Healthwatch are increasingly focussing on planning for, identifying and communicating outcomes and impact achieved for people who use health and care services. This contributes to ensuring your organisation's financial stability and increases support from members of the community.

About this resource

Recruiting a volunteer to take on responsibilities relating to monitoring outcomes can help give this work a greater profile within your Healthwatch. In particular, the role could provide additional capacity to update the Impact Tracker and liaise with other team members to check on how different areas of work and opportunities to influence are progressing.

This document provides guidance and tips on introducing an Impact Assistant volunteer role. It includes a suggested role profile.

The profile for this role has been developed so that it can be adapted to meet your specific local needs. Create your own role description by using whichever of the listed activities you feel will be most useful for your team.

Link to other resources

This guidance and role profile is an addition to our other volunteer role descriptions, which are available for you to use and adapt.

In Our Future Focus: the Healthwatch England Strategy for 2023-26, there is much mention of the challenges and opportunities we face, and how the context of health and care has changed, in a way that feels like it will be here to stay for the foreseeable future at the very least.

With the NHS and social care under unprecedented demand, and with its resources under enormous pressure, what does this mean for our role in ensuring people’s experience of care helps shape improvement? 

How can we be stronger organisations in our own limited resource context? How can you build impact in an environment where commissioning is often a challenge to stability? How can we perform our statutory duty of supporting you better?

As we celebrate our 10^th anniversary, we’ve much to be proud of - here’s why and what you have told us.

You show time after time how:

• You are connected to your communities –whether it is getting cervical screening sorted for Bangladeshi women, gathering feedback on cancer services from those facing health inequalities or bringing attention to the impact of vaping on young people
• You can bring the right people around the table to find solutions and act as a critical friend
• You stay true to your independence and hold bodies to account

We could list others, but here are some harder things that we hear:

• “I’ve never heard of Healthwatch”
• “You come over as amateurish”
• “You don’t meet your potential”
• “I listen to you grudgingly because of your statutory role”
• “Healthwatch need to reach beyond those we already hear from”

The response to these challenges could simply be: we do our best on the (shrinking) resources at our disposal. After all, our funding has reduced by 20% and 38% respectively, with significant variation across the network. Staff retention and the ability to plan ahead are also affected by short term contracts; and changing health and care structures make influencing harder.

But the truth is when the economic environment is harsh, it’s even more critical to demonstrate our value and ensure our house is in order – especially if we are making the case for our sustainability.

Our future relationship

In our strategy consultation, this is what you’ve asked us to do. This builds on what you’ve said to us and the team over the last few years.

Resource and commissioning 

If there is a legislative opportunity, we want to be ready with a sustainable and effective model – tried and tested if there is time. We’ll need your help to build on what’s already working well and look at the different options.

In the meantime, we will continue to work with local authorities to support effective commissioning, including looking at a more consistent approach to contract monitoring.

Our culture 

Culture defines our internal and external identity, motivates and keeps our people and makes us feel part of a team and movement. Many of you have already set out the values and behaviours that underpin your culture. We'll be looking at our own culture, and we thought it would be beneficial to do this alongside the network so we can all adopt or align to a shared set of values and behaviours. This work will commence in Autumn 2023.

Communications 

You told us that two-way communication between us should improve, the number of asks can feel burdensome, and it can be challenging to find the information and resources you need. We’ll review how we communicate, including revamping the network site – with your help. This will be ready by March 2024.

Impact, facilitating peer support and collaboration 

Mindful of your feedback about not making too many asks, we’re keen to better understand the impact you are achieving, spot any trends across the network to inform our policy work and make sure we promote it to all our audiences – including other Healthwatch. We will also offer to facilitate collaboration between Healthwatch and peer support networks – all the time making this optional so as not to impact your local priorities. We’ve started having these conversations at regional forums and will set out our approach in more detail before September 2023.

Professionalism and skills 

Our value relies on the professionalism and skills of our people – staff, boards and volunteers. With your help, we’ve set out the core skills and corresponding training and support options – many of which are developed and delivered by network members. You can find out more here.

Equality, diversity and inclusion 

We are continuing our commitment to support equality, diversity and inclusion, set out in the Roadmap. You will see we are offering a programme of training; we will be looking to profile Healthwatch activity that addresses inequalities; we will continue to support the Equality Diversity and Inclusion Peer Network and support sharing of best practice.

We also want to ensure we understand the Healthwatch network’s profile amongst communities and people with protected characteristics. We’ll need your help to significantly improve the response rate to our anonymous Healthwatch People Diversity Survey, as we previously had a low rate of return. We will shortly send you the survey questions in advance, so you have plenty of time before we collect the survey results in November 2023.

The value of Healthwatch

So yes - we must take on board the harsher things that are said about us, but equally I hear that we punch above our weight; that Healthwatch are being commissioned on the strength of your connection to communities, the value you bring to your systems; and how you support each other to overcome challenges and capacity issues.

I wholeheartedly believe that by supporting each other and collaborating on the priorities outlined above, we can secure our sustainability and unleash the full potential of the Healthwatch movement, which will ultimately improve care and the lives of the people we serve.

With unprecedented challenges facing NHS and social care services, we've launched 'Our future focus' - a plan setting out what we want to achieve by 2026 and the steps we will take to get there. 

Why have you decided to refresh your strategic direction?

The environment in which we operate has changed. Seventy-five years after its birth, the NHS and the social care system face enormous challenges and big questions about how we invest in future services.

How can services:

• Tackle the care backlog and building a future service that can help people stay well and support those in need will be challenging?
• Help address the deep inequalities, which see factors like where you live, ethnicity or gender result in different health outcomes?
• Work together to provide better, more joined-up, efficient care that gives more control to you?

Health and social care decision-makers can't answer these questions alone and need the public's input. And this is where Healthwatch comes in. 

You've demonstrated the power of feedback to help services understand what's working, spot issues and think about how care can be better. But, with investment in our work under pressure, we need to think carefully about where focus our efforts to make the biggest difference. 

This is why, in 2022, our committee initiated a review of our strategic direction.

What will Healthwatch England focus on? 

We will focus on three aims: 

1. To support more people who face the worst outcomes to speak up about their health and social care, and to access the advice they need.
2. To support care decision-makers to act on public feedback and involve communities in decisions that affect them.
3. To be a more effective organisation and build a stronger Healthwatch movement.

Read 'Our future focus' to find out more about how we will achieve these aims, but the steps we plan to take include:

• Continue to raise our profile so every community, especially those facing inequalities, knows we are there for them.
• Focus on the big issues that most concern the public and the communities that face the worst inequalities. These include access to primary care services, social care and women's health. 
• Work with the NHS at every level – locally, regionally and nationally – to find solutions and make listening to service users the default approach across all health hand care.
• Harness the resources of the Healthwatch network more efficiently and put our funding on a sustainable footing.

Why have you decided to focus on these three aims?

We have chosen these three aims because they are flexible enough to help us respond to a changing environment but focused enough to ensure we can have specific and sustained impact, crating change based on feedback from people. 

We've incorporated many things that you told us were important to you. These include:

• Continuing to raise the profile of Healthwatch, so people know how we can help;
• The importance of social care, as well as doing more to tackle access issues in primary care, as this is one of the main issues people tell us about;
• Taking steps to try and address funding issues and variation across the Healthwatch network; and
• Reduce the asks we make of you, streamline our communications and make it easier to find help and resources.  

How will you know if you are successful?

Each aim includes measures to help us know if we have been successful. We will know if we are successful if:

• More people than ever know who we are and how we can help. We have a powerful supporter base, representing every community, who share feedback, get involved in our work and know the difference their views have made.
• The voice of people is heard at every level of health and social care. The strength of our evidence, especially when it comes to health inequalities, is acted on more than ever to provide better care.
• We have the funding, culture, skills and infrastructure we need to be our best.

What was achieved by the last strategic review?

Our future focus looks at what has improved since the last time we reviewed our strategic direction and areas that still need to improve. However, key achievements include: 

• Greater public awareness of Healthwatch and what we do.
• We better understand who uses our service and shares their experiences with us.
• Knowing the critical ingredients for delivering a high-quality Healthwatch service and the support you need from us to deliver this.
• We can better demonstrate our impact, and an increasing number of health and social care decision-makers value us.

How did you involve people in developing your future focus?

We started the process last Autumn. We're grateful to everyone who helped shape our plan by sharing their thoughts, ideas, and reflections.

As well as looking at all the existing evidence we have, we undertook several activities, including:

• Getting regular input from a reference group made up of local Healthwatch leaders;
• Workshops with our staff and Committee;
• Discussions at Healthwatch Week 2022, where we were joined by staff and volunteers from across the country; 
• Sessions with Healthwatch lead officers and chairs;
• 1-2-1 meetings with NHS, social care and third-sector leaders; and
• Events with patients, service users and those that represent them. 

What does this plan mean for me, and how can I get involved?

The support we provide to you should continue to improve. We'll also be providing lots of opportunities to get involved.

If you have a question, please speak to a Healthwatch team member. 

It is good practice for all local Healthwatch to have clear agreements about roles, responsibilities and decision-making.

You told us you wanted more support for Healthwatch boards.  Margaret Curtis and Phil Morgan, the two consultants from local Healthwatch who led the board support programme in 2022-23, have produced these checklists and templates that will help you in your role as a Healthwatch Chair or board member, in both hosted and standalone Healthwatch.

You will find all of the resources you need below, so that board support is all available on one easy to use page.

These existing resources will also be fundamental for Chairs and board members.

Decision-making template and guidance

How we make decisions (Easy Read)

Code of conduct template and guidance

Conflict of interest template and guidance

Guide to running a Healthwatch

English local authorities have a legal duty to commission local Healthwatch.  Healthwatch England has a role to play in supporting local authorities with this function to make sure they understand their duty and learn from good practice.  We do this through publishing a guide for commissioners and through individual support to them.

We have launched an update to our guide, following the enactment of the Health and Care Act 2022, and to reflect local authorities’ key learnings from their experience of over a decade of commissioning local Healthwatch.

About the commissioners' guide 

The guide: 

• explains the key statutory requirements relating to Healthwatch;
• outlines local authorities' role in commissioning local Healthwatch for their area;
• explains Healthwatch England’s role and how this relates to both local authorities and local Healthwatch;
• sets out how commissioners can use the Healthwatch Quality Framework to commission and monitor local Healthwatch;
• identifies ways that commissioners can set clear expectations on outcomes and impact to ensure their Healthwatch is effective;
• provides a checklist to support local authorities when developing a tender specification, contract or grant agreement.

Download the guide

Before you start, think about whether you need to collect people’s names and contact details. If you don’t, then GDPR doesn't apply, and you don’t need to have a consent question for personal data in your survey or feedback form. 

This document includes examples of how to word intriductions and questions about consent and explicit consent in:

• Surveys
• Webforms
• Interviews and focus groups

If you have any questions about this guidance or the examples, please contact the research team: research@healthwatch.co.uk. 

We rely on local Healthwatch insight to understand trends in how people experience health and social care services. It is also a legal requirement for Healthwatch to share their data with Healthwatch England.

Formalising data sharing 

As part of our work to strengthen our data standards, all Healthwatch are required to sign a data sharing agreement. 

This has been developed on the advice of data protection experts and in line with guidance from the Information Commissioners Office, for any system or process involving data sharing between Healthwatch and Healthwatch England. The agreement sets out our roles and standards of what is expected from the arrangement and each party, with a schedule for each system.

Each year we ask you for:

• information about your activities (the Annual Survey)
• feedback on the support we provide you (Satisfaction Survey).

We also ask about your learning needs every two years.  

We use this information to shape the support we provide to you.

How we’ve used what you told us previously

Communications and asks

We heard mixed views about how we communicate with you. Some of you have seen a better flow of communications. However, we’ve had a strong message that we should reduce the number of asks and improve how we communicate our priorities. 

You should have noticed that we’ve introduced the Month Ahead – which sets out forthcoming campaigns, publication of new resources and guidance and the priority areas we would like you to tell us about, such as winter pressures. We share this on Workplace and in the newsletter on a monthly basis.

Support on Integrated Care Systems

At the time of the last Satisfaction Survey, Integrated Care Systems were not yet legal entities. You told us that support and resources on working with ICSs had been welcome. In the annual survey, 80% of you reported that relationships were effective when working with other Healthwatch within ICSs and 70% reported effective relationships with your ICS/ICB.

Understanding the demographic profile of staff volunteers and Board members

Along with last year’s annual survey, we included an anonymous survey on the demographic profile of Healthwatch boards, staff and volunteers to understand the extent it reflects the national profile with respect to protected characteristics. We want to track the diversity in the network – the importance of which Berkeley Wilde, CEO of the Diversity Trust recently spoke about at the meeting of Lead Officers to assist in understanding whether the actions Healthwatch are taking individually and collectively are having an impact.

Disappointingly, due to a low response rate we are unable to carry out meaningful analysis and establish an accurate benchmark. Only 40% of Healthwatch completed the survey. We will be repeating the survey in 2023 and will review how best to improve the response rate from Healthwatch and would welcome your cooperation.

Collecting, storing and analysing data can be achieved using a CRM/database like Charity Log or Salesforce. Some Healthwatch have fed back that these solutions are not affordable.

This guidance looks at the pros and cons of data capture using a form or survey tool (Smart Survey), data storage using Excel and briefly touches on data analysis using Excel or Microsoft Power Bi – either the free or subscription service.

There is a step by step guide to setting up Microsoft Forms plus links to the templates for both Microsoft Forms and Smart Survey – both of which you can amend to meet the requirements of your Healthwatch. The templates are based on the Healthwatch taxonomy and there is a commentary on how this applies to the questions in the templates.

We need to demonstrate diversity and inclusion in all of our work. To understand different approaches, we funded two local Healthwatch to work closely with others across the network, share their model and provide support to help their colleagues replicate or adapt those successful methods.   

In this article, we'll tell you about Healthwatch Essex's Learning Disability Ambassador scheme, the 2021 pilot where other local Healthwatch got together to discuss the approach and how you can do the same in your own Healthwatch.  

About the Learning Disability Ambassador Scheme 

Working with their local hospital, Healthwatch Essex recruited and trained 14 volunteers with learning disabilities to undertake visits to the hospital and identify improvements. This includes reviewing signage, accessible information, and the language used. 

Ambassadors also met with Healthwatch Essex staff and the hospital's patient experience manager to discuss issues affecting them and others in their network and attend focus groups and steering group meetings. They contributed to case studies and social media campaigns led by Dan Potts, Healthwatch Essex engagement manager, to showcase the difference they are making.

We spoke to Dan, and he shared his top tips for involving volunteers with learning disabilities.  

Map your stakeholders first  

These might include charity organisations, hospitals, local councils, health care professionals or other agencies working in a similar field. 

Use your stakeholders to help with recruitment

Recruitment is easier once you have a stakeholder map. Make a flyer or leaflet to share virtually and face to face in shops and community settings. During your recruitment, include an informal interview face to face or online to enable you to understand the needs of the individual and what you can do for them during their role. 

Keep recruitment simple and accessible

Include an informal interview face to face or online to understand the needs of the individual and what you can do for them during their role. Remember, it is not always about what the volunteer can do to help your organisation but more about how you can add value to their future.  

Make sure you have everything you need in Easy Read  

Ensuring information is accessible is vital to including disabled people in our work, but it also benefits everyone. You should make sure your crucial volunteer documents are available in Easy Read.  

If you want to create Easy Read documents:  

• Limit text – keep it very simple and don’t use any jargon.  

• Use clear images – either illustrations or pictures of real people, objects and places.  

• Do not overthink it – if you are asking for someone’s address, you do not always have to use a postcode symbol.  

• Attend a training course (Healthwatch England provides these) or find a local provider to help you produce Easy Read formats.  

Our Easy Read role description, application form, volunteer agreement, declaration of interest and volunteer handbook are all available below as downloads which you are welcome to use.  

Work as a team and be patient

Co-production works best when people with lived experience form a working group alongside health and care professionals to influence how services are designed, commissioned and delivered. Make sure you manage your volunteers’ experience. These are huge organisations, and it can take time and a lot of patience to influence and change services.  

Get your engagement method right 

Remember that all voices should be heard and that each project may need a different approach. It may be a survey, focus group, one-to-one conversations or social media campaign but remember to be flexible in meeting the needs of your volunteers.   

Carry out volunteer well-being checks  

The well-being of your volunteers is so important. Check-ins are a great way to keep up to date with how they are feeling and give them time and space to share any concerns they may have. These can be by phone or face-to-face. Remember, well-being checks are not always about mental health and well-being. It could be something they have seen or witnessed that they feel they need to bring up with you, or it could be that they are struggling with their physical health and need to take some time off. This will help you support and retain your volunteers.  

We asked Dan for his reflections on a small group of local Healthwatch coming together to discuss his approach and what they all learned. 

• Being able to share good practice between local Healthwatch was brilliant as everyone is so different, and you can learn from each other. 

• There was a high level of engagement and sharing from the group, and everyone was committed, which made it easy to facilitate. 

• Everyone appreciated the supporting resources and documents, particularly the Easy Read forms, role descriptions and handbook.  

• Six Healthwatch had made progress which they were happy to give updates on in the second session. 

What have local Healthwatch done as a result? 

• Recruited learning disability ambassadors. 

• Ran a learning disability steering group meeting. 

• Worked on digital transformation and addressed learning disability access to Zoom and Teams.

• Set up a learning disability health check programme.