How can an organisation funded by Calderdale Council – and, indirectly, central government – be expected to act as an independent, public watchdog for Calderdale Council public health policies, strategies and actions, and for the NHS purchasing decisions of the new Calderdale Clinical Commissioning Group?
Calderdale Council has awarded the £302k 2013-2015 contract for Local HealthWatch to Voluntary Action Calderdale, who bid for it in 2012.
The Coalition government’s Health and Safety Act 2012 requires Councils to fund a Local HealthWatch group. This is supposed to be “the consumer champion within the new NHS and social care arrangements, providing influence, signposting and advocacy for service users”, according to a Calderdale Cabinet Report of 10 December 2012.
Aren’t we citizens?
The use of the word ‘consumer’ here is telling. What exactly does an ill person in need of health care – which they’ve paid for through National Insurance in order to be able to access it free in time of need – have in common with a shopper?
By setting up HealthWatch for consumers, not citizens, the implicit assumption is that our needs for NHS “influence, signposting and advocacy” are as individuals. This implicit assumption is an essential part of preparing us for backdoor privatisation of the NHS. In a privatised health system, the public are individual consumers.
But the NHS is a collective service, created by a democratic, political act. It’s very hard to see how a “post-political” Healthwatch will offer the public any way of addressing what is in fact a collective, political problem: how to keep our NHS public, by protecting it from the backdoor privatisation which the Health and Social Care Act has legislated for.
What Calderdale Healthwatch is going to have to deal with
In this Calderdale SOS video, Dr Susi Harris very clearly explains the new NHS that Healthwatch is going to have to deal with. At 6min 55 sec she introduces Healthwatch England and says,
“Healthwatch has been stripped of any statutory powers it was about to be allocated”
Healthwatch costs and accountability
Calderdale Council is paying Calderdale Voluntary Action £150,994/year for two years from 1 April 2013, with the possibility of a one year extension for 2015/16. This is to cover what is called the “voice and influence” work. The Cabinet Report 2012 states that there are other costs of commissioning this service, including performance management and that existing Communities budgets will pay for these.
Of the money it will pay to Calderdale Voluntary Action, the Calderdale Cabinet Report of December 2012 said that £100K/year will come out of Calderdale Council’s Budget Growth fund and the rest will come out of central government funds for local authorities to cover Local HealthWatch duties around Signposting and Complaints Advocacy.
In addition to the £150,994/year that Calderdale Council is paying Voluntary Action Calderdale for the Calderdale HealthWatch “voice and influence” work, the Council will also pay £54,445 in 2013/14 for a joint “ NHS Complaints advocacy service” with Kirklees Council. Calderdale and Kirklees Councils have not yet awarded the contract for this work, but will do so by 1 April 2013. The budget beyond 2013/14 for NHS Complaints Advocacy is to be confirmed.
Bureaucratic language, eh? Signposting? That’s the hospital over there. Oh, sorry, it doesn’t provide the healthcare you need, that’s a Procedure of Limited Clinical Value (RCS Briefing – Procedures of a Limited Clinical Value – Jan 11-use back button to return to this page) and you’ll have to go private and pay for it yourself. What? You want to complain? Bit late for that, it’s all a done deal, sorry. You want us to advocate for you? You want some influence? Do you really expect the Healthwatch dog to bark at the organisations that feed it?
The public’s watchdog for the new-style NHS won’t only be indebted to Calderdale Council, it will also be indebted to the Coalition government. Just how real is such stage- managed “consultation” going to be? And it will cost at least £200K out of Calderdale Council’s severely cut budget.
Dr Soo Nevison, Chief Officer at Voluntary Action Calderdale, said,
“VAC is an independent charity with independent rights to campaign, regardless of where funding is received from (this is supported by the Calderdale Compact which both VAC and Calderdale Council are key supporters of). Should any issues arise of a nature where HealthWatch is not being ‘listened’ to, VAC will ensure that its rights are exerted to the benefit of the local communities it serves.
VAC will work closely with the advocacy service provider to ensure that when people have personal complaints about services they have received, these are also supported.”
On 5th March VAC plans to launch Calderdale Healthwatch at a public meeting, open to all, where it will explain how it intends to run Calderdale HealthWatch, and start the process of recruiting members of HealthWatch Calderdale Programme Board, which should be set up by 1st May. Dr Nevison said,
“The Board will be made up of local people who can represent their local communities and/or communities protected within the Equality Act.”
Calderdale Compact – a guarantee of Calderdale HealthWatch’s independence?
Compact is an agreement between the voluntary sector and the ConDem Government to ensure better working together. Its tagline is “The Coalition government and civil society organisations working effectively in partnership for the benefit of communities and citizens in England.”
Its approach can most charitably described as ‘naive.’ In its own words,
“A diplomatic approach to challenging bad practice works best. If a government department or statutory body hasn’t followed Compact principles, asking them whether they are being Compact-compliant can make things right.”
The national Compact organisation has over 2,300 members, ranging from community organisations to large national charities. There are also local Compact organisations, like Calderdale Compact.
Voluntary Action Calderdale’s reliance on the Calderdale Compact to safeguard Calderdale HealthWatch’s independence is not wholly reassuring, given that the national Compact 2012 survey of local Compact groups reported that,
“…alarmingly, many respondents felt that the independence of the voluntary and community sector was declining…”
Given anxieties about the new Calderdale Clinical Commissioning Group’s lack of transparency and accountability, and the way that the Health and Social Care Act opens the back door wide to NHS privatisation, it’s damning that the Compact 2012 survey found that in Yorkshire and Humberside, there was low compliance on consultation and funding. Asked whether pre-tendering events were held to make sure that potential bidders were well informed about the procurement process, 14% of respondents said this happened ‘Always’; 0% said it happened ‘Most of the time; 86% said it happened ‘Some of the time’ and 0% said it ‘Never’ happened.
The Second Annual Assessment of the Panel on the Independence of the Voluntary Sector is called Independence Under Threat in the Voluntary Sector in 2013. It concludes that the voluntary sector
“…is at risk because its necessary independence is under threat, and that that threat is greatest for organisations working with disadvantaged people.”
The threat to the ‘necessary independence‘ of voluntary organisations raises the serious question of whether Calderdale HealthWatch will be able to effectively challenge the Calderdale Clinical Commissioning Group or Calderdale Council, in its role as provider of NHS public health services, if the public finds they are not providing proper care.
Dr Nevison said,
“Calderdale was recognised nationally for its Compact work in 2008 and then again in 2009 (when I was given an award for being a national Compact Champion). We were the first Compact in Yorkshire and Humber (and indeed one of the first 10 nationally) to gain Green Flag status to recognise our good work. This Green Flag also includes the NHS as our local compact covers all public agencies and the private sector rather than just the council.
Yes Compact has its issues – all documents and agreements of this kind do. I have also been a regional Compact Champion in the past and understand that Compacts in other districts are completely ignored and dysfunctional.”
The Report Independence Under Threat in the Voluntary Sector states,
“It is particularly surprising to see direct attacks by Government and others on the freedom of expression of voluntary bodies working with the state. Self-censorship by voluntary bodies is also a problem because some fear losing vital and increasingly scarce state funding if they challenge the status quo.There is widespread non-compliance by central and local government with measures to protect independence.”
Dr Chris Day of Calderdale 38 Degrees said,
“We would like to call for an investigation of the proposed local Healthwatch group, with the clear intention to campaign for a boycott of the group if we are not reassured by its findings.”
Changing More Than Lightbulbs invited some Calderdale Councillors to comment. If any Councillors (or anyone else) would like to comment, please use the contact form.
There is more here about the threat to democracy from the ConDem’s treating citizens as consumers.
Updated 2 Feb with link to Guardian article