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:
- The scale of the work is enormous:
Over £1 billion of public money is spent on health and social care every year in Somerset.
- 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?
- Lay people need lay language:
Believe me, patients have no interest in your authorisation pipeline.
- 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.
- 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.
- 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.
- 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:
- Patient Voice? by Martin Rathfield, published by the Socialiast Health Association.
- Warning Local Healthwatch: proper health scrutiny requires investment by Lucy Nicholls, published by the Westminster Briefing.
All comments welcome!
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*:
- 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.
- 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:
- 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;
- 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.
- Healthwatch Fact Pack on Funding: Not sure who wrote this factsheet (or when they wrote it), but it’s pretty comprehensive and answers a lot of questions about Local Healthwatch Funding. (It looks like it was written for Bexley Borough Council.)
- LINks Funding Allocations (dated 10 December 2007): Look at Year 3 for the LINk allocation for your area.
- Local Government Association Healthwatch Factsheet – Funding. This contains the indicative amounts for the additional functions of Local Healthwatch.
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.
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!
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!).
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’….:
- Use positive images:
Display posters, or other media, in public spaces, especially reception areas, which include positive images reflecting LGB&T everyday lives.
- 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.
- 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 firstname.lastname@example.org.)
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:
- Read all about PEAT – and download PEAT scores – on the NHS Information Centre website here.
- Find out more about PLACE inspections – including the info pack sent to the pilot hospitals – on the Associaton of Healthcare Cleaning Professionals website here.
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.
And then I made a version with Public Health England on it…
“Where is Public Health England?” pointed out a keen Twitterer, who was perusing my very pretty “NHS Reforms on one side of A4“, so I had to go back and glue in some more pieces.
Hmmm… I do worry that the trouble with sharing this version with members of the public is that it might be tipping the diagram into Thanks-But-Now-I-Really-Am-Glazing-Over territory (the ‘PCT Clustering’ effect), but I will include it for accuracy:
What to do with this data:
- Stick it on the wall for people who say: “Where is Public Health England, eh?”
- Make your own version! Here’s the template for you:
>> The original PowerPoint slide for you to fiddle with
What you can download here:
After explaining the NHS Reforms for the millionth time to a member of the public (in biro on the back of an NHS Catering serviette) I set myself the challenge of trying to produce a one-page diagram showing the very basics of the reforms.
Here is my final effort:
I decided to make it very simple and stick to the BIG MESSAGES, rather than attempting to capture the detail e.g. of clustering, which seems to make the most enthusiastic member of the public glaze over and start looking for their PPI sandwich rations, but so far this diagram seems to do the job. I think it gets the balance between boring people senseless and over-simplifying, but I’m very open to any suggested amendments.
And then I made a local version…
Well I liked this so much that I made a local version for Somerset, showing exactly what budgets were going where, and what the GP localities looked like in the county. So here is the local picture for Somerset:
What to do with this data:
- Print it out and stick it on your wall so you can admire it.
- Print out copies and hand them out to members of the public (and local councillors, they will LOVE you big time).
- Make a local version – oh yes you can! – just like mine.
>> Here’s the original document in Powerpoint for you edit and make your own!
This will make you very popular.