Ray Collins on the need to ensure independence of Healthwatch England from the CQC
Over the last 40 years or so we have seen Community Health Councils, then the Patient Participation Forums and most recently Local Involvement Networks (LINks). Each built upon on the progress of its predecessor to deliver greater patient involvement, but because of the Health and Social Care Act we now have a further change.
Healthwatch England (HWE) is a great opportunity to continue progress in meeting the goal of effective patient representation. But without genuine independence it will not gain public confidence.
Ministers have said it will have genuine operational independence by ensuring the majority of its members are not also members of the Care Quality Commission (CQC). Yet under regulations being debated in the Lords tonight, the HWE Chair must consult the CQC Chair before the first appointments are made.
It remains difficult to see how HWE can build public trust when its governance is controlled by a body whose own problems have been so publicly aired. The fear is that HWE will be rapidly absorbed into, moulded and overwhelmed by, the dominant culture and infrastructure of the CQC. Sharing resources including technical data management and gathering is important to advancing patient involvement. Subsuming the organisation is not; and Labour argued strongly throughout the Health Bill that HWE should be independent – something Ministers resisted at every turn. Indeed, those same Ministers also stressed the importance of a duty of collaboration within their reorganised NHS, so why not use that duty rather than leave HWE within the CQC governance structure?
From recent statements it is clear that the new HWE Chair, Anna Bradley (a former Chief Executive of the National Consumer Council) fully appreciates why the organisation must meet the challenge of independence and effective patient representation if it is to succeed.
A key to this will be the strength of the Local Healthwatch network, which must illustrate that it listens to patients and service users and captures their feedback – a role LINks and the third sector have performed with some distinction. With no clear rules in law however, we are potentially left with various local social enterprises determining the national representation. Rather than provide a statutory basis to govern relationships, Ministers answer to this, the inevitable financial pressures and potential conflicts of interest, is to require councils to "have regard to ... any Secretary of State guidance on this matter".
In the end, it will come back to how the structure proposed in the regulations will play out in practice and how conflicts of interest will be dealt with. So, I am seeking an explanation on how public trust can be maintained when a complainant about a CQC investigation discovers the body investigating the complaint or championing improved quality of care on behalf of patients is a committee of the CQC itself? I am also asking Ministers to explain how the culture clash between HWE and the CQC will be managed.
It is important that Healthwatch is able to challenge and scrutinise the work and decisions of the regulators – Monitor as well as CQC. That is why it needs be independent, and that is why we need Local Healthwatch bodies that are genuine patient representatives. The government’s planned regulations gives us neither.
Lord Ray Collins of Highbury is a frontbench Labour Peer in the House of Lords
Published 21st November 2012
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