Baroness Chisholm of Owlpen (Con)
My Lords, I thank the noble Lord, Lord Harris, for securing a debate on this important issue and for his kind words, and those of other noble Lords, towards my noble friend Lord Prior of Brampton. I know that they will be much appreciated. I also wish that my noble friend was here but I will try to answer the questions raised and, if I fail to do so now, I will make sure that I do so in writing. I shall also try to put the department’s view.
Capturing, listening to and acting upon the views, preferences and experiences of individuals, including those mentioned by the noble Earl, Lord Listowel, and the noble Baroness, Lady Watkins, such as young people in care, those with mental health issues and all types of service users, and of communities, is crucial if we are to deliver the first-class services that people not only expect but deserve. Healthwatch England has two principal roles: first, to gather intelligence locally, which it can then feed back into the CQC and its inspections; secondly, to be the strong voice of users of care services at a national level. There is a powerful rationale for its close working relationship with the CQC. The CQC needs to hear the patient voice in the exercise of its responsibilities, while service users benefit significantly from Healthwatch being able to trigger action by the CQC where it finds that things are going wrong.
The recent changes to the accountability arrangements mean that Healthwatch England remains a statutory committee to the CQC, with its chair a CQC non-executive director. Under the new arrangements it retains a line of accountability to the Secretary of State, via the CQC chair, because the Healthwatch England chair is a Secretary of State appointment. The national director of Healthwatch England reports to the CQC chief executive on a regular basis. They continue to remain accountable to the Healthwatch England committee for delivering Healthwatch England plans. The CQC will be responsible to Parliament for the effective delivery of its statutory duties and finances, and for the delivery of the statutory functions of Healthwatch England through its framework agreement with the Department of Health. In future, the CQC will be responsible for allocating sufficient funds to Healthwatch England to deliver its role and statutory duties.
Let me stress that Healthwatch England’s important role is not changing; there is no change to the functions set out in legislation. The Healthwatch England committee will continue to set its own priorities and publish its own business plan and annual report. We expect it to continue to act as a strong, independent voice for patients and share its findings with the system. These new arrangements reflect the changed landscape since Healthwatch England was set up. The Government remain committed to strengthening the role of patients and communities, with greater focus on local leadership of the health and care system, and we have given the Care Quality Commission itself a stronger role in hearing patient views.
A big part of Healthwatch England’s role is to work with the Healthwatch network to provide leadership and support, as each local Healthwatch builds its profile and impact on local services. In answer to the question from the noble Lord, Lord Tunnicliffe, about a patchy and fragmented system, it is a priority for Healthwatch England. In fact its number one priority as set out in its business plan for 2016-17 is:
“To provide leadership, support and advice to local Healthwatch to enable them to deliver their statutory activities and be a powerful advocate for services that work for people”.
Healthwatch will continue to develop its own business plan and priorities. It will also continue to produce an annual report, which will be laid before Parliament.
This Government have a collective ambition that the people of this nation should have their voices heard, and have local health and care services designed and delivered around their local needs. Whether that be helping to set up a new local community provider of domiciliary care services in Cornwall or investigating mental health services in Birmingham, proper involvement and representation is indeed required to amplify this citizen power and to influence change. This is where local Healthwatch organisations fulfil a pivotal role. Their aims can be neatly summarised as: giving citizens greater influence over the commissioning and provision of local services; using people’s experience of services to bring about improvements locally and nationally; and providing local people with information about health and social care services, and their choices in respect of those services. I am very pleased to inform the House that these aims are now a reality for many local Healthwatch organisations up and down the country.
None the less, I am aware that there is some concern about the perceived lack of independence of local Healthwatch organisations which are funded by, and accountable to, their local authority. I do not consider that the funding and accountability arrangements for local Healthwatch organisations undermine their effectiveness or independence. We are not aware of any specific accusations that a local Healthwatch has felt unable to raise issues for fear of repercussions. Local Healthwatch organisations set their own priorities, based upon information and intelligence gathered on issues relating to local health and social care services. Their place on the local authority health and well-being boards helps to promote their independent role in representing the views and experiences of local communities.
Local authorities are well practised in commissioning organisations to deliver services that benefit communities and, at the same time, scrutinise the council. Local Healthwatch organisations also have independence in that they will be able to feed information directly to Healthwatch England, ensuring that a local voice has influence at a national level. Healthwatch England is assisting by providing leadership, support and advice to local Healthwatch organisations to enable them to deliver their statutory activities and be a powerful advocate for services that work for people.
However, the fact needs to be acknowledged that local authorities are facing challenging funding decisions. In such times, it is crucial that in fulfilling their statutory duty to commission local Healthwatch, local authorities have the freedom to ensure that their arrangements meet the needs of their local population and represent value for money. Central control of local funding decisions would diminish the voice of local communities and ignore other voluntary or partnership arrangements that a local authority may already be funding for the benefit of its population. But let me be clear on one important point: local authorities are still accountable for the funding that they allocate to local Healthwatch.
This Government are committed to transparency around local Healthwatch funding. Healthwatch England publishes figures showing how much councils are spending so that local communities can hold their councils to account. Your Lordships may have seen Healthwatch England’s report on 2016-17 local authority funding. I will say up front that the data show that some local Healthwatch organisations have large reductions in their funding. It is in the interests of local authorities and other local care system partners to have a well-performing local Healthwatch that will help to drive up the quality of local services. Those local authorities will need to demonstrate how their local Healthwatch organisations can still carry out their duties effectively. None the less, I am pleased that Healthwatch England reports that local authorities are recognising the overall value of local Healthwatch and, when compared with other council-run services, are continuing to invest. This is encouraging.
I now turn to some of the questions that were raised by noble Lords during the debate. The noble Lord, Lord Harris, talked about local Healthwatch not influencing CQC inspections. CQC actively seeks intelligence from patients, the public and staff prior to its inspections, including from local Healthwatch. The noble Lord and the noble Baroness, Lady Warwick, raised a point that I want to emphasise. Local Healthwatch has an independent voice and its statutory powers to relay patient and user voices at national level remain unchanged and unfettered.
The noble Lord, Lord Harris, also said that there is underspending and that not enough is spent on local Healthwatch. Going forward, much more of Healthwatch England’s resources will be spent on supporting local Healthwatch as this strand is being given a stronger priority by Healthwatch England. Changes to the governance and organisation of Healthwatch England reducing the duplication of, for example, corporate functions mean that Healthwatch England will be able to refocus more of its resources on its essential duties, especially on supporting local Healthwatch. It retains independence of voice and will continue to speak truth unto power, including, where necessary, to the CQC itself.
Several noble Lords, including the noble Lord, Lord Harris, spoke about problems with IT. The IT company concerned, Patient Experience Library, provides an existing service which draws together a range of reports and reviews from organisations across the country. Healthwatch England subscribes to the service rather than going to the expense and duplication of setting up a parallel system. Healthwatch England also undertakes analysis of the reports as part of its national role to understand and relay the user voice and concerns to national decision-makers. The service is a subscription service, and local Healthwatch organisations are free to decide how to spend their funds.
My noble friend Lord Lansley mentioned the independence of Healthwatch England within CQC. I agree with him that Healthwatch England is independent and acts as a rigorous scrutineer to use its place within CQC as leverage to support the voice of users. As my noble friend said, Healthwatch England has powers to challenge at national level which were not available to predecessor organisations, which puts it in a unique place to bring the voice of users to national decision-makers.
The noble Baroness, Lady Pitkeathley, made, as always, an extremely good speech on this subject. She comes with so much knowledge. She mentioned Healthwatch England’s subordination to the CQC, as did several other speakers. Local authorities are accountable for the funds they allocate to local Healthwatch organisations to ensure that they meet their statutory functions. Healthwatch England will be closely monitoring the ability of local Healthwatch organisations to deliver their statutory functions while also continuing to engage with local authorities in order to support the sustainability of local Healthwatch organisations.
The noble Baroness, Lady Masham, asked about the profile in local communities, particularly rural communities. Simon Stevens and Jim Mackey wrote a letter on 12 December to STP leaders saying how important local engagement is and that rural areas must be included in this. It is an ongoing problem which we must keep addressing.
The noble Earl, Lord Listowel, mentioned the important problem of continuity of mental health between young and old. I am going to take that back to my noble friend Lord Nash. This is a problem that keeps cropping up, and it is something we must keep bringing up. It is very important. There is no doubt that there is a problem when you leave children’s services and move on to adult life. People are definitely slipping through that net, so I will take that back.
The noble Baroness, Lady Walmsley, mentioned the experts by experience groups. CQC is strongly committed to the involvement of patients and service users in its inspections. The new contracts for experts by experience provide a more flexible and cost-effective method of engaging service users to carry out this important role. CQC is taking action to improve contract delivery, which has indeed been less than what is required in some areas of the country. Meanwhile, CQC has been very clear that there has been no diminution of the involvement of service users in the inspections programme.
The noble Lord, Lord Tunnicliffe, raised several very important questions. One was about providing analysis of information provided by CCGs. There is no analysis, but each CCG has to publish an annual report, and these reports are taken into account as part of the CCG assurance process with support provided to those not performing to a suitable standard. The noble Lord also asked whether there is a breakdown of the best and worst performances of CCGs or areas in this respect. NHS England does not do this. It focuses on supporting, not naming and shaming.
The noble Lord also asked NHS England to address poor performance in involvement. NHS England offers bespoke support according to local need. It is currently refreshing the statutory guidance for CCGs in partnership with local Healthwatch, voluntary organisations, patients and the public. He also asked about removing patient groups from the membership of the patient and public voice assurance group. I understand that this is not to be the case and that the membership of that group has been reviewed to refresh and strengthen it.
I hope I have answered all the questions, but I shall make sure that I go back and read Hansard to see what else the department needs to consider following this very important debate. Effective representation of the public voice is vital if we are to have a health and care system that meets the needs and preferences of individuals and local communities. Healthwatch England and local Healthwatch are powerful champions for this public voice and, as the noble Baroness, Lady Walmsley, said, the patient voice is vital.