As you will be aware, ensuring the sustainability of the Healthwatch network is a top priority for Healthwatch England. We know that the current model is at breaking point, with considerable variation across the network and a collective real-terms budget at less than half of what it was in 2013/14. 

We have also seen some instances where local authorities cannot award a contract due to no viable provider being willing to deliver the Healthwatch for the available funds. Of course, many Healthwatch do excellent work despite their limited resources, but they often operate with considerable uncertainty regarding their future and face challenges recruiting and retaining staff.

I want to express my thanks for the invaluable contribution made by Healthwatch in shaping our thinking on the future of Healthwatch. Over the past several months, we have engaged with over 100 Healthwatch and the same number of local authorities. We also received insightful feedback and proposals from an independent agency, Kaleidoscope, following comprehensive interviews with representatives from Healthwatch, local authorities, and integrated care boards.

Kaleidoscope's findings, recommendations and next steps

What stands out from our findings is the collective recognition of both the opportunities and challenges within the network, accompanied by a consensus on effective strategies to address them, while also acknowledging diverse perspectives. It's clear that the primary concern revolves around insufficient funding and significant disparities across the network – brought about due to lack of ring fencing.

The primary recommendation proposes that Healthwatch England should lead the commissioning of Healthwatch services. This proposal aims to achieve a fairer distribution of funding, establish longer-term contracts, and improve consistency across the network, all while safeguarding Healthwatch independence and addressing community needs. While we acknowledge that each approach has its strengths and weaknesses, we're at the very early stages of developing a model and keen to explore deeper into these proposals with your input to maximize strengths and mitigate weaknesses.

It's important to remember that these are findings and proposals. Ultimately, implementation of the main recommendation would require primary legislation, which is beyond the control of Healthwatch England. There are numerous steps to be taken along the way, including those that can be enacted without legislative change to enhance our effectiveness – again which we would like to explore further with you.

We are organising a series of further webinars (see below) to gather your feedback on these proposals, which will be instrumental in refining our strategies. During these sessions, we will also outline the next steps forward, including further engagement with you. Once again, I extend my appreciation for your invaluable input and collaboration.

How you can get involved

Following the recent conversations, we are running a series of futher sessions which will involve a short presentation on the findings and proposals, plus an opportunity for you to contribute to shaping the proposals further.

These events are for anyone in a Healthwatch (please note - those on 16 and 28 May are specifically set aside for chairs and board members) as we want to hear everyone’s views on how we can secure the future sustainability of Healthwatch.

'The Healthwatch Network: A National Picture of Key Trends' highlights that while impact and income generation have increased and many more Healthwatch are sharing data, variation means it's hard to compare activity levels and core funding has experienced a real-terms cut. 

In the report, we also consolidate key information we collect from the Healthwatch network to look at key areas including: 

• Demonstrating impact
• Relationships with integrated care systems and the Care Quality Commission
• Funding and commissioning
• Colloaboration and current/future priorities

We highlight some of the diverse outcomes Healthwatch across the country have achieved, including making services more accessible, helping to expose safety concerns and improving access to dental appointments. 

We also use the report to explain what we are doing, and what more you as the Healthwatch network could be doing, to further help each other and the communities we serve. 

Our Future Focus sets out what we want to achieve by 2026, with one objective being to improve our effectiveness as an organisation and strengthen the Healthwatch movement. Our culture, values and behaviours are crucial to achieving this objective, which defines, inspires and drives us. 

We’re about to start the process of developing our shared values. We want you to help us agree our core values, the behaviours the public expects from everyone who is part of Healthwatch, and the actions we need to take to embed them in our everyday practice.

To get you thinking, should they be equity, collaboration and/or integrity? There’s much to consider and you will help us to get this right.

The values and behaviours that underpin Healthwatch culture are the glue that binds us together, as independent organisations working on a shared mission. They provide the basis for us to earn the trust of the public, including people who have experienced discrimination and inequality, and the respect of health and care decision-makers who we are encouraging to act on our insight and recommendations.

All too easily, values can be glib and inauthentic words on paper. What’s important is how we put them into practice whether we are a lead officer, staff member, volunteer or Board member. As organisations delivering public functions, it is right that we support each other and hold ourselves to account for how we act and behave.

The process of how we arrive at our shared values is important and worth taking time over. Just like the work we started on equality, diversity and inclusion, it’s an ongoing conversation that’s needed, rather than an item that needs ticking off from the to-do list. We’ve put on both face-to -ace events and online webinars, as the former can elicit rich conversations while the latter ensures there are opportunities for everyone to participate. If the online events are oversubscribed, we’ll add more sessions to the calendar.

How you can get involved

There is one in-person workshop being held in London and two online webinars scheduled where you’ll:

• Help define our shared values and behaviours.
• Identify how we might best use the values and behaviours, including to help motivate our Healthwatch teams.
• Identify how we’ll measure their effectiveness.
• Identify opportunities to continue the conversation, such as through peer networks.

In organising the events, we’ll be considering how to balance making sure people can talk openly in a safe space that’s also enjoyable, worthwhile and inclusive. Our National Committee and staff will also participate in the workshops, so this is a collaborative process.

We firmly believe that developing shared values is not only right for a stronger Healthwatch movement, but also important in our ambition to deliver improvements for the public and secure a sustainable future.

What is social value?

Social value is the wider positive economic, social and environmental impact your organisation has on society.

This impact is often measured using proxy values attributed to things such as improving local people’s skills, using local suppliers for goods and services or reducing carbon emissions. But it also includes telling the story about how your organisation operates in an ethical way to achieve these things.

Why think about social value?

Social value is part of the overall narrative about how Healthwatch benefits local residents. Although you may only be specifically asked about it as part of the tender process for your contract, thinking about it more routinely as part of your annual planning cycle will not only strengthen your tender response but also increase ongoing public and stakeholder support.

Different angles on social value

There are two ways of looking at the added social value of a Healthwatch service.

One way is to consider the added social and economic benefits linked to improvements made to healthcare services due to your insight. Your work contributes to people being more able to retain their employment, maintain a stable home, be socially active, focus on education and can reduce pressure on carers. Reduction of health inequalities can also benefit healthcare services by reducing demand. These links can easily be forgotten, so it’s useful to find opportunities to remind stakeholders, such as local councillors, about them as you talk about the impact achieved from investing in Healthwatch.

However, service commissioners view this social value achieved through the delivery of your core contract requirements as 'benefits realisation'. It's part of the rationale for why they are commissioning the service in the first place.

What they are looking for you to address during a procurement process is the additional social value you will bring through doing things over and above core activities and contract requirements. How will your socially responsible approach to the delivery of the contract benefit the community and wider society?

Social value as part of your contract tender process

The Public Services (Social Value) Act 2012 requires public authorities to consider how delivery of procured contracts could improve ‘economic, social and environmental well-being’ in their area. Scoring of tenders for contracts now typically includes between 5% and 20% based on the provider’s commitment to deliver additional social value.

While nationally commissioned public contracts tend to use the Cabinet Office’s Social Value Model, local authorities usually use either the National themes, outcomes and measures (TOMs) model from the Social Value Portal or their own locally developed social value framework. A new ‘TOMs Light’ was introduced to encourage further take-up of this model.

Both the Social Value Model and the TOMs model contain lists of social value outcomes that potential providers are asked to address and instructions for evaluating the responses. There’s usually a quantitative element with financial values attached and a qualitative element related to the plan or 'method statement' the provider gives to explain how they will achieve the outcomes. Usually, local authorities have one procurement team member who leads on social value as an additional responsibility.

Ideally, the approach shouldn't be totally prescriptive but instead, give broad category headings from TOMs or the council’s own framework priorities – such as achieving net zero or 'developing a strong, resilient local community' – and ask you to refer to the relevant framework to propose what you’ll deliver. This helps ensure your offer is relevant, proportionate and within your gift in relation to the contract itself. Less sophisticated and probably less helpful is when the question you’re asked to address more vaguely asks, 'What social value will you bring'.

Part of business as usual

One of the best ways to strengthen your organisation’s position on social value when it comes to tendering for a new contract is to have already embedded it into your wider planning cycle.

If you’ve not already, then may now is the time to introduce a social value strategy and policy and an ethical procurement policy. Following that, develop an annual action plan with objectives to contribute to positive change through your added social value.

Thanks to Carol Glenn, Social Value Programme Manager, Solihull Metropolitan Borough Council for advice during the writing of this item.

About the logo

The Quality Framework is a self-assessment process that helps a local Healthwatch understand what aspects of your service are working well and identify areas for further improvement.

The process requires hard work and commitment and some local Healthwatch have asked for a visual device they can use to show they have been through this process and communicate their commitment to continuous improvement.  

The quality logo:

• Is an acknowledgment of having completed a self-assessment quality assurance process at a point in time. The logo is given retrospectively to Healthwatch who have completed the self-assessment and who have conducted a review with their Regional Manager.
• Can be used to indicate to external stakeholders that you regularly self-assess your quality against a set of standards set by us and are committed to quality improvement. It can support you as an enterprising Healthwatch to demonstrate that you are continually improving.

Terms and conditions for using the quality logo

• You can use the quality logo if you have completed a Quality Framework self-assessment and you have conducted a review of the findings with us.
• You can use the quality logo from the date of your review meeting and, in line with the Quality Framework process, use of the logo is valid for three years.
• The logo should not be more prominent than the local Healthwatch mark or used directly alongside the mark.
• However, it can be used to support communications. For example, it can be used at the bottom of  email signature, letterhead stationery, website, or on marketing materials. Guidance on how to use the quality logo is available, along with the logo in a range of formats. 
• The quality logo is a brand asset provided by Healthwatch England. So, like any brand asset, it can no longer be used if a service provider's contract to provide a local Healthwatch service comes to an end.
• The logo cannot be transferred if there is a change of provider, they will need to undertake a fresh self-assessment.The logo can only be used by the specific local Healthwatch who have completed the self-assessment and should not be used by other local Healthwatch who come under a multiple provider if they have not undertaken the assessment.
• This logo is not intended to be perceived as a quality mark as this would give false assurance that we have conducted an audit or inspection. It is confirmation to stakeholders that you have committed to working with us to continuously improve.
• The quality logo must not be used in any manner that expresses or might imply the affiliation, sponsorship, endorsement, certification, or approval, other than as set forth in these terms.
• Except for size, the logo must not be altered in any manner, including proportions, colours and elements. Nor should it be animated, morphed, or otherwise distorted in perspective or dimensional appearance.

Text to support the logo

Committed to quality

At Healthwatch Anytown, we aim to provide the best service we can to our community and to make the greatest difference we can to local people.

To help us be the best we can be, every three years we undertake a comprehensive assessment of our work using a tool called the Quality Framework.

This helps us to understand what we are doing well and where we might need to improve.

You all provide an information and signposting service, as it is a statutory function. These differ in scope and scale due to local commissioning arrangements, but you told us that many of you have seen an increase in complex calls since the pandemic and many are now facing the challenge of providing the service from home.   

You also told us there can be a need for more clarity on the role of Healthwatch and the remit of the information and signposting service with the public, commissioners and sometimes within Healthwatch themselves. We also know that due to high levels of commitment, some staff feel they go above and beyond due to a lack of alternative sources of help. 

We met with 14 people who either manage or deliver Healthwatch information and signposting service across 12 different Healthwatch to find out how they address the current challenges and see if we could identify some good practices and principles. Above all, we urge you to be clear about your service and remit with your teams, board, commissioners, and the public.  

What can I do to meet these challenges?  

Read on for a summary of their ideas and suggestions to help you manage your own information and signposting service. It isn’t guidance but could be a useful conversation starter in your teams.   

Your good practice checklist  

• Update your home working policy to include regular contact with colleagues and the manager and try to schedule annual leave to ensure one person is not covering the service alone. 
• Include out-of-office voicemail and e-mail auto-responder messages with clear guidance on opening hours, how long it will take to get a response, useful numbers, and local information. 
• Include information and signposting as an agenda item in your regular team meetings to allow people to discuss calls and get advice and support from colleagues.  
• Build relationships with the Integrated Care Board and health and social care partners to understand local support options and agree on circumstances when you can make escalations and referrals. 
• Ensure you have the right level of insurance for the level of service you deliver. 
• Join or set up local information and advice hubs where queries can be handled by the most appropriate organisation so that callers are not given more numbers to call. 
• Create a clear information and advice section on your website. Include details of local organisations, the support they provide, and frequently requested information such as how to register with a GP, make a complaint and access emergency dental care. Check out our website for up-to-date advice content you can localise for your own website.    
• Include a clear section on your website covering what you offer but also what you don’t do to help manage expectations. 
• Agree on the number of calls that are reasonable to take in a day and develop a process to prioritise these so that staff wellbeing can be looked after. Decide how to set the phone system to deal with out-of-hours calls and if you have the capacity to respond to the number of voicemail messages that are left (i.e. in effect, provide a 24-hour service) 
• Consider if there are supporting roles that would allow volunteers to contribute to the information and signposting service. 
• Work with local voluntary and community sector partners to share insight into needs that are not being met and the impact on local people. Make the case for funding an enhanced service over and above traditional ‘information and signposting’. 
• Consider working towards becoming a 'Trauma Informed Organisation', which includes include incorporating the principles into all staff policies from induction and training and ongoing support for staff.  
• Update your call-handling process to give clear guidance on ending calls if a person becomes aggressive. Include a structure to end calls where there is no solution and a debrief process to support call handlers.  
• Access dedicated support that is available for information and signposting staff. This includes: 
  • How to structure a call webinar 
  • Handling challenging calls webinar 
  • Assessing safeguarding and risk webinar (for I&S staff) 
  • Call handling guides 
  • Listening skills webinar 
  • Personal resilience and wellbeing webinar  

Over the past few months, I have spoken at regional forums and other events about some of the changes we propose to make in how we work with local Healthwatch. These changes follow on from what we shared with you in Our Future Focus and in my last blog with Louise Ansari.

In proposing these changes, we're keeping in mind the priorities you shared with us:

• Reducing the asks we make of you.
• Having a better understanding and making the most of local Healthwatch achievements.
• Improving two-way communication.

Here’s what I’m covering and what they mean for your Healthwatch:

1. Demonstrating your value – advance notice of the questions in the annual survey, which we will ask you to complete in September 2023.
2. Understanding the diversity of Healthwatch – advance notice that we will be asking you to complete a survey on the demographic profile of your Healthwatch in November 2023. In the meantime, we are providing a template to help you collect this information.
3. Sharing your accomplishments – we’re busy analysing your annual reports, and we want you to continue to share the difference you make.
4. Working with the Care Quality Commission – we’re supporting Healthwatch with the new approach to assessing local authorities and Integrated Care Systems.
5. Quality Framework – we’re continuing to support Healthwatch who want to undertake the Quality Framework and have introduced a badge for those Healthwatch who have completed it.
6. Check-in with your Regional Manager – we’re encouraging all Healthwatch to have, at least, an annual check-in to understand your support needs.
7. Integrated Care Systems – a new ICS Healthwatch Representatives network is holding its first meeting on 12 October.
8. Data sharing – just a big thanks to for everyone sharing your data, including demographic data.

Demonstrating your value

In response to your feedback, this year we have reduced the number of questions in the annual survey.

Click here to see what data we intend to collect in the annual survey in September.

Our annual report, which is presented to Parliament, makes the case for investment in Healthwatch and supports the National Committee with their statutory role in ensuring Healthwatch activities are carried out properly.

Understanding the diversity of Healthwatch

In our last blog, we asked for your help to significantly improve the response rate to our Healthwatch People Diversity Survey, as the response rate was less than 40% in 2022.

We said we would send you the questions in advance, which you can view here.

This year we are asking for data on the combined total of your staff, volunteers and Board. The data you provide will be anonymous and not linked to your individual Healthwatch – but we will ask whether your Healthwatch has completed the survey using a linked but separate survey.

If you currently do not have the required data on the demographic composition of your staff, volunteers and Board/Advisory Board members, you can use the Healthwatch Diversity Survey template which is available on this page and in SMART Survey if you have an account. Go to ‘My Surveys’ in SMART Survey, make a copy and then you can send this to your staff, volunteers and Board members.

Given that Healthwatch advocate for health equity, it is important that we strive to reflect the communities we serve. Our training programme includes support for Healthwatch on improving volunteer and Board diversity. We want to track whether these and other measures that individual Healthwatch are taking are making a difference. We'll report the results back to the network.

Sharing your accomplishments

You told us we should make better use of your stories of change – to support raising our profile, demonstrating what Healthwatch have achieved and sharing what's working with Healthwatch and our external stakeholders.

We're currently analysing all of your annual reports to get a picture of the individual and collective impact of Healthwatch. We'll draw on your examples to support our national work and share them in forthcoming newsletters.

Please also start using our new Impact Tracker or the simplified sheet to tell us about the difference you’re making on an ongoing basis. The more of your recent success stories available to promote and talk to national stakeholders about, the better.

Working with the Care Quality Commission

You may be aware that the Care Quality Commission (CQC) are piloting how they will assess local authorities and Integrated Care Systems. Healthwatch England is working with CQC to support local Healthwatch in the pilot areas which will be evaluated. We will share learnings from the pilots with Healthwatch so you know what to expect and how CQC will engage with you.

You will have a dedicated point of contact within CQC, but be aware that  some posts are yet to be filled. If you are unsure who to contact at CQC, please get in touch with your Regional Manager.

Quality Framework

Demonstrating your effectiveness is never more important than in difficult financial times. Over three quarters of Healthwatch have now completed the Quality Framework - with 50 in the last year.

We’re continuing to support Healthwatch who want to undertake the self-assessment process. Some have used the process to help prepare for a tender process, while others have used it in preparation for a new strategy. We’ve seen several Healthwatch use it to consider how they apply equality, diversity and inclusion across their work. We’re recommending Healthwatch complete it every three years.

Analysis of completed Quality Frameworks demonstrates many strengths, including reaching and engaging with people facing the greatest health inequalities and managing people. Healthwatch reported challenges with the role of Boards/Advisory Boards who support the governance and decision-making of Healthwatch and meeting the statutory requirement for transparency in our work. In response, we developed an extensive programme to support your boards with recruitment and self-appraisals, from which we developed guidance for both hosted and standalone Healthwatch.  

We’ve made it easier to complete using the improved Smart Survey format, which we expect all Healthwatch to use after December 2023.

We’re introducing a badge so your Healthwatch can demonstrate your commitment to improvement. This could be displayed on your website footer, email signature or other appropriate materials. If you are eligible, you will receive an offer directly.

Check-in with your Regional Manager

We encourage all Healthwatch to have at least an annual check-in with their Regional Manager. We use these meetings to check if you have any support needs and talk through the Quality Framework if you have recently completed it. It’s a really important opportunity for us to make sure we understand your needs so we can inform our national work and how we can best support you.

Integrated Care Systems

In response to requests from Healthwatch, we are establishing a network for Healthwatch ICS Representatives, with the first meeting taking place on 12 October. For ICS areas with more than one Healthwatch, you will need to decide among yourselves who will represent your area. You can sign up here.

Data sharing

Local Healthwatch tell us that our new Data Sharing Platform is easy to use. Between April and June, 21,839 pieces of feedback were shared with us by 54 Healthwatch from 28 ICS areas. We’re in the process of onboarding the remaining Healthwatch and supporting you to regularly share your data.

We are also seeing a welcome increase in demographic data, which helps our analysis and enables us to highlight where the health and care system needs to listen better and take further action, including on tackling inequalities.

A big thank you to everyone for helping us; keep sharing your data and reach out if you need any help: DataSharing@Healthwatch.co.uk.