The Wrappings on Local Health Watch

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.


  1. Andy Harrison says

    In your article you see no problem with accountability and establishing HealthWatch as a CIC yet a paragraph later state that LINks have not been held accountable. How would this improve with CICs?
    Our LINk is held accountable as every meeting is either a public meeting or held in public and all discussions/decisions are published. Anyone from the local community can turn up on the day and vote at a public meeting(always well publicised) or place an item on the Agenda beforehand for discussion and voting.We do not have a membership so there are no restrictions on who can take part from this point of view. We also report to different bodies and networks on a regular basis and accounts and spending are also published regularly. All our reports are sent to the CQC and Scrutiny. Accountability is ‘easy’ – you just have to be very very transparent and honest

  2. neil woodnick says

    LINks has been a complete waste of £90,000,000 of taxpayers money and a further £30,000,000 will be wasted for 2011-2012 at a time of real cutbacks and hardship. The DoH assertion that LINks represents good value for money because it saves £4.10p for ever £1 invested is further evidence of them having to justify throwing over a £100 million down the drain in the mistaken belief that it will reassure a dis-enfranchised electorship that they can actually influence local health and social care services. The responsibility of monitoring local front line services is too serious a task for groups of self appointed volunteers who think that they will actually make a difference when one only has to ‘follow the money’ in the NHS to see where the real power lies.

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