What does this mean for support for local Healthwatch from Healthwatch England?

With key details of the proposed changes still to be determined, organisations delivering Healthwatch are operating in a challenging and uncertain environment. In this context, Healthwatch England’s support will need to be tailored to the specific circumstances of each local Healthwatch.

Issues such as contracts, staffing and volunteer management, finance and risk, governance, stakeholder relationships, and demonstrating impact and value may all come into even sharper focus during this transition period—whose length remains unknown.

Your regional manager is your first point of contact for discussing any challenges your Healthwatch may be facing. While we cannot offer advice outside our statutory remit, we can help you think through your options, signpost to relevant support, or connect you with others in the network who have faced similar situations and can share their experience.

Policy

Healthwatch will continue to need a clear understanding of health and care policy developments. Healthwatch England will provide regular updates and briefings to help local Healthwatch interpret what these changes mean for your work.

Research and data sharing

We will continue to support Healthwatch in planning and delivering research through our Research Help Desk and other support.

We will also continue to collect and analyse data from across the network and use this insight to produce briefings on emerging issues and trends, so please continue to share your data with us as normal. 

Recognising the pressures many Healthwatch face - such as staff turnover - we will remain sensitive to local capacity and continue to provide inductions and ongoing support for new staff with responsibilities for sharing data with Healthwatch England.

Learning and development

Maintaining staff skills and confidence is essential during this period of uncertainty.
We will continue to offer core skills training, adjusting based on demand, including content relevant to those considering career development.

We will also analyse the results of a short learning needs survey, which we’ll be sending to local Healthwatch shortly. This will help shape our future support offer, ensuring it is targeted, relevant, and includes support for staff through change.

Impact and demonstrating effectiveness

Prior to the Dash Report, we had commenced work on a platform to assist local Healthwatch to log anticipated outcomes and streamline activity to follow-up and record impact. We will make this resource available and provide support to Healthwatch wishing to use it. 

We also worked with local Healthwatch on guidance on categories of impact, to help understanding and realise your full value.

The Quality Framework will continue to be available for Healthwatch to use as a tool, but we will not be updating it or proactively supporting individual Healthwatch, unless you contact for help through your regional manager.

Communication and engagement

Strong communication between Healthwatch and Healthwatch England is essential throughout the transition period. We are committed to openness, timeliness, and working in line with our values.

We will continue to:

• Share monthly updates with lead officers and chairs
• Host quarterly webinars for both lead officers and chairs
• Communicate directly when there is significant new information
• Provide a weekly newsletter with policy updates for all subscribing staff
• Keep the Healthwatch network site updated with resources and guidance
• Maintain the brand template and communication resources
• Support the Healthwatch online community on Workvivo, where you can exchange advice and insights
• Facilitate regional forums where there is demand, particularly in light of ICB or local government changes
• Provide support for crisis or urgent media communications

Digital

Many Healthwatch rely on digital systems supported by Healthwatch England. We will continue to:

• Support local Healthwatch using our website template, including syndicated content and supplier liaison. For now, we will continue to onboard those wishing to transfer to this platform
• Provide free access to SmartSurvey, in line with existing arrangements

Working between Healthwatch and the Care Quality Commission

We will continue to support the Care Quality Commission to strengthen working arrangements with local Healthwatch, including in preparations for local authority assessments.

Commissioning of local Healthwatch

Healthwatch England will continue to proactively support local authorities with commissioning Healthwatch, in line with any government guidance issued during the transition period. We encourage commissioners to get in touch to discuss any challenges they may be facing, and to explore potential solutions to avoid breaks in service or to adjust existing arrangements where needed.

Any breaks in service will be reported to the Department of Health and Social Care.

Change

Like local Healthwatch, we are also experiencing the challenges that come with uncertainty. Understandably, some colleagues will need to prioritise their careers, and we are likely to see valued team members with expertise move on, requiring us to adjust how we deliver our support to local Healthwatch.

We’re deeply grateful for the warmth, patience, and understanding shown to our staff during this period. We recognise the pressures facing all teams across the network and remain committed to providing you with the best support we can in accordance with our shared values.

What’s changing?

We are replacing the less secure practice of sharing people’s experiences via email with a new, secure login to the National Data Store. This means once the changes have been implemented:

• You will no longer receive submissions by email.
• Instead, you will log into the National Data Store to access the data you were receiving by email, and separately to access the contact details of individuals who have consented to be contacted by their local Healthwatch.

Why does Healthwatch England collect people’s experiences?

The Have Your Say form provides an easy way for people to share their experiences of health and care services. Many people discover the Healthwatch England website due to our shared brand presence, which is built on the collective work of local Healthwatch and Healthwatch England.

We receive around 1,500 responses each month, with about half of respondents opting to be contacted by their local Healthwatch via a tickbox prominently located just above the ‘submit’ button. Media coverage and other events often drive spikes in submissions.

How does this benefit local Healthwatch?

People completing the form tell us the area they live in, allowing us to link their feedback to the relevant local Healthwatch.

Under GDPR, we require explicit consent before sharing personal details with you as our organisations are separate legal entities. This is especially important given the sensitive nature of the experiences people share with us. 

We appreciate most members of the public will not see a distinction between their local Healthwatch and Healthwatch England, but on balance we think trying to explain this issue within the form would put some people off completing it, given the significant additional wording which would be required.

The new approach ensures that:

• You can access local insights more securely and with more flexibility – improving the way Healthwatch handles data and reducing reputational risk.
• You can retrieve contact details securely – if an individual has asked to be contacted.

How can local Healthwatch access responses?

All data, including submissions from the Have Your Say Form, Healthwatch reports and data collected by local Healthwatch, is stored securely in the National Data Store. This system will allow for deeper analysis across multiple datasets while ensuring strong data security and GDPR compliance.

We have introduced secure, individual logins for each local Healthwatch so you can:

• Upload your own reports to the Healthwatch National Reports Library.
• Access Have Your Say data and contact details.
• Ensure that data remains secure – you cannot access data outside your area, in line with our data protection policies.

We are also working on a solution to allow access to statistical data on a local, regional and national level.

Healthwatch has long advocated for the ability to contact people who need advice and information—but why has it taken so long?

This has been a significant piece of work and we needed to get it absolutely right, both from a technical and data protection point of view.  

To ensure this, we’ve:  

• Worked closely with our technical suppliers to build secure logins for each Healthwatch,  
• Sought expert guidance to ensure full compliance with GDPR and data protection best practices, and; 
• Piloted the solution with Healthwatch, incorporating feedback to refine it before rollout. 

Why isn’t advice and information more prominent on the webform?

We know there is huge public demand for advice and information on health and care. While providing this support is a key part of local Healthwatch’s role, Healthwatch England does not deliver it directly.

However, because each local Healthwatch is commissioned separately, their capacity to respond to requests varies. A sudden surge in web traffic—especially after media coverage—could overwhelm a small Healthwatch team.

That said, a section providing people with the ability to find and contact their local Healthwatch is prominently featured on our website and attracts a lot of traffic. We also offer people the opportunity to request contact from their local Healthwatch through the webform.

We will continue to review the webform wording, monitor demand, and listen to feedback from Healthwatch to ensure we strike the right balance between providing a great service and managing capacity.

What happens next?

The Digital Team is rolling out this new system in phases to ensure:

• Proper training and support.
• Secure log-in access for each local Healthwatch.

If you’re interested in accessing the system, please email the Digital Team digital@healthwatch.co.uk

This year, my team and I thoroughly enjoyed reading through your annual reports. It’s such a rewarding and motivating experience to see the difference you're making for communities across England. From influencing local plans and strategies to ensuring public communications are accessible and understandable, revising service delivery for better effectiveness, and facilitating people’s involvement in service design—you’re making a tangible impact. It’s clear how much your work means for the experience and health outcomes of local people.

There’s a strong consensus across the Healthwatch network that demonstrating impact is essential to maintaining support and securing funding. This priority has been reinforced in our conversations with local authority commissioners and other key stakeholders—demonstrating outcomes is a clear expectation we've incorporated into the new template contract specification we are developing at their request. Highlighting impact is also vital for making the case for Healthwatch’s future sustainability and growth. That’s why we’ve made impact a core service value and placed greater emphasis on outcomes in our updated annual report template.

Next steps

At Healthwatch England, we’re tasked with forming an opinion on the effectiveness of local services. The outcomes achieved by each local Healthwatch are key proxy indicators that inform our reporting on the State of the Network – the picture of the effectiveness of Healthwatch. We look forward to showcasing examples of Healthwatch outcomes across health and care, particularly those addressing inequalities, including our forthcoming National Awards 2024.

In just two years, there’s been a remarkable shift towards outcomes-focused reporting. In 2021/22, only 40% of annual reports demonstrated a good level of outcomes reporting. This year, we saw that figure rise to 80%! The progress over the past year alone is impressive: between the 2022/23 and 2023/24 reports, a third of the network significantly increased their focus on outcomes reporting, with another third showing a marked improvement.

Moreover, the majority of annual reports that communicated outcomes highlighted changes with a clear impact on reducing health inequalities—a tremendous shift in focus that the network has achieved in a few short years.

There’s still a little way to go for some Healthwatch to communicate achievements as effectively as the front-runners. However, we’re confident that in most cases, it’s a matter of following up on completed work or refining how the story is told about what’s achieved for local residents. 

For the Healthwatch that may be struggling with outcomes reporting, we understand there can be various challenges. It might also be that we’re not fully capturing the real picture from the annual reports alone. That’s why we’ll be reaching out to better understand your experiences locally and explore how we can provide further support.

Thank you for your ongoing dedication and for sharing the incredible work you do. It’s inspiring to see the progress made and the growing focus on outcomes that truly make a difference for local communities. Together, we are building a stronger, more impactful Healthwatch network.

For further information about this or the wider impact programme then please feel free to contact jon.turner@healthwatch.co.uk 

At last year's conference, I outlined a key strategic objective: to address the sustainability and variation within the Healthwatch network—something many of you highlighted when I first joined Healthwatch England.

With a general election on the horizon, we knew we had to be ready to make our case for change and seize any potential legislative opportunities.

Since then, these discussions have been both necessary and, at times, challenging. You've shared firmly held views rooted in your conviction and experience – including those at odds with the proposal preferred by our National Committee with Healthwatch England as commissioner, referenced in National Committee member Jane Laughton's blog.

We all agree on the scale of our challenges: unsustainable, inequitable funding and negative variation, often driven by factors beyond individual Healthwatch control, such as commissioning.

Without change, some Healthwatch will become unviable, leaving communities without a public champion and eroding the collective influence we've worked hard to build.

However, we didn't foretell the Dash Review, which now examines local Healthwatch and Healthwatch England alongside patient safety organisations.

These tough conversations have prepared us for any changes from the review. We are committed to supporting it, enabling local Healthwatch to have a voice in the process and putting forward our case for change.

Your views have been crucial in shaping our thinking. We've heard about the critical role Healthwatch plays in your communities, the importance of local decision-making and the deep relationships you hold with local people, groups and stakeholders.

The case for local Healthwatch in every area has been heard. There's consensus that we must maintain and strengthen relationships with local authorities while carefully keeping what's working well in certain areas. There is much more work to be done on what this looks like.

Is the proposal fully developed? No, it remains a high-level proposal as part of our broader case for change. 

In any case, we are committed to presenting all the models we've explored and their respective advantages and risks. Ultimately, if we succeed in making our case, it will be up to government decision-makers to shape our future, including decisions on our funding. A full implementation and transition plan will be required.

Healthwatch provides significant value, with even greater untapped potential. Reading your annual reports and hearing about your impact on my visits to your communities has been inspiring.

From your insight into driving national change to individual Healthwatch contributing to select committees and collaborating to influence ICB decision-making, we achieve far more than our size suggests.

For just a penny per person per week, we deliver incredible value—and we know we can achieve even more.

In the wake of the Darzi Review, much attention has focused on fixing the NHS. We’re poised to play our part in helping to shape the 10-Year Plan for the NHS with the involvement of local Healthwatch.

We believe social care needs the same focus—a message we will continue to champion. As the public's health and care champion, Healthwatch must be central to any revitalised system—where lived experiences, particularly from those facing inequalities, drive improvement and accountability.

This is key to ensuring a more equitable system with better outcomes for all.

I joined the Healthwatch England Committee in September 2023 to bring the voice of local Healthwatch to committee discussions and decisions. At the time I was the Chief Executive Officer (CEO) of Healthwatch Nottingham and Nottinghamshire, a post I held for five years until I stepped down at the end of 2023. 

I believe passionately in the value of local Healthwatch. We achieve some amazing things locally and nationally. But as a Healthwatch CEO I faced issues that many of you will have experienced:

• How to fulfil our huge remit across health and care with poor levels of funding (Healthwatch Nottingham and Nottinghamshire are some of the lowest-funded Healthwatch in the country based on pence per head of population). This was more difficult because of increasing multiple needs in our local communities, especially those with no voice and those experiencing health inequalities.
• Our contracts were for only three years, creating challenges with long-term planning for our strategy and impact.
• Increasing numbers of partners and groups to connect to, including four place-based partnerships and the integrated care board. These were important partnerships, but they generated yet more meetings to attend. 

Like many Healthwatch, these issues limited our capacity to empower local people to have a voice and hold local NHS and care organisations to account. They limited the number of communities and providers where we could make a difference with in-depth investigation, so we could not always achieve as much impact as would have liked. 

Why we need to change 

Local Healthwatch are crucial. We are the only organisations with the independence and statutory power to hold health and care services to account for listening to their communities. If their voices are not heard, services will be commissioned in a way that does not work for them or excludes them altogether. 

Individual local Healthwatch make their own decisions about how to prioritise, which leads to an inconsistent approach across the local Healthwatch network. As King’s College London said in its report on Healthwatch: “The diversity of the Healthwatch network … has considerable implications for equity of access to influencing health and care planning and provision for residents across England”. This affects our brand and profile.

Despite consistently raising this issue with the previous administration, Healthwatch funding has continued to decrease. Under the current economic climate this is unlikely to change. The risk is that we reach a point where delivering Healthwatch England and Healthwatch becomes financially unviable.

The total resource for Healthwatch England and the local Healthwatch network is £28m, £25m of which funds local Healthwatch. How can we work differently to achieve more and deliver a more consistent local Healthwatch offer across England, without additional funding? 

What needs to happen now

Healthwatch England has led a 12-month engagement process during which chairs, lead officers and staff representing 101 local Healthwatch have contributed their views and debated the issues. A working group of representatives from ten local Healthwatch representatives has had further detailed discussions. With 153 Healthwatch it is no surprise that differing views exist. However, the need for change is something we all recognise. We now need to decide how we are going to change.

There are some things that must not change, such as our independence, and our statutory power to hold commissioners and providers to account. We have also agreed that we must not lose the localism of local Healthwatch.

Any decisions about a future Healthwatch model will be made by the Department of Health and Social Care. Healthwatch England will present the range of views to them, acknowledging the range of views within our network. 

However, after carefully reviewing the options, the Healthwatch England Committee supports the model where Healthwatch England assumes the role of commissioner – a solution we heard loudly during our conversations with the Healthwatch network. 

I want to thank each of you for contributing over the last few months to help us explore our shared values and consider what it means to put them into action. It was inspiring to hear so many great examples in my meetings with chairs and lead officers and also in my conversations with five Healthwatch leaders, which you can watch on our YouTube channel.

In case you are new or missed these discussions, I am delighted to share our five values, agreed by you, Healthwatch England staff members and our committee:

The journey so far

When we embarked on this journey last year, we committed to ensuring that our values don't become mere words on paper. It's about embodying these values in our everyday work and interactions.

Since we collectively agreed on our five values and announced them at our National Healthwatch Impact Awards event in March 2024, we have met with several of our peer network groups to discuss what we can do to turn our values into action in our different roles.

Here are a few of the fantastic ways that you are all living our shared values.

Equity

• We establish safe, inclusive spaces where everyone can share their views and value and respect the opinions of others.
• We comply with the Equality Act 2010 in all aspects of staff recruitment and care, collect demographic data, and ensure our staff continue a learning journey on equality, diversity, equity and inclusion. 

Collaboration

• We collaborate with all other local Healthwatch within our integrated care system footprint and offer feedback collectively. 
• We involve providers in projects from the start to ensure their buy-in and give recommendations the best chance of being acted upon.

Independence

• We balance our critical friend role with being a valued system partner.
• We publish our decision-making process and are clear about the involvement of laypeople and volunteers. 

Truth

• We challenge system and provider messages when they do not align with feedback from local people.
• We make sure all reports and insights have a solid evidence base.

Impact

• We track, record and promote outcomes and impact for our work. 
• We give feedback on the difference we make to people whose experiences we have gathered.

At Healthwatch England, we’re making time to reflect on how our values and behaviours shape our work, recognising that getting this right is essential to building the culture that defines, inspires, and drives us forward.

We’ve run several sessions for staff to explore how our behaviours align with our individual roles. We’ve presented some scenarios for staff to reflect on how they can apply our values and behaviours in their work and all staff objectives include application of the values and behaviours.

We’ve asked each staff member to identify at least one behaviour to discuss with their line manager during one-to-ones – something we aim to repeat throughout the year and our National Committee will be developing a charter based on these values and behaviours.

Moving forward

Although each Healthwatch is independent, with some being part of larger organisations with their own set of values, it's crucial that we can all align with a common set of values. This cohesion resonates with our funders and stakeholders, emphasising our commitment to the communities we serve. Furthermore, it demonstrates our unity as we advocate for our future sustainability. 

I'm already looking forward to our National Conference 2024, where we'll have the opportunity to reflect on these shared values.

Together, let's harness the power of our shared values to drive meaningful impact and enhance our effectiveness in serving the public.