It’s a familiar scene.  It’s mid-June, and the Healthwatch lead officer is pulling together content for the annual report. The hoped-for lull in other work demands has again proved to be something of a mirage, so it’s another evening at the keyboard, writing up accounts of outcomes achieved over the year and ensuring all statutory content is included. “If only I’d spent a bit of time earlier in the year …” she thinks to herself. 

If this scenario resonates with you, then maybe there are a few things you could do right now that you’ll thank yourself for in five months’ time. 

Of course, I'm not suggesting you spend ages writing annual report content in January! 

But a bit of time spent now on some of the following things could really pay dividends when the time comes to produce an engaging report about your work up to the end of March. This helps to demonstrate the value of Healthwatch to local people, your funders, Integrated Care System (ICS) and other stakeholders. 

We're really seeing yearly improvements in how you're evidencing outcomes and impact. Last year over 70% of Healthwatch annual reports included references to outcomes that had been achieved. That's up from 50% the year before! This is fantastic to see, as local authority commissioners also tell us how important it is for their Healthwatch to be aware of communicating this. But there's still variation in whether the write-up conveys something about how improvements are likely to be felt by people using the services. Taking that extra step of mentioning a service change's wider impact really helps convey the value of your Healthwatch's contribution. 

To think more about the wider impact of your work, don't forget to take a quick look at this e-learning module on outcomes and impact. 

1. Consider which areas of work and outcomes you’re likely to headline? 

This year, the design of our template will again suggest the report is kept short so that people are likely to read it.

This means choosing two or three areas of work to succinctly showcase, with as much focus as possible on how you’ve contributed to positive change for the public. The two information and signposting case studies and paragraphs on "Three ways we have made a difference" should also focus on impact. 

If outcomes from work started in previous years have now been achieved this financial year, then there's no reason you can't feature those. It's all part of the story of what service you deliver for the public. 

Key things to consider: 

• Do you have an idea now about which areas of work you’re likely to feature?  
• Is there anything additional you could do now in your planning or delivery which can help evidence the outcomes of that work?  
• Is there anyone you could ask now for a quote about the difference you made? 
• Could you hold a workshop with your team and others to reflect on your strongest achievements? 

2. Decide if you'll be able to reuse much of your ‘Statutory Statements’ section. 

Most Healthwatch will be able to reuse or just slightly update the text in the sections of your last report:

• The way we work
• Methods and systems used across the year’s work to obtain people’s views and experience
• Health and Wellbeing Board

Since April 2021, you may have done more face-to-face activities, so most updating will be about this. Other content might stay exactly the same. Make a note of that now, and be pleased you are already a step ahead!

Other figures on the number of people who've shared experiences, signposting and information enquiries, website and social media reach and funding levels will be needed for both your annual report and the annual national survey. Healthwatch England will be sending this out around the same time as you submit your annual reports, as they need to report the figures to parliament. Having these numbers to hand will save time on both fronts. 

3. Decide which volunteers you’d like to feature and ask them for content now. 

There’s no reason you can’t ask volunteers to write a personal profile and send you a preferred photo at any point in the year.

This can help make sure you can feature those who’ve contributed lots but might move on before the year ends. Plus, ensuring you aren't rushing last minute to find a photo that’s the right size and not pixilated – we’ve all been there! 

Three profiles of up to 80 words with photos usually fit well on the one page. 

Aim to feature different stories about why they volunteered or the work they’ve done to make a difference to your community. 

This is also an opportunity to show people from diverse backgrounds who read your report and who might want to volunteer that they’d be welcome. 

4. Take a look at what other Healthwatch did last year. 

By looking at the approach taken by some other Healthwatch, you can start to talk to your team about how you write for your next report. 

Each week until the end of February, I'll post on the Annual Reports Workplace group an example of one of last year's reports with a strong impact focus. 

You'll then need to decide if anyone in your team should join our workshops about writing for impact that we have coming up from March 2023. Keep a lookout for these and other related learning opportunities on our events listings page. 

Here’s to hoping that this year producing the annual report feels more than ever like a fantastic opportunity to showcase the outcomes that Healthwatch has achieved. 

It's helpful to try to ensure we have a shared understanding across the Healthwatch service of what we all mean when we use the words'  outcomes' and 'impact'. 

This basic introductory course is for any staff member or volunteer with Healthwatch. It's an ideal short session to be completed as part of an individual induction process. 

By taking this course, you'll understand: 

• The difference between outputs, outcomes and impact. 
• How do these relate to Healthwatch work. 
• Why it's important for a Healthwatch to think about outcomes and impact. 

This will help you contribute to planning activities and ensure your work with Healthwatch is as successful as possible. 

Before you start 

This course should take you no more than one hour to complete. It's best to do it all in one go, but you can return to it if necessary. 

Tell us what you think

Please tell us how useful you found the course, and if there is anything else that you would have liked included. Email Marianne, Learning and Development Manager at Healthwatch England, with your feedback. 

The first phase involved undertaking an initial research project with six local Healthwatch who interviewed people from ethnic minority communities with either limited or no English about their experience accessing health and care services. 

Local Healthwatch shared their reflections from the project, including their experience working closely with us on a national campaign and engaging with diverse, hard-to-reach communities. 

Background to the project

We funded six local Healthwatch to interview people from ethnic minority communities with limited or no English. 

The six local Healthwatch were:

• Healthwatch Camden
• Healthwatch Croydon
• Healthwatch Hackney
• Healthwatch Liverpool
• Healthwatch Norfolk
• Healthwatch Reading

Local Healthwatch engaged 109 people from diverse ethnic minority communities, including people who identify as Arab, Bangladeshi, Chinese, Polish, Ukrainian, Somalian and Honduran.  

Additionally, 38 staff members working in different healthcare settings took part in the research to share their experiences. 

Find out more about the findings from the research project. 

What worked well?

Local Healthwatch reflected that a key strategy was to work with local organisations with existing contacts in hard-to-reach communities.

The project created a need to build strong relationships with new organisations. These relationships were cemented as local Healthwatch worked closely with local organisations.

Local Healthwatch reflected that a powerful aspect of the project was that local organisations felt they were part of a national campaign. As a result, organisations were motivated to maintain good communication with local Healthwatch. In turn, this expanded the reach of Healthwatch to new and broader audiences. 

Monetary incentives were helpful and, at times, were used to pay for administration for other organisations. Local Healthwatch felt it worked well to be given the authority to use funding as they thought necessary to establish community contacts. 

Local Healthwatch also felt that this project helped them become more aware of existing communities in their local area and their challenges. We heard how Healthwatch was the 'talk of the town' amongst some local communities who recognised that Healthwatch allowed them to amplify their voices at a national level. This project helped to establish a trusting connection with this community.

Outcomes from taking part in the AIS primary research project

• Healthwatch Hackney is working with their local council, which currently has no policy around interpretation, and there is no consistency with using interpretation services. Healthwatch Hackney feels its findings will be helpful in this context.
• Healthwatch Liverpool reported that Liverpool Trusts had been spurred to review Accessible Information Standard (AIS) policies. They also felt the issue is much more on the radar now locally.

What didn't work so well?

It was challenging to find professional interpreters. Local Healthwatch had to work with multiple agencies, experienced cancellations and lost money when interpreters did not show up. The cost of professional agencies is high and would not be feasible within the budget if Healthwatch had required professional agencies for all participants. 

Finding interpreters for specific languages, such as Ukrainian and Tamil, was also challenging which could be more costly. Community contacts were vital here, as they were willing to provide interpretation at a low cost or even for free.

Local Healthwatch would have liked to have recruited a more representative sample and found it easier to speak to people women from specific communities.

Reflections from Healthwatch England

We were impressed by the strength of the community contacts and the ability of local Healthwatch to recruit such a diverse sample in a short timeframe.  

In future projects, we will aim to improve the support provided to local Healthwatch to deliver successful projects, including greater consideration of the following:

• Provide more one-to-one support and training. For example, more thorough testing of questions and role-play activities with Local Healthwatch to establish greater confidence in qualitative interviewing techniques and familiarity with materials.
• Provide greater support around unique project challenges. For example, how to deal with the additional challenges of working with interpreters. 
• Better time management of the project and ensuring local Healthwatch have enough time to prepare with minimal impact on existing projects and priorities. 
• Better support for local Healthwatch around how to share data with us to minimise the risk of sharing personal data and ensure data is cleaned and in a usable format. 
• Provide more guidance around how to develop and utilise findings at a local level.

What is the Theory of Change?

There are many tools for understanding how organisations make a difference. One widely used by the non-profit sector is called ‘Theory of Change’. 

Your Theory of Change for an individual project or area of work describes a sequence of events or outcomes that you expect to lead to your desired long-term outcomes.

Producing a Theory of Change before starting a new piece of work can help you consider how likely you are to achieve positive changes. It can help you identify anything you might do differently to maximise the likelihood of success and make the best use of your resources. 

Usually, a Theory of Change is produced at a very early stage of planning a piece of work; before the more detailed project plan. 

We regularly provide workshops about using a Theory of Change approach. We can consider providing an online session for your team. Contact jon.turner@healthwatch.co.uk for more information. 

Template to create your own 

Based on a model provided by Healthwatch Islington, we’ve developed a template that you can use to produce your own Theory of Change in an easy format. 

It’s best used after you have attended a workshop. However, the template now includes instructions to remind you about each of the stages. It can help you to understand the process even if you haven't yet been to a workshop. 

The template uses Microsoft Excel. To view and use it properly, you will need to open it using a desktop version of Excel rather than an online or Office 365 version. 

After you’ve opened the document, go first to the tab that says ‘Overall Summary – read first.’ 

Having a page showing your impact can help everyone understand how your Healthwatch improves the lives of people living in your community. By adding new stories about what you have achieved, you can show the difference you have made. 

Here are three examples of Healthwatch who have built their impact page using our guidance: 

• Healthwatch Bristol
• Healthwatch Lambeth
• Healthwatch Sunderland

When creating your impact page from this guidance, it is essential that you:

• Keep each story short and to the point so readers can understand the difference you made. 
• Only add new stories when positive changes have been achieved. 
• Go back and update the stories if new outcomes happen so the content stays up to date. 

The Health and Care Bill is expected to pass in time for changes to come into effect in July 2022. This transformation will change health and social care decision making across 42 ICS footprints. In turn, the way that people's experiences inform these decisions will also need to change. 

Local Healthwatch, have a vital role in ensuring that the public continues to be heard. Whilst they already do this within Local Authority boundaries (at 'place' level), they will now need to work together with other Healthwatch to ensure the system acts on what they hear from communities across wider areas. 

Common themes for success

Although every case study is different based on population needs in each area, there are some common themes for success which you could consider when working with your ICS or local Healthwatch.

• A formalised working agreement between local Healthwatch, which defines how you will work together.
• Clear roles and responsibilities for local Healthwatch when representing on Integrated Care Boards, partnerships and committees.
• Clarity on the local Healthwatch resources currently available and a realistic expectation about what ICS involvement is possible within these limitations.
• The ICS resources local Healthwatch representation, engagement and insight gathering.
• Local Healthwatch are proactive in demonstrating the support they can offer the ICS.
• Local Healthwatch coordinate the sharing of insight and learning from engagement of people and communities and use this expertise to inform system decision making.
• An agreement between local Healthwatch and ICS guides the relationship, recognising the autonomy of local Healthwatch.
• The role of local Healthwatch in development, delivery and governance of ICS people and communities engagement is clearly defined and championed by the ICS.
• The independent role of Local Healthwatch is understood and valued by the system.
• The ICS utilises the strength of local Healthwatch to ensure that the voice of the public is heard.

Healthwatch Together is a collaboration of four local Healthwatch organisations: Healthwatch Blackburn and Darwen, Healthwatch Blackpool, Healthwatch Cumbria and Healthwatch Lancashire. They have come together to provide engagement support across the Lancashire and South Cumbria Integrated Care System (ICS) footprint. 

The Partnership serves a diverse population of 1.8 million people. Some areas have high deprivation, such as Blackpool and Blackburn and Darwen (29.1% of the population live in some of the most deprived area in the country). 20% of adults are not meeting the recommended levels of physical activity and 18.5% of the adult population smoke.

How are they working together? 

• The four local Healthwatch organisations have an agreed Memorandum of Understanding in place establishing how they will act as Healthwatch Together.
• The approach to collaborative working as Healthwatch Together is documented as an 'Our Offer' document and shared with stakeholders such as NHS organisations and local authorities.
• Healthwatch Lancashire acts as the lead organisation, sending representatives to system meetings and coordinating efforts.
• Healthwatch Together has two key forums for strategic and operational collaboration: a monthly strategic meeting where chief executives of the local Healthwatch organisations meet to discuss strategic and operational priorities; a fortnightly operational meeting where teams work together to help shape and deliver projects.
• Using these agreed approaches, Healthwatch Together responds to ICS commissions as follows: A project lead is appointed from one of the local Healthwatch organisations, based on expertise in delivering the work; resources are pooled and then reallocated to deliver the project as required depending on the population of interest, expertise and capacity to deliver; service level agreements are put in place for specific projects where relevant.

What are the enablers of working together? 

• Local Healthwatch organisations in Lancashire and Cumbria have a legacy of strong working relationships with the health and care system, community and voluntary sector. This includes CCG Board representation, supporting past Sustainability Transformation Partnerships, delivering engagement activities, and developing the ICS.
• The ICS and Healthwatch Together ensure that Healthwatch is represented at key local forums, including: 1). the ICS Board and the Strategic Commissioning Committee. In these meetings, Healthwatch Together shares insight from local people to inform high-level decision making. For example, using this group Healthwatch Together has set up governance arrangements for the ICS to engage with local people. 2). The Partnership Board. This ICS sub-group brings together stakeholders and partners more directly.
• Healthwatch Together has developed a way for local people to connect and engage with the ICS, articulated in their support offer. They are also in the process of agreeing a pricing schedule with a menu of options that Healthwatch Together can offer which will enable them to respond quickly to requests for pieces of work.
• A data-sharing agreement is being developed between Healthwatch Together and the NHS across Lancashire and South Cumbria and information sharing routes have been established.

Example of working together 

Healthwatch Together has been commissioned by NHS partners across the ICS to explore local people’s perspectives, especially those from communities whose views are often overlooked, about the New Hospital Programme suggestions for Lancashire.

The plans explore the option to replace one or two local hospitals and instead access specialist clinical services from one hospital site rather than multiple sites.

To do this Healthwatch Together launched an early engagement campaign across Lancashire which will be followed up with a formal consultation process with the public.

Phase one of the engagement efforts informed the business case for the New Hospitals Programme and explored why people felt this was an important change. Phase two of engagement currently involves local Healthwatch using different methods (e.g. surveys and focus groups) to hear from seldom heard communities and vulnerable groups. These include asylum seeker and refugee communities, South Asian women, veterans, and LGBT groups.

Healthwatch Together are using their local knowledge, expertise and connections with voluntary and community groups. The aim of this engagement is to understand people’s views to inform decisions about where the new hospital will be and what services it may offer. As well as producing an independent report, Healthwatch Together is also sharing emerging learning with the project managers across the ICS to inform decision making as they go along.

This case study was produced by the Strategy Unit for Healthwatch England.

The Quality Framework is a self-assessment tool you can use to understand whether your work is practical or needs to improve. 

Healthwatch Cambridgeshire and Peterborough deliver their services to around one million residents, serving one Integrated Care System and seven local authority areas. They talk us through how they use the Quality Framework to support their work.

Why is quality important to you? 

We believe that a visible commitment to quality shows that we are a well-governed organisation that operates with transparency. This increases our commissioner’s confidence in us. 

In 2018 we decided to apply for the Practical Quality Assurance System for Small Organisations (PQASSO) accreditations designed for small charities. We completed the assessment in 2019 and drafted an action plan to work on the identified improvements. 

Why did you decide to complete the Quality Framework?

Despite having just completed the PQASSO, we decided to undertake the Quality Framework because it was far better suited to our needs as it specifically related to Healthwatch. 

How did you carry out the assessment?

The project was led by our Chief Executive Officer, but all the staff helped complete the work. 

We identified a manager to lead for each of the six domains of the quality framework (Leadership and Decision-Making, People, Sustainability and Resilience, Collaboration, Engagement Involvement and Reach, and Influence and Impact.)

The domain lead would work through the questions within the Quality Framework and identify areas for improvement.  

The action plan that we had created for the PQASSO assessment was used and absorbed into our new action plan. 

The initial findings were presented to our Board, who checked that the improvement areas we had highlighted aligned with our strategic direction.

What benefits did you find? 

The benefits of using the Quality Framework can be split into three sections: 

1. People
2. Sustainability and resilience 
3. Engagement, involvement and reach

People

We prioritised gaining our “Investing in volunteers” accreditation. We reviewed our volunteering policy and processes to achieve this, and our existing volunteers helped us with this. 

We also reviewed the Human Resources systems we use to ensure all our records are GDPR compliant. 

Sustainability and Resilience

We developed a better understanding of the value of a business development strategy and put one together. We were also able to write a work plan to support this strategy. 

These written plans in place gave us better clarity of our business goals and offer and enabled us to introduce a project cost analysis review. 

Engagement, Involvement and Reach

The benefits include that we have been able to introduce a demographic analysis of our reach so that we can better target people we do not hear from. 

We have also been able to include engagement with young people in this year’s work programme as it was highlighted as an area we could improve in. To achieve this, we have recruited for a new role of Associate Director to help advise on youth engagement. 

What outcomes did you get from the Quality Framework? 

Many of the changes we have implemented due to the Quality Framework have led to positive outcomes. 

Short term outcomes include:

• Increased volunteer confidence due to our “Investing in volunteers” accreditation.
• Better team working and improved project planning.
• Improved public understanding of our impact through better tracking and reporting. 

Longer-term outcomes include: 

• Increased voice for younger people across Cambridgeshire and Peterborough.
• We can better target who we can influence.
• Our understanding of resource allocation has been improved through the project management systems we now use. 
• We can better amplify the voices of people less often heard from as we enhance our understanding of our reach. 

How will you continue to check quality?

Areas that we are aware of that still need improvement have been included in our annual work programme to ensure we continue to improve. These include: 

• Delivery of our communications and engagement strategy
• Delivery of our business development strategy
• Targeted engagement with less heard from communities
• Embedding use of the Healthwatch England Impact Tracker

As part of our strategic review in 2022, we plan to gather stakeholder perceptions to get more information and insight into areas we can continue to improve. 

What are your overall views of the Quality Framework?

Completing the Quality Framework assessment was a very worthwhile investment of our time. We found it hugely beneficial in identifying areas for improvement. 

We found spreading the different areas of the Framework across the team helped break down the workload and keep it more manageable alongside the rest of our workload. 

The Quality Framework provided our Board and commissioners with the reassurance they wanted, and our quality action plan keeps them informed of our ongoing progress. 

Who is working together?

Eight local Healthwatch organisations in North East London are working together with the North East London Integrated Care System (ICS). These are:

•  Healthwatch Hackney 
• Healthwatch City of London
• Healthwatch Tower Hamlets
• Healthwatch Newham
• Healthwatch Waltham Forest
• Healthwatch Barking and Dagenham
• Healthwatch Havering
• Healthwatch Redbridge

Geographically, the ICS covers a large and complex patch. The inner-city boroughs are more ethnically diverse, have higher levels of deprivation and unemployment and higher density populations. Newham borough is the most diverse in the country and Hackney borough has a significant orthodox Jewish community. The outer city boroughs have older populations.

How are they working together?

• The ICS covers seven former Clinical Commissioning Groups (CCGs), which formally merged into one in April 2021. Prior to the development of the ICS, the eight local Healthwatch worked together within their own CCGs, attending the CCG board and the Patient Participation Groups.
• The developing ICS has provided a route for local Healthwatch to work together via an informal network with regular communication over email.
• Local Healthwatch have been working with the North East London People Engagement Working Group which is developing the strategic approach in advance of the ICS being established in April 2022. Representatives attend either the working group or related sub-groups.
• The ICS and all eight local Healthwatch now meet every two months. This regular meeting provides the ICS Chair, Chief Executive, the Communications and Engagement Lead and the local Healthwatch Leads with a forum for dialogue and a space to highlight local issues.
  • The ICS is co-producing six principles for engagement with partners including local Healthwatch. This incorporates the learning from the Co-production Charter which is currently used in City and Hackney.
  • Healthwatch are also supporting the development of the ICS engagement strategy. Healthwatch is viewed as best placed to champion patient voice for the ICS, to understand local issues and connect the ICS to local people and seldom heard groups.
• Local Healthwatch first worked together in response to a tender from the ICS to deliver community insights through a single database across the ICS, particularly in relation to COVID. The eight local Healthwatch combined their data, using a system already in use by some local Healthwatch to provide ICS level insight (see example below).
• Local Healthwatch have also organised themselves into three partnerships around the footprints of the Hospital Trusts so that they are better able to serve their local hospital or Trust:
  • Hackney and City of London for Homerton University Hospital NHS Foundation Trust.
  • Tower Hamlets, Newham and Waltham Forest for Barts Health NHS Trust.
  • Barking and Dagenham, Havering and Redbridge for Barking, Havering and Redbridge University Hospitals NHS Trust.
• Local Healthwatch are invited to the CCG Governing Body meeting and Primary Care Commissioning Committee. Currently local Healthwatch volunteer to join specific ICS boards based on interest and capacity, but this will be reviewed once the ICS finalises the design of their governance and decision making. There is expected to be further agreement of local Healthwatch participation arrangements in ICS governance, for example sub-committees such as ‘quality, safety and improvement’. Healthwatch are actively involved in and expected to have seats within local place/borough partnership boards.
• Healthwatch activities for the ICS are funded through the ICS engagement budget. Specific commissioned ICS projects are distributed amongst the local Healthwatch taking into account the nature of the work and individual Healthwatch priorities and skill sets.

What are the enablers of working together?

• The ICS held an early development session for all system partners including commissioners, providers, community and voluntary sector leads and local Healthwatch to set the ambition and the priorities for the ICS and strengthen relationships between partners.
• The ICS Chair is a strong advocate for Healthwatch and the voluntary and community sector, ensuring that these organisations have a voice within the ICS. In turn, local Healthwatch provide objective and independent data-informed evidence to the ICS.
• Healthwatch acts as ‘the golden thread’ across system partners, including the community and voluntary sector, providing community insights and sharing reports.
• A mutually beneficial relationship between the ICS Corporate Communications team and Healthwatch. For example, Healthwatch provides local intelligence for the ICS Corporate Communications team and the team support local Healthwatch with publicity strategies.
• There is diversity in Healthwatch senior leaders with respect to age, ethnicity background and interests. Regular structured meetings as well as ad hoc meetings ensure a good level of communication between Healthwatch leaders.
• Local Healthwatch are supportive of one another and willingly share data. They are also able to critically reflect on each other’s projects to make improvements.

Example of working together to deliver community insights

Led by Healthwatch Tower Hamlets and with Healthwatch England as a strategic partner, local Healthwatch in North East London are working collaboratively to produce a Community Insights Repository which collates feedback for providers from different sources, such as NHS Choices, Care Opinion, Google reviews, website feedback, surveys and complaints. The system, together with more detailed community insights projects, was funded in 2020 by the ICS for three years and is governed by a joint steering group of local Healthwatch, Healthwatch England and the ICS.

Healthwatch staff can use the Insight System to synthesise feedback on an issue of interest, providing a full picture of that feature of care across boroughs, services and providers in the ICS. Through this system, approximately 161,000 issues have been recorded based on feedback from almost 44,000 people, and 40 insight reports on areas of interest have been produced to date.

Data from the system also allows local Healthwatch to advocate for improvement efforts where it is most required. For example, using the Community Insights System, local Healthwatch identified residents with disabilities in North East London were the most challenged by poor health and care communication during the pandemic. As a result, Healthwatch were able to target research activity towards this population and produce a range of reports, including easy to understand infographic reports.

In addition, teams from across the ICS have made good use of the Community Insights System to further explore local views before commissioning services. For example, ahead of submitting the North East London Long Term Plan strategy, local Healthwatch were commissioned to host two focus groups and complete 250 questionnaires in each borough. They engaged with 2000 people face to face and 1275 patient surveys were completed. This insight was invaluable in the development of the strategy and directly influenced plans. To actively encourage partners to utilise the system, training sessions are being offered on a regular basis.

This case study was produced by the Strategy Unit for Healthwatch England.

Who is working together?

Six local Healthwatch organisations in South East London are working with Our Healthier South East London Integrated Care System (ICS), including:

• Healthwatch Greenwich
• Healthwatch Lewisham
• Healthwatch Southwark
• Healthwatch Lambeth
• Healthwatch Bexley
• Healthwatch Bromley

What's the population like?

The ICS serves a diverse population of approximately two million people with pockets of deprivation sitting side by side with significant pockets of wealth. Age profiles vary widely across the six boroughs - Bromley has the oldest population in London, and Lambeth and Southwark are the most diverse and youngest boroughs. In Greenwich, with a population of 280,000 people, 47.9% are from an ethnically diverse background with a seven-year range in life expectancy from poorest to wealthiest parts of the borough.

How are they working together?

• Six local Clinical Commissioning Groups (CCGs) formally merged in 2020. This provided the impetus for six local Healthwatch who were already working together to consider how best to organise their collective approach and relationship with the new South East London CCG.
• The six local Healthwatch are now represented by a single South East London Healthwatch Director, who has a dedicated leadership role in ensuring that patient voice across South East London is central to decision making within the ICS.
• The South East London CCG currently funds the director role. System partners are confident about continued funding of this role with the formation of the ICS Partnership.
• Local Healthwatch meet every two weeks with a set agenda, including developments within the ICS and other relevant committees shared by the South East London Healthwatch Director. This forum also provides an opportunity for local Healthwatch to feedback on significant concerns collectively.
• Communication and engagement specialists across local Healthwatch meet regularly with the South East London Healthwatch Director. The Director works with the ICS communications and engagement leads to contribute to developing an ICS engagement strategy.
• Local Healthwatch have a joint working agreement and pool resources for relevant projects. They have developed an approach to team working and allocate tasks based on the issue being addressed and area targeted. For example:
  • Southwark and Lambeth partner together to work on local initiatives which involve Guy's and St Thomas’ and King's hospitals.
  • Lewisham and Greenwich work together to support and progress improvements and developments at the Lewisham and Greenwich NHS Trust, for example policy and process on charges for patients not eligible to access free NHS services. o Lewisham have been active members of a GP task and finish group. This is helping to provide input from local users into fast-moving issues like the development of digital tools and proposed GP mergers. 
  • Greenwich took a key role on the mutual aid governance board during the COVID pandemic.

What are the enablers of working together?

• Local Healthwatch have prior experience of working in partnership at a place-based level with local providers, smaller provider collaboratives, and the previous South East London Sustainability and Transformation Partnership.
• The Healthwatch Director has previously worked as a Healthwatch Chief Executive and has a specific leadership and coordination role for local Healthwatch within the ICS.
• The Healthwatch Director is a member of various governance bodies in the CCG/ICS. This includes the Primary Care Commissioning Committee, the Engagement Assurance Committee, the Equality Committee, the Equalities Task Force (which was set up specifically to look at vaccine distribution and COVID inequalities, and is expanding its remit), the Quality and Safety Subcommittee, the Data Usage Committee, the Information Governance Steering Group of the ICS, and the South London COVID-19 Preventing Mental Ill-Health Taskforce.
• Local Healthwatch perceive their work with the ICS to be an extension of their statutory duties. Joint reports are shared and published on all six local Healthwatch websites.
• Following the local Healthwatch joint working protocol, the Healthwatch Director delivers a progress update to the six local Healthwatch and the ICS. This reports activity against the domains set out in the Quality Framework but also captures impact, for example, where the ICS has accepted evidence or recommendations presented by the Healthwatch and agreed an action plan. This means it can be followed up to ensure the ICS is responding appropriately to feedback from users.

Working together to improve access to GP services

Local Healthwatch are working collaboratively, with support from the ICS, to assess access to GP services in South East London. The purpose of this work is to help the ICS dig beneath the surface satisfaction figures provided by the annual GP Patient Survey, and to properly contextualise the current media stories around problems with access to primary care. This means the ICS has an accurate local picture of current experience and an understanding of why people are having these problems.

To provide this insight, each of the six local Healthwatch is responsible for assessing (with agreed parameters) the quality of information regarding access on GP websites. A website audit tool has been developed and shared across the six boroughs to support this task. In addition. each Healthwatch is tailoring a base survey, that was developed in collaboration, to collect people’s experience of accessing GP services. For example, Lambeth is gathering insight at GP practices; Bexley and Southwark are carrying out qualitative research, in addition to the survey; and Lewisham, Bexley and Bromley have added questions to their survey. To date 1,145 people have participated in the survey.

Developing and administering the survey in collaboration has reduced the administrative burden and allowed for the identification of cross cutting emergent themes that are common across the six boroughs. For example, a key theme that has emerged is that online triage and waiting for telephone calls from GPs causes patients to experience confusion and anxiety. The ICS has committed to using the findings from local Healthwatch to inform local plans to improve patient experience of accessing GP services.

This case study was produced by the Strategy Unit for Healthwatch England.