Thanks to Jeremy Taylor for raising in a comment on the LINks and Healthwatch post the thorny issue of Local Health Watch (LHW) and the proposed relationship to local authority funders. He said: HealthWatch should be funded through local authorities but not accountable to them. How can you be accountable to the body that – in part – you are holding to account yourself? Why not make them accountable to local communities as community interest companies?
Look beneath the wrapping
This is a very pertinent question and about much more than just what wrapping eventually gets put around LHW. It’s what in the box underneath the pretty paper that matters. Community Interest Companies (CICs) and other forms of social enterprise might be a viable form for LHW to take if other things were also true about their status.
Jeremy is right that the conflict with the LA as funder and the LA as a key body to be held to account by LHW could pose big issues. The phrase “lap dog not watch dog” (a twist on the old ACHCEW slogan) comes to mind. To make it more tricky, the LHW would be on the Health and Wellbeing Board run by the LA as well. So if that’s the problem, maybe a social enterprise form – and CICs are attractive if they have a wide community membership base – is a way for LHW to get out of a potential governance tangle with their funders.
Having mulled this over, here’s what we think about a way forward.
Best of both worlds
Re the governance status and accountability relationship of LHW, we don’t see a conflict with being a CIC social enterprise, with all the community ownership/accountability that should go with that, and having a statutory foundation, legal powers and public funding stream. We certainly would not support anything that said LHWs were not to be statutory bodies. They should be no less established in law than LINks are now and with powers of enter and view at least as strong as those that currently exist.
If LHW were simply voluntary bodies, whether not they were SEs doesn’t matter so much, their potential would be lost and there would be a status issue with CQC and everyone else they need to influence. No one would have to listen to them.
LINks accountability unclear now
On the point of accountability, it is a moot point to whom LINks are accountable at the moment. Certainly not to DH or the SOS in any formal way. The previous government, when they said anything at all about LINks governance, just repeated the mantra that they are accountable to their members/communities, but gave no idea of how that process was meant to operate. Locally our LINk sees itself as accountable to its 350+ members in some way, but this is never put to the test and it is unclear how it would be.
CIC would clarify accountability to community
If LHW were CICs for governance purposes, however, that would at least clarify a big part of the accountability point. As there is a CIC Regulator, she would hold them to account for fulfilling their governance and engagement obligations to the community through their membership.
Their funding local authorities, through a model contract, would then be able to hold them to account for doing their job and keeping within budget. Messy though it might be, part of that job would be scrutinising/entering and viewing/possibly blowing the whistle on local authority social care services that were not up to scratch. That’s part of the LHW job and it can’t be ducked.
We think that dual arrangement would meet the point that Jeremy as raising in his comment that accountability only to the funding LA would be asking for trouble when scrutinising their services/talking to their users.
Analogy with Foundation Trusts
LHW as CICs could have the best of both the statutory body and social enterprise worlds. The analogy with Foundation Trusts as “community benefit corporations” comes to mind. FTs are technically owned by and accountable to their members through their elected governors. This theory has never been elaborated very much, but we think there are signs of more progress towards a clearer SE model for FTs after the Health Bill. After all the coalition say they want to create the biggest social enterprise sector in the world. Pushing FTs and LHW down that road would certain achieve it.
What of Health Watch England?
And if we get LHW sorted out, then there is HealthWatch England (HWE) to consider. Is that to be a new Arms Length Body? – probably not when some have just been given their death warrants.
And what does HWE nesting in CQC actually mean? Just facilities, pay and rations for staff? Or maybe something stronger. Who is HWE going to be accountable to?
Trouble is, everything is connected to everything else. We should always keep an eye out for unintended consequences of what might otherwise appear to be tidy solutions.