Better Health For All

Does Local Healthwatch offer a fresh start for democratic accountability in healthcare, or more of the same structural problems that lead to tokenism and a lack of inability to have real influence? This was the question at the heart of the debate about democratic accountability at the 2012 FPH conference. The workshop was chaired by Professor Mark Gamsu of Leeds Metropolitan University, who specialises in tackling health inequality through strong citizens, local government and the voluntary sector.

Mark talked about how government policy often focuses on the ‘manual’, or process of delivery, rather than outcomes and impact. He – partly in jest – apologised for his part in the inclusion of Joint Strategic Needs Assessments as a duty in the Health and Social Care Act, because in his view it is only a tool – and tools should not be legislated for. It might have been better to have a duty requiring local strategies and commissioning to be based on local intelligence. There is also a tendency for all new governments to assume they are starting from a ‘year zero’ positionand therefore a danger that the achievements and experience of the present and past is not recognised and built on sufficiently.

Mark looked at the challenges and opportunities offered by Local Healthwatch, which launches in April 2013 and will take on the work of the Local Involvement Networks (LINks). Healthwatch and public health are potential allies. They share some characteristics, not least because they are both comparatively small and achieve much of their impact using evidence to influence change.

This led to lively discussion of what drives commissioners, and the kind of leadership that can be expected to make the new systems work effectively once they take effect in 2013.
This will have a direct effect on what Healthwatch can realistically achieve, given that its lack of statutory powers mean it could face the same problems of tokenism and inability to effect change that have affected LINks.

There a was both positive and negative experience among delegates, who included commissioners and current LINks members, about how likely it was that Healthwatch could have the necessary influence to hold local services to account. As one LINks member put it, very few people in his area had heard of the service, or knew what it did.

There is also a tendency for all new governments to assume they are starting from a ‘year zero’ position, so that new systems are required regardless of how well the existing ones are working or how much time and effort is put into reorganising systems.

Reorganising health systems is not always a good use of resources: Mark Gamsu

This led to lively discussion of what drives commissioners, and the kind of leadership that can be expected to make the new systems work effectively once they take effect in 2013.

This will have a direct effect on what Healthwatch can realistically achieve, given that its lack of statutory powers mean it could face the same problems of tokenism and inability to effect change that have affected LINks. There a was both positive and negative experience among delegates, who included commissioners and current LINks members, about how likely it was that Healthwatch could have the necessary influence to hold local services to account. As one LINks member put it, very few people in his area had heard of the service, or knew what it did.

Mark gave an example of how important it is that information reaches the people who need it. Sheffield Mental Health Citizens Advice Bureau gives advice to patients on mental health wards, helping to bring the outside world into an institutional setting.

Ultimately, Healthwatch’s success matters for public health professionals because without local accountability for health services, there is a risk that health inequalities will be increased. Healthwatch’s success will be measured in part by how complaints are heard and acted on. With the final report from the Staffordshire public enquiry due in October, there is still much to be learnt about how statutory bodies act on the information they receive.