Reflecting on HealthWatch in the Health White Paper melee (updated)

Whilst the pandemonium about various changes proposed by the Health White Paper continue (rightly so, by the way), the issue of patient and user voice remains as high up the agenda as it usually does.

That is, not at all.

I've focused on this area in two previous posts - one on patient voice in the White Paper and another on the question of democratic accountability.

I have to confess I've not had chance to read the government's response to the White Paper consultation ("Next Steps") and what it says or updates about HealthWatch (HW). As far as I can tell, it's strengthened issues around advocacy (particularly by saying advocacy services can still be contracted for directly by LAs, rather than sitting within HWs), strengthened HW representation on Public Health and Wellbeing Boards, and generally reduced the need for overview and scrutiny.

Of course, I'll blog on what Next Steps actually says about HW when I've read it.

But in the meantime, today saw an event in the area I work on the establishment of a local HW. Here are some quick and dirty observations of the day:

• The level of understanding of what the Health White Paper is seeking to achieve is low
• The level of understanding of what HW England and the local HW will do is low
• The level of understanding of the relationship between HW England and the local HW is low
• There is a significant divorce between health and social care in the views of service user "representatives"
• "Entrenched interests" doesn't come anywhere near explaining the problems facing commissioners of local HW over the next few months
• If today was anything to go by, the profile of people directly engaged as "representatives" and volunteers in LINks at the moment can be summed up in two words: (1) old; and (2) white
• Partnership working between organisations who are or will be relevant to the local HW feels a long way off
• For areas where there are unitary and county councils close together, the question of whether there is a joint Health and Wellbeing Board across all of them or a separate one for each is a very, very thorny one
• This said, the question of whether there is one local HW per council or a local HW operating across several is a bit easier - it's only a very thorny question and not a very, very thorny one
• No one knows what money will be available to commission the local HW, or whether it will be ring-fenced. I'm guessing not, since it will sit in LA budgets. (As a comparison, in 2009/10, the DH awarded £24.3m across all 150 LINks.)

This may all sound like doom and gloom, and at least in that regard it's similar to most other proposals in the Health White Paper.

But it's not.

All the government needs to do is create some clarity soon on the topic of HW England and local HW in order to allow commissioners to demonstrate the local leadership they are hugely capable of.

Next week's Health and Social Care Bill may give us this, so amid the tumult of discussion about the big ticket items, remember to keep an eye out for what the Bill says on HealthWatch.

Update: Of course, I forgot to mention whether social media was mentioned as a means of engagement for HW. Apart from the most cursory of mentions - a gesture towards Facebook - it wasn't. A few of the kool kids at the back of the room whispered about it away from the more vocal participants in the day, but it was a useful reminder of how little wider awareness social media there is amongst parts of the population and as part of the debate/solution to engagement.

It would be great to have the opportunity to change that.

More positively, there seems to be some excellent LINks work at the moment on Twitter - see and .