What is a Volunteer Responder?

NHS and Care Volunteer Responders has over 40,000 volunteers who support people in their local community with activities including friendly phone calls, shopping and prescription delivery. The programme is delivered by Royal Volunteering Service and GoodSAM and is supported by NHS England.

What support can volunteers provide?

NHS and Care Volunteer Responders take on a range of activities, including:

• Check-In and Chat: Provides telephone support to people in need of companionship and encouragement to improve their mental health and wellbeing. This support will be a phone call from a different volunteer for up to 18 weeks.
• Companionship Calls: Provides regular friendly phone calls and a listening ear up to three times a week up to six weeks. This is with the same volunteer. 
• Community Response: Provides support with collecting and delivering essential shopping, prescriptions or accompanying someone to a local activity. This is on a one-off basis or for six weeks, days, and times to be agreed between the volunteer and the person supported.
• Pick Up and Deliver: To transport equipment, supplies and medication between NHS services and sites.

How can I refer someone?

You can make referrals for volunteer support by submitting details online via the Volunteer Responders GoodSAM referrer portal or by calling their Support Team on 0808 196 3382.

How long does it take to make a referral?

NHS and Care Volunteer Responders will approve requests within 72 hours, or you can make referrals through your Local Authority.

Who is eligible for support?

Check-In and Chat

People who may need a friendly chat and some encouragement to improve their mental health and wellbeing.

Companionship Calls

• People who would prefer or benefit from speaking to the same volunteer.

You can see support for vulnerable people for more information on who is eligible for support for other services.

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.

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.

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.

What is community research? 

Community research involves working with communities - speaking to people, identifying key issues, and seeing where change or practical solutions can be achieved. 

The research is action-focused and participatory, meaning communities are at the heart of this approach from beginning to end. 

Working this way means local Healthwatch can bring resources, time, and effort to support, listen, and build skills.  It can help communities to bring their views and voice to the fore and explain what health and social care issues are important to them. 

Together, we can work creatively - building skills with individual community researchers or supporting community groups to do their own research. 

Community research is important because it is: 

• Community-led throughout and focused on issues of concern 

• Action focused – achieving results for the community themselves 

• Reaches people whose voices are underrepresented 

• Builds confidence and recognises skills, knowledge and expertise in communities

• Reimburses community members for their time and input 

• Can start to address inequalities in access and resource 

• About the process as well as the result 

• Moves away from extractive research approaches 

• Supporting communities is a continuous ongoing dialogue: it can influence health and care providers to build responsive and culturally appropriate  services for underrepresented communities, based on equity, trust and access.

How do we do it? 

Healthwatch works with communities in many ways. Through open discussions we can support communities to identify how best to raise what is important to them in health and care and to get their voices heard. This two-way process takes time to build relationships, trust and dialogue. It is not a shortcut approach. 

In 2021 Healthwatch Oxfordshire supported two community researchers under a Community Participatory Action Research (CPAR) programme. This support was initiated and funded by Health Education England South-East and developed in collaboration with the Office for Health Improvement and Disparities, the Scottish Community Development Centre and NHS England and Improvement.

Healthwatch Oxfordshire developed two models of community research

Model one: Supporting community action researchers on their chosen topic 

People from a community who want to focus on an issue of importance to them can work with Healthwatch as community researchers. We support them in highlighting the important concerns in their community. We are alongside them to provide support, build skills, help research planning, and provide resources for this to happen. We help the researchers and communities to share what they have heard directly with the health and care system. 

In this model, the community chooses the issue, the research methods, and how the research will be used. This process takes time and strongly focuses on participation and change, identifying areas for practical action.  

Model two: Working with community researchers on specific issues 

In this model, Healthwatch can work with community researchers on a specific piece of research. The focus topic is defined up front, either from the community or in response to pressing issues or themes.  

This is a shorter-term commitment and focuses on enabling voices to be heard by the health and care system. We provide support and training to community members to build research skills and highlight areas for change to decision-makers.  

Whilst the community researcher builds skills, there is less focus on wider community participation within the research process. 

Step-by-step guide.  

NB flexibility and adaptation are required! 

Action research cycle through five steps – Plan, Observe, Act, Disseminate, Reflect. 

Step one: Plan  

Lay foundations (Healthwatch led): 

• Set up internal Healthwatch procedures first 

• Establish scope, timeline and budget for the project 

• Agree on reimbursement process for community members' time in group sessions, including transparency around responsibility for tax/benefits declarations etc.  

• Provide equipment and staff support as needed  

• Provide dedicated staff time for support and mentoring 

• Recruit community researchers via local links (E.g. from a community of interest, place, culture)  

• Provide training, induction, mentoring and support for community researchers  

Community plan (community researcher-led) 

• Support researchers to identify the community of focus  

• Support researchers to identify project theme/problem/question/issue in collaboration with the community 

• Build bridges and dialogue between researchers, community and local health and care services 

Step two: Observe (community researcher-led) 

• Develop research methods, approach and plan with the community 

• Promote any events through community networks and social media 

• Gather information, listen and involve communities – make sure research is inclusive, culturally appropriate and accessible and remove barriers to participation 

• Use creative methods to reach people and hear their voice  

• Focus on process, challenges and solutions 

Step three: Act (community researcher-led) 

• Based on what you hear, decide the way forward and identify action points 

• With the community, determine what practical changes are needed; where, how and by whom? 

• Decide on how you will tell the story. 

Step four: Disseminate (Healthwatch with researcher and community) 

• Help community researchers and community members share insights and lessons, e.g. to health and care providers, Health and Wellbeing Board  

• Facilitate round table discussions, community events etc. 

• Make sure health and care providers report back to the community and highlight what has happened as a result. 

Step five: Reflect 

• Change may not be immediate and make take years. Follow impact over time  

• Keep the community updated about progress and changes  

• Keep learning and developing with communities’ input: use lessons to inform the improvement of this approach for

Community action research is part of a family of participatory approaches, e.g. Community Participatory Action Research (CPAR), Action Research, and Community-led research. To learn more:  

Resources and helpful guides: 

Healthwatch Oxfordshire's community researchers explainer film

Scottish Community Development Association

Centric community research hub

Literature review community research

Healthwatch Oxfordshire are happy to share insights into their experience working with community researchers. Please get in touch with them by email at hello@healthwatchoxfordshire.co.uk or calling 01865 520520. You can see examples of this work on their website.  

Costs (based on model one, up to nine months)

• Training (three days @ £11/hour): £231
• Research (100 hours @ £11/hour): £1,100
• Support (10 hours @ £11/hour): £110
• Presentations (10 hours @ £11/hour): £110
• Phone: Nine months @ £15/month: £135
• Travel: Reimbursement/mileage @45p/mile: £100
• Events: 2 @ £200: £400

Total/community researcher: £2,065

Community research is: 

• A process as much as an outcome 

• Time-consuming 

• It takes commitment, skill, risk and an iterative learning approach 

• Rewarding for both community and Healthwatch 

• Highlights issues, perspectives and concerns of seldom heard communities on their own terms and led by them 

• Action-based and focused on change 

• A way of working with communities based on respect, partnership and value 

What community research is not:

• A quick fix 
• Easy 
• Tokenistic
•  A clear-cut ‘toolkit’ approach 
• A guaranteed product, outcome or ‘success’ 
• Without risk 
• Appropriate in all circumstances

What are the challenges?

• Doesn’t stick to ‘office hours’ -challenges boundaries  

• Researchers vary in skills and confidence and may need different levels of support 

• Researchers and community members have busy lives, often juggling jobs and family, so they have little time 

• Needs ongoing problem solving, e.g. challenges with boundaries, GDPR and confidentiality 

• May not be free of community ‘politics’ 

• Needs understanding how to support beyond the research to protect/ navigate researcher and community in dialogue with health and care system and subsequent demands 

• Organisational and service change is slow and takes time, leaving communities frustrated. Make sure to focus on real changes that people can see 

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.

Use our Case for support guidance to help you have discussions with ICS about Healthwatch resourcing, including effective collaboration and acknowledging the additional burden of delivering functions within the ICS.

The guidance helps show the value of Healthwatch to an integrated care system. In particular, how the work of Healthwatch can help ICSs achieve its aims and meet needs.

This tool should be used alongside conversations with ICS stakeholders and not sent without prior discussion with them.

How to use the template

As this is a PowerPoint template, you can easily make changes to include local details and context, as well as any specifics relevant to the partnership under discussion. You could also personalise the template using:

• Quotes of support and testimonials from local people
• Facts and statistics relevant to the ICS
• Details of all the Healthwatch requiring support and the work you do
• Specific projects for which support is needed and costs
• Local photography

Whilst this PowerPoint template gives you the tools to provide an overview either in person or digitally, we recommend following up with a more detailed proposal. This should set out the specifics of the relationship, and should focus on how the ICS can meet their priorities, rather than Healthwatch's needs.

We hope the new Case for Support will prove to be a valuable tool in discussions with the ICS in your area, acting as an introduction to how a partnership could develop and a starting point for discussions.

This guidance for Memorandums of Understanding (MoU) provides a structure which local Healthwatch and the Integrated Care System (ICS) can use and adapt to reach an agreement on how they will work together.

This Guidance is designed to use existing and emerging guidance and legislation, whilst also taking into consideration the differences that exist across systems.

Before you start drafting an Memorandum of Understanding with your ICS, you should work with other local Healthwatch to develop a collaboration agreement. This will help you determine a shared understanding of how you want to work together with other local Healthwatch first. To do this, check out our Collaboration Toolkit, which gives you a step by step guide on how you can build a solid working relationship with other Healthwatch.

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.

From April 2022, new health and care legislation will come into force, changing the way the NHS and other organisations plan and fund the delivery of care. The development of Integrated Care Systems (ICSs) through the Health and Care Bill will make significant changes, shaking up the system as we know it. 

It's essential that you understand how ICSs will affect the way you work locally, as well as the steps you’ll need to take to be ready for this change. If we aren't prepared as a network, it will be harder for us to get NHS decision-makers to hear people’s views and hold services to account moving forward.

How will the new structure work?

Systems, places and neighbourhoods

As the legislation is debated over the next few months, we will get a clearer view of how the new structure will work. We currently know that NHS England and NHS Improvement have proposed a three-tiered model of systems, places, and neighbourhoods to better integrate care.

At ‘System’ level, the Integrated Care Board (ICB) and Integrated Care Partnership (ICP) will set out the plans and strategy for the area. At ‘Place’ level, local organisations will collaborate on local planning and delivery. ICSs will be based on the principle of ‘subsidiarity’, with planning and delivery being based as close to local communities as possible.

For more information, read the King’s Fund’s explainer guide.

What does ICS guidance say about Healthwatch?

Although the legislation is based on implementation starting from April 2022, guidance has already been published, setting out various aspects of how ICSs will work. Although these may be revised in the light of Parliamentary decisions, they are useful indications of what will be expected of ICSs.

We’ve outlined a quick summary of each guidance document and how they might affect Healthwatch:

1. The Design Framework (June 2021): Sets out the high-level ambitions for ICSs. It also includes the principles that ICSs should use to develop their engagement strategy, building on the existing relationships, good practice and networks across system partners.
2. Thriving Places (September 2021): Looks at what is needed to support work more locally than at System level. It considers how ‘Place’ may be defined, who should be involved and different types of governance. Healthwatch is listed as being expected to be involved at this level. As decision-making will be delegated to the most appropriate level, Healthwatch needs to be clear about when and where decisions will be made. It’s important to note that this is the Place-based partnership which is different from the ICP that works at System level.
3. ICS implementation guidance on working with people and communities (September 2021) Includes System-level guidance setting out how ICSs should work with people and communities. It includes a section on working with Healthwatch, building on current good work, and draws a distinction between Healthwatch and the wider Voluntary, Community and Social Enterprise (VCSE) sector. This guidance can provide a helpful basis for you to discuss engagement plans with ICS engagement leads as well as other Healthwatch in your ICS area.
4. The Integrated Care Partnership (ICP) engagement document (September 2021): Is designed to engage partners in the development of ICPs. It sets out how ICPs should build on existing good practice and structures, such as Health and Wellbeing Boards, and includes "mandatory requirements" and "guiding expectations". It also emphasises the role of Healthwatch “to bring senior-level expertise in how to do engagement and to provide scrutiny”, with the expectation that Healthwatch will be members of the ICP. This guidance has been developed with local government, VCSE organisations and other stakeholders, including Healthwatch England. It will be updated following this piece of engagement.
5. ICS implementation guidance on partnerships with the voluntary community and social enterprise sector (September 2021):  Recognises both the challenges and the benefits of partnership working. It includes different models of engagement, including working at System and Place level, supported by short case studies. Healthwatch across the country have strong relationships with VCSE partners, so it is worth thinking about what you can offer to help build relationships between the VCSE sector and the ICS, particularly to tackle health inequalities.

To support the development of governance arrangements, NHS England has set out the functions of clinical commissioning groups that will be transferred to ICSs and has produced a model constitution. Other guidance covers issues such as the HR Framework, clinical leadership and ICB readiness to operate.

Additional guidance being developed

A working group, which includes Healthwatch England, is currently developing statutory guidance about working with people and communities. This guidance is expected to be completed early in 2022.

What will this mean for you?

Local systems will be working their way through the guidance and deciding what this means, so this is the best time to influence their thinking and remind them of the contribution that Healthwatch can make. When your ICS includes several Healthwatch, you will need to ensure a coordinated and consistent approach so that the ICS has a clear picture. Some of the key questions you might want to consider asking include:

• How will local voices be heard by the ICS?
• What is the ICS strategy for involving local people?
• How will the engagement strategy ensure that marginalised communities are properly represented?
• How can the ICS best use Healthwatch insight?
• How will issues raised at Place level get heard at System level?
• How will the ICS ensure it is transparent and accountable to local people?
• How can Healthwatch best support the development of the ICS?

What is Healthwatch England doing?

We are working at both the national and ICS level to get our message across. Our contribution includes participating in groups that have developed or are currently developing guidance. As the Health and Care Bill works its way through parliament, we are meeting with politicians from all parties to make sure that they understand our case. For example, Sir Robert’s recent appearance at the legislative scrutiny committee was an excellent opportunity to raise the issue of public voice in ICSs, and Healthwatch’s role in supporting that.

Sir Robert has had a programme of meetings with ICS lead and chairs. These help us get a sense of where ICSs are and how they are developing - yet another opportunity for us to talk about what Healthwatch has to offer. Your local insight has been instrumental in the briefings we produce for these meetings.

We are also working with the System Transformation Team at NHS England to identify and promote good practice across the country. The Transformation Team surveyed ICSs and the network to test out relationships. We have also commissioned case studies to show good practice where ICSs and Healthwatch collaborate well, which can also help other areas with ideas to consider and adapt. This work is supported by an ICS Readiness reference group drawn from volunteers across the network.

To help local areas, we are working with Traverse to provide bespoke support for a small number of ICS areas that face particular challenges in developing their partnerships.

As legislation progresses and ICS arrangements become clearer, we will keep you updated on changes that you may need to respond to.