comment or suggestions for action.
  • 151 Complaints to MPs
    MPs are advised to consider adopting some simple system for identifying trends in the complaints and information they received from constituents. They should also consider whether individual complaints imply concerns of wider significance than the impact on one individual patient.

Other useful links:

What to do with this data:

  • Read it and digest it.
  • Circulate it to your LINk volunteers and colleagues.
  • Consider how you will respond to the recommendations and lessons learned.
  • Ask your local CCG and providers how they are responding to the recommendations.

LGB&T training resources (that we knitted ourselves)

A quick post to recommend some really useful Lesbian, Gay, Bisexual and Transgender (LGB&T) Training resources that you can use for FREE! for your Healthwatch/LINk Volunteers (and staff!).

> You can go straight to the training resources here if you don’t want to read the rest of my very interesting post

How did this come about?

Here at the Somerset LINk we have been part of the local Equality Delivery System group, looking at how local health services can make their services more accessible for everyone.

As a result of this work it became pretty clear that not enough work had been done engaging with the Lesbian, Gay, Bisexual and Transgender Community in Somerset. LGB&T people in Somerset reported feeling excluded from certain services or receiving the wrong advice – for example, some medical staff telling lesbian women that they didn’t need cervical screening.

So we got together with NHS Somerset and funded the very lovely Berkeley Wilde at The Diversity Trust to do some specific research work with some LGB&T people in Somerset, finding out more about people’s experiences of services in Somerset.

The final report makes enormously interesting reading and we used the findings of our work to make recommendations for health, social care and education in Somerset.

Three Simple Changes:

We recommended that health and social care services make ‘three simple changes’….:

  1. Use positive images:
    Display posters, or other media, in public spaces, especially reception areas, which include positive images reflecting LGB&T everyday lives.
  2. Display a mission statement:
    Include the ‘Protected Characteristics’ in the Equality Act 2010: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.
  3. Mind your language:
    Use language that includes everyone. When you use words like “husband/wife” and “boyfriend/girlfriend” you are making assumptions about people. Use more inclusive language like “partner”.

And we also recommended that everyone across the board takes part in LGB&T training, so that we are all more aware of these issues and services are better for LGB&T people (and everyone).

So here is the training….

You can find all of the training here:

What to do with these resources:

  • Train your staff and volunteers!
    We have just tried out the “Awareness” Module with our LINk volunteers and they found it enormously interesting and also good fun (frankly I almost had to go home and lock them in, as they didn’t want to leave….).

    (You could carry out this training yourself using these resources, which are free (because we want to spread the good work as far as possible!) or if you want someone to carry out this training for you, you can contact Berkeley Wilde at info@lgbt-training.org.uk.)

 

 


Patient Inspections and Local Healthwatch: from PEAT to PLACE

There’s a lot of new Healthwatch info being published  – check out the new Healthwatch website at www.healthwatch.co.uk  – and one of the many new tasks for Local Healthwatch is involvement with new patient-led inspections. The info about this seems a bit fragmented, so to be nice and helpful I thought I’d try to summarise it here.

Patient-led inspections?! How did that sneak into my Healthwatch basket?!

David Cameron announced in January of this year that current PEAT (Patient Environment Action Teams) inspections would be replaced by new patient-led inspections, which will be known as Patient-Led Assessments of the Care Environment or PLACE.

What are (… were … ) PEAT inspections?

PEAT inspections, as they are known, have been going on since 2000. PEAT stands for ‘Patient Environment Action Teams’.  PEAT Teams are made up of NHS staff (such as nurses, matrons, doctors, catering managers, directors etc.) and also patients and patient representatives.

PEAT inspections are an annual event for all NHS sites that have more than 10 beds.  The PEAT teams look at non-clinical aspects of patient care – such as the environment, food, privacy and dignity – basically everything from how clean the floor is to how tasty the jelly is…

NHS sites and trusts are given scores from 1 (unacceptable) to 5 (excellent). The idea is that the inspections produce scores for each site to encourage them to improve their services – and to share best practice.

How are the new PLACE assessments going to work?

The final details haven’t been decided yet – but the new assessments are being piloted this October. A total of 68 hospitals are currently involved in pilot PLACE assessments. The Pilot assessments will run from 1 October to 12 October 2012. You can read the documentation that the hospitals have been sent here. They will be similar to the current PEAT inspections but with more lay members/patients on the teams (over 50% of the team members must be patients).

How will Local Healthwatch be involved?

Local Healthwatch will of course be the ‘new consumer champion for health and social care’ – and hopefully a source of eager patient representatives champing at the bit to do This Sort Of Thing. Local Healthwatches – like LINks – will decide what work they get involved with  so they might decide that they don’t want to get involved with the new PLACE assessments. But the initial message seems to be that Local Healthwatch should be invited to have a key role in the new PLACE assessments.

Which hospitals are taking part in the Pilot PLACE assessments?

Here’s a list of all the hospitals that are taking part (the list names the Trust and then the name of the hospital):

  • Sheffield Children’s, Sheffield Children’s
  • Salisbury NHSFT, Salisbury
  • Avon And Wiltshire, Callington Road
  • Worcester Acute, Redditch
  • Birmingham And Solihull, Ardenleigh
  • Royal Wolverhampton, New Cross
  • Sheffield Teaching, Northern General
  • Manchester Mh And Sc, Park House
  • Morecambe Bay NHS FT, Royal Lancaster
  • Leeds Teaching, St James
  • Devon Partnership, Langdon
  • Leicestershire Partnership, Evington Centre
  • Nuffield, Plymouth
  • Pennine Care, Fairfield General
  • S/W Yorkshire Partnership, Fieldhead
  • Bmi, Rochdale
  • East Cheshire NHS Trust, Congleton
  • Yeovil District NHSFT, Yeovil District
  • Bedford Hospitals NHS Trust, Bedford
  • Barking Havering And Redbridge, Queens Hospital
  • Chesterfield Royal NHS FT, Chesterfield Royal
  • Queen Victoria, Queen Victoria
  • West London Mh, St Bernards
  • Norfolk And Suffolk NHS FT, Hellesdon
  • Birmingham Women’s, Birmingham Women’s
  • Pennine Acute, North Manchester
  • South West London And St Georges, Springfield
  • Norfolk And Norwich, Norfolk And Norwich
  • Kent And Medway Partnership, Thanet
  • West Kent , Gravesham
  • Uclh, Heart Hospital
  • Southern Health, Parklands
  • York Teaching, York
  • Royal Brompton, Royal Brompton
  • Royal Liverpool And Broadgreen, Royal Liverpool
  • North Cumbria University, Cumberland Infirmary
  • Central And N/W London, Park Royal
  • Spire Healthcare, Harpenden
  • Western Sussex, St Richards & Worthing
  • Central Manchester, Central Manchester
  • Medway Maritime NHSFT, Medway Maritime
  • Dorset Healthcare, Blandford
  • Gloucestershire, Cheltenham General
  • South Tees, Friarage Hospital
  • University Hospitals Bristol, St Micheals
  • Southport And Ormskirk, Ormskirk
  • South Warwickshire NHS FT, Leamington Spa
  • Liverpool Heart And Chest, Liverpool Heart And Chest
  • Tees Esk And Wear Valley, West Park
  • Nottingham University, Nottingham City
  • Humber NHS FT, East Riding Community
  • Barts Health, Whipps Cross
  • Cambridge University Hospitals, Addenbrookes
  • North Staffs Combined, Harplands
  • Plymouth Hospitals NHS T, Derriford
  • 5 Boroughs Partnership, Hollins Park
  • Royal National Orthopaedic, Stanmore
  • Ramsay Healthcare, Colchester
  • Anglian Community CIC, Clacton And Harwich
  • Calderstones Partnership, Calderstones
  • Surrey Community, Woking Community
  • St Georges Healthcare, St Georges
  • County Durham And Darlington (Ex County Durham PCT), Richardson Hospital
  • Nottinghamshire Healthcare, Rampton High Secure
  • Leicester University, Leicester Royal
  • Papworth Hospital NHS FT, Papworth
  • South Staffordshire An Shropshire Healthcare, St George’s
  • Hinchingbrooke Healthcare, Hinchingbrooke
  • County Durham And Darlington NHS FT, Darlington

Some useful links:

What to do with this data:

  • Make sure your LINk understands that PEAT inspections are changing and – once established – Local Healthwatch should be offered the chance to be involved in the new PLACE assessments.
  • Check the list of Pilot areas to see whether your local hospital/s are involved. If so, get in touch with the hospital (ask for someone with ‘Director’ and ‘Nursing’ in their job title…) to ask whether you can be a part of the Pilot – or at least kept informed of developments.