The NHS deserves a powerful new mechanism for patient and public involvement in health.

Under our proposals, “Health Watch” would be an independent, national body with the power to monitor the NHS and to refer patients’ concerns to a wide range of authorities.

Overall, its role would be to promote the interests of all NHS patients by: -

Being a voice for patients on all NHS issues
Investigating and reporting on the effective delivery of NHS services
Providing a mechanism through which informed public opinion influences the regulation of healthcare

To carry out this role, Health Watch would have, among others, the following specific functions: -

1) To represent the interests of patients as consumers to the healthcare regulator

Under Conservative proposals, Monitor would be an independent, pro-competition regulator of the health service responsible for licensing providers – including those from the private and voluntary sectors. All providers would be required to adhere to NHS prices and contract terms and to operate in accordance with NHS standards and clinical guidelines.

The main function of Health Watch would be to provide a voice for the consumer in relation to the exercise of pro-competitive functions by Monitor. Health Watch would help to ensure that the structure and features of the market in healthcare maximise the quality of patient care.

Monitor would consult Health Watch on the terms of a provider’s license and, more importantly, on the terms of its renewal after any problems have been identified.

Health Watch would also have the power to submit complaints to Monitor in cases where the structure of the market or the conduct of agents within it works against the interests of consumers. Providers would therefore be under great pressure always to have regard to patient interests.

To achieve its aim of championing patient interests in the design of the market, Health Watch would have the means to monitor and investigate the health service and to hear from patients when they have concerns – including when NHS services are being reconfigured.

2) To represent the interests of patients to the NHS in strategic commissioning

Under Conservative proposals, most commissioning would be undertaken by GPs or by groups of GPs acting on behalf of patients. Ordinarily, Health Watch might not become involved in very local decisions. However, there will continue to be a role for strategic commissioning in the NHS – particularly as new clinical guidelines mean service developments, as capital funding is required to support new services, and for new medical technology and other high cost/low volume interventions as and when they become available.

At a strategic level, Health Watch would have the power to make a case for different commissioning priorities when it believes patient interests are not being best served. Health Watch would therefore have a responsibility to find out – through surveys and other means – the priorities and views of local people and to represent these views, complementing the duty on NHS organisations to consult.

3) To monitor the NHS and disseminate information nationally and locally

Health Watch would have an investigative and accountability function – with the statutory power to enquire, make visits, receive information about the NHS, and possibly even call NHS witnesses for questioning. Health Watch would have the freedom to decide its programme of work.

As well as obtaining information for its own use, Health Watch would make this information widely available so as to facilitate meaningful patient choice, promote accountability in the widest possible sense, and help local people identify areas of provision where their needs are not being best served.

Health Watch would have the power to refer matters to the Healthcare Commission acting as auditor of the NHS in cases where NHS providers were under-performing, not meeting standards of care set by NICE, or not making a prudent use of public money.

4) To pursue and refer individual or collective patient complaints

Health Watch would assist patients in lodging a complaint with the provider, express an interest in the case, and lobby the NHS to take the complaint seriously. It should also be the body to bring together collective complaints, which would then be referred to the individual Trust concerned or to the Healthcare Commission (if the nature of the complaint is national or involves several NHS organisations). Health Watch would then help to ensure that the actions which need to be taken in order to respond to a complaint are effected, and it would be able to refer the matter back to the Healthcare Commission if they are not.

5) To contribute to public debate about the NHS at a national level

Health Watch would be empowered to voice the concerns of patients to Ministers, local authorities, political parties, and the media. We would aim to avoid a situation in which Health Watch represent a single viewpoint as being the definitive view of all patients. Its role would be to ensure that a range of views is put forward in order to reflect the different concerns patients have.

By making high-profile interventions in public debate, Health Watch would establish itself as a strong, independent brand, inspire the confidence of patients, and encourage members of the public to come forward with information and views at a local level.

Health Watch: A Consultation with Patients, the Public, and PPIH Stakeholders

The Conservative Health Team invites comments and suggestions on the following topics and questions relating to “Health Watch” and the future of Patient and Public Involvement in Health (PPIH).

1) Independence

PPIH must be independent, but how is this independence best guaranteed? Health Watch would be a statutory body with an independent funding stream and its own staff. But who appoints the head of Health Watch and its leading officers – the Appointments Commission or the House of Commons Select Committee? Should Health Watch be responsible to the Government or to Parliament? What type of independence is required to inspire the confidence of patients and the public?

2) Localism

PPIH should be close to the people who use the NHS on a day-to-day basis, but how local is ‘local’? Health Watch would have a national identity and a regional presence only in staffing terms. There would also be smaller committees for local people to get involved, but what is the correct relationship between individual volunteers and the regional administrative support they require? What is the best organisational level for this support – i.e. SHA, PCT, or local authorities with social care responsibilities?

3) Volunteers

A large proportion of the work of PPIH is carried out by individual volunteers. Who exactly should be actively involved in the NHS? What training or qualifications do they require? To what extent should they be broadly representative of mainstream society? How much (if anything) would they be paid? How many should there be? How will they be recruited? What are the problems of volunteer retention? How can the experience of existing patient forum members be engaged in the future?

4) Publicity

As a national body, Health Watch would have the opportunity to establish itself as a well-known and respected brand. A strong national profile will encourage members of the public to contact Health Watch and get involved at a local level. What are the best means to bring PPIH to day-to-day users of the NHS? How could Health Watch be promoted in GPs’ surgeries or acute settings? Should there be a named contact and a local branch? Might Health Watch have a roadshow of events in local towns?

5) Information

One of the roles of Health Watch will be to access and share information about NHS services. This has many benefits in terms of informing patient choice, exposing the workings of the market, and perhaps identifying areas in which patient needs are not being best served. What type of information is most badly needed? What powers are required to obtain this information, and how might it be shared? How can problems such as commercial confidentiality be overcome?

6) National Voice

The NHS needs a national voice for PPIH, but what exactly should be expected from such a body? What need would it meet that is not currently being met? Health Watch would certainly have significant bottom-up elements as well as a strong executive, but how should this balance be struck? How would Health Watch, in expressing its views, not oversimplify the various concerns patients have, perhaps in a way that undermines (rather than challenges) Ministerial decision making?

7) Voluntary Sector

Charities, including national and local patient organisations, clearly have a significant role to play in shaping and expressing patient voices. How can the expertise and enthusiasm of organisations be engaged for the benefit of patients and the public? What is the best way of involving third parties nationally (e.g. through a committee or national advisory group) and locally (e.g. through networks and partnership)? What is the most valuable contribution charities have to make to PPIH?

8) Partnership

What weighting should exist between individual volunteers and the organisations engaged in PPIH? How can the expertise and unique perspective of the voluntary sector be used without robbing organisations of their separate status? Is there a trade-off between independence and influence, as some have suggested? Many charitable bodies may be future providers of services, so how can potential conflicts of interest be resolved when it comes to bidding for contracts?

9) Patient/Public?

Overview and scrutiny committees and Health Watch would together express the ‘public’ and the ‘patient’ voices. What relationship should exist between voluntary PPIH and democratic mechanisms for accountability? Health Watch would be independent, but with the power to refer matters to OSCs. Should there be more formal links and shared programmes of work? Which strand of PPIH should take responsibility for bridging the gap between health and social care?

10) Reconfigurations

What powers should Health Watch have to intervene in service reconfigurations? Should there be a requirement on the local NHS to secure the agreement of Health Watch before making significant changes? If so, what level of public and patient opposition to a service reconfiguration should be required for Health Watch to withhold its agreement? If Health Watch does not support a service change, what provisions should there be for the decision to be made by an independent panel?