Lord Ray Collins of Highbury is a frontbench Labour Peer in the House of Lords
In pushing through the Health and Social Care Act, the Coalition Government made much play of the need for patient involvement. Sadly, despite all the worthy words of Ministers, they rejected calls from crossbench and Labour Peers to make the body proposed fully independent. Instead, they went ahead with the national body being a committee of the Care Quality Commission (CQC), meaning that Healthwatch, the name given to patient organisations, will not be seen to be independent or able to guarantee genuine local representation.
This is just another example of the little thought Ministers have given to implementing the Health Act. As with Clinical Commissioning Groups (CCGs), local Healthwatch will take many months – year, even – before they are fully established.
At a time when a strong patient voice is most needed, the government has launched into a costly programme that will fragment services, cause confusion and demoralise key patient organisations. Indeed, as Toby Harris argued during the Bill’s Report-stage, an effective organisation for patients must be measured against three basic principles: independence from providers, commissioners and regulators (because a complaint may involve the need to challenge any or all three of those interests); genuine grassroots representation from group and individuals; and sound local information.
So what is the Government planning?
Despite the clarion call of no more top down reorganisations, we will have a national body that is little more than a committee of the CQC. But with no clear rules in law, we are potentially left with a range of different local social enterprises determining the national representation. Rather than provide a statutory basis to govern relationships, Ministers answer to this, and the inevitable financial pressures and potential conflicts of interest, is to require local authorities to: "have regard to ... any Secretary of State guidance on this matter".
Well, as Groucho Marx once said a verbal promise is not worth the paper it is printed on. In not providing statutory status to local Healthwatch, Ministers missed the opportunity to establish organisations that were fully trusted and supported by patients and the wider public alike.
Instead, with the commissioning of Healthwatch to be carried out by local authorities, there is huge potential for conflict of interest. Can we really ask a patient or carer to have confidence in a complaint being properly pursued when it involves a regulatory failure in the council’s social services?
But what is worse is that when local resources are really tight, we face the prospect of fragmented services, delivered by multiple providers. Take the patient advocacy service used by adults and children/young people wishing to make a complaint about NHS healthcare. Currently three providers of the Independent Complaints Advocacy Service in England are commissioned centrally by the Department of Health. In future, this will be commissioned by 152 councils. Estimates suggest this will add £2.2m to the cost of the service, massively reducing what is available for other patient services provided by the Local Involvement Networks.
Only one Healthwatch will be contracted in a single local authority area, but this body will be permitted to subcontract most if not all of its activities, resulting in some areas in multiple contracts, solicitors’ fees and all the other knock on-cost of commissioning – and the evaporation of already small budgets. Such a waste of public money on contracting would be absolutely appalling.
Finally, while local Healthwatch must be a social enterprise in either the charity or private sector, the subcontractors they use need not be. Yet another potential gap for private insurance companies to fill. Surely it’s not too late to stop this madness and put the planned additional spending on bureaucracy back to where it’s most needed – in the hands of the patient.