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.

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.