80 London Road
London SE1 6LH
2nd August 2014
Dear Ms Bradley,
Local Accountability and meaningful public involvement in decisions about service redesign.
We share some of the concerns you raised in your 16th July 2014 letter to the Secretary of State for Health.
We hope that some Local Healthwatch organisations use their statutory powers to promote transparency and accountability by Clinical Commissioning Groups (CCGs) and other NHS organisations. Unfortunately the Healthwatch organisations we have encountered do not do so. In our view, the main reason for some CCGs’ failure to properly engage with patients and the public is not due to the formation of “Super CCGs”, it is due to the failure of some Local Healthwatch organisations to hold them to account. We believe that Healthwatch should urgently deal with its own problems of weakness and lack of transparency and accountability before asking the Secretary of State for more legislation.
Our comments are based on our experience of Bristol and South Gloucestershire Healthwatch, described in the attachment to this letter. The examples are not exhaustive and we do not believe the problems are unique to this part of the country.
We ask you to review and respond to this information, please. We would welcome the opportunity to meet you to discuss how the Local Healthwatch organisations which are failing to perform as “consumer champions” can transform themselves and provide value for the public money.
Mrs Daphne Havercroft, on behalf of SWWHAG
.cc Rt Hon Jeremy Hunt MP, Secretary of State for Health
Mr Simon Stevens, Chief Executive, NHS England
Councillor David Sparks OBE, Chair, Local Government Association
Mr David Prior, Chair, Care Quality Commission
1. Local Healthwatch and Service Redesign
In November 2013 South Gloucestershire Council’s Health Scrutiny Committee referred the future of a community hospital at Frenchay, Bristol to the Secretary of State for review by the Independent Reconfiguration Panel (IRP).
The IRP’s report to the Secretary of State says “That residents of the area should feel exasperated by the years of delay, changes to the NHS organisation, pauses in developments and amendments to plans is entirely understandable. The overall process to date has shown a marked lack of empathy for patients and the public who have a right to expect better.”
“Progress to date has suffered from a lack of trust from the public and it is important now that the NHS works hard to regain that trust. A new approach to public engagement and involvement is required that demonstrates mutual co-operation and ensures that the public can have confidence in a quality service.”
If Local Healthwatch had used its existing powers to hold local NHS organisations to account to engage openly, honestly and constructively with local people, it is likely that a referral to the IRP could have been avoided and public money saved.
The problem was described in a recent exchange of correspondence between local campaigners Save Frenchay Hospital Group (SFHG) and South Gloucestershire Clinical Commissioning Group (CCG). The CCG confirmed that the membership of a Project Board which oversaw a Rehabilitation and Reablement Review (the future of Frenchay is within scope), included “lay representatives” nominated by the Local Involvement Networks (LINks) for Bristol, North Somerset and South Gloucestershire. Subsequently “lay representatives” on the Project Board were nominated by local Healthwatch.
The SFHG spokesperson, Mrs Barbara Harris, told the CCG that during the South Gloucestershire Council Health Scrutiny meeting in November 2013 where the resolution for referral to the Secretary of State was passed, she was handed this note by the South Gloucestershire Healthwatch Volunteer who sat on the Rehabilitation Project Board as a “lay representative”. He wrote the note after hearing the CCG claim to Councillors that patient and public involvement was satisfactory.
Mrs Harris explained to the CCG that she was surprised by the note because she did not once hear the author complain about the poor standard of public and patient involvement at the meetings she had attended.
She asked the CCG how the “lay representatives” discharged their duties to the public they purported to represent by asking it to describe when, where, how and by what means they reported back to the public on the CCG proposals.
The CCG’s revealing response confirms what the public already knows – local people are being cut out of local decision making by Healthwatch “lay representatives” who sit on NHS Project Boards and represent nobody’s interests except their own.
“The role of each of the lay representatives has been to contribute to the work of the Project Board in an individual capacity and there was no specific expectation that the lay representatives would individually report back to the wider public.”
This problem extends to NHS England’s Citizens’ Assemblies where, in the South West at least, all members have been nominated by Healthwatch, not the citizens whose interests they purport to represent.
2. Written evidence to the Commons Health Committee
We described our experiences of Local Involvement Network and Healthwatch responses to concerns about the quality of Bristol’s paediatric pathology and histopathology in our written evidence to the Commons Health Committee’s Inquiry into Complaints and Raising Concerns. The link to the evidence can be found here, paragraph 19. The LINk member who tried to quash patient safety concerns is now a Volunteer Champion for Local Healthwatch.
a. We raised our concerns with Local Involvement Networks (LINks). One LINk member tried to quash any public and patient concerns about histopathology and paediatric quality and safety.
b. A verbal allegation was made by a chair of one LINk that a neighbouring LINk had been offered “inducements” to suppress public concern about histopathology and paediatric pathology. We asked the LINks, their host organisation and the two local councils which funded the LINks to investigate this allegation. All refused.
c. Our Local Healthwatch organisations seem to be as ineffective as LINks.
d. In late 2013 we raised our concerns about paediatric pathology staffing with a local Healthwatch. Its reply indicates that it is content because “the NHS suggests that there are plans in place to cover any shortfall in staffing.”
e. We want to see the plans because shortfalls in Bristol’s paediatric pathology staffing have existed since 2001 and we know that at least one child died because it was not managed safely.
f. Healthwatch said it would welcome the opportunity to hear from patients, parents or carers whose treatment has been affected by any failure in paediatric pathology staffing plans.
g. Healthwatch has not considered how parents would know whether treatment had been affected by any failure. There is no statutory duty of candour which would require NHS staff to tell them.
h. We regard our local Healthwatch’s response to patient safety concerns as dangerously complacent.
3. Healthwatch and Health and Wellbeing Board (HWB)
Healthwatch’s representative on South Gloucestershire Council’s Health and Wellbeing Board is the Head of Nursing and Clinical Services at private health provider Care UK’s Emerson’s Green Treatment Centre. We have asked Healthwatch to publish the process by which this individual was appointed to the Health and Wellbeing Board and how they meet these requirements set out in the Council’s Service Specification with Healthwatch:
“…….elevating residents’ voice to the Board by effectively representing their views in a clear and evidenced manner, without bias or subjective influence”
“To provide constructive challenge, from a residents’ perspective.”
We are still waiting for an answer and we have seen no evidence that the Healthwatch representative on the HWB has made any effort to understand residents’ perspective.
© South West Whistleblowers Health Action Group 2014