Councils up and down the country will be commissioning local Healthwatch organisations. If it’s not too late, I’d like to suggest they think about alternatives to the tendering route. Local Healthwatch is to be the new champion of patients, carers, social care clients and the public. They are to replace the Local Involvement Networks (LINks). They are to be the means of ensuring the voice of local communities is heard when it comes to commissioning, changing and improving health and social care. Councils need to contract with organisations to fulfil this function. The organisations have to be social enterprises – not for profit, working in the local interest and able to employ staff. The Department of Health has said that councils can do this through ‘grant-in-aid’ or by tendering for the activities [1]. It seems to me that there are some good arguments for choosing the grant-in-aid route. The first is a point of principle. I don’t think we should be thinking of Healthwatch as a service to be purchased. We should think of it as part of the democratic process [2]. It should be inclusive: owned and controlled by as many local organisations and individuals as can be persuaded to become involved. They can come together through an appropriate organisational vehicle (such as a Community Interest Company). I accept, though, that not everyone agrees on such limits to markets. There are other practical reasons for choosing not to issue a tender for the function. The tendering route may be chosen as the safer option. It seems to be transparent and open (at least to those able to bid) so that no-one can complain that they were excluded. It may even create some pressure to keep costs down. And the more that authorities see others going down this route, the more likely they are to follow – safety in numbers. However, the grant-in-aid route can be just as open and transparent. It may exclude some organisations from outside the area, but it could be set up to be open to all residents and voluntary organisations locally. In contrast, there are many practical arguments against contracting:
A part of the role of local Healthwatch is to hold the local council, along with other providers, to account. For that, it needs as much independence as possible within an arrangement where the council contracts and funds it. The grant-in-aid route at least allows for a more arms length relationship with light touch monitoring and evaluation [3]. This is not about looking for a ‘cosy relationship’ with the Council or trying to avoid the difficulties of competition. On the contrary, Healthwatch needs to be able to hold the Council, along with other providers, to account, without fear or favour. Whatever happens, there will be continuing financial pressure on the fledgling Healthwatch organisations and the need to make the limited funding stretch as far as possible. Any council has the right to go down the tendering route, but they should consider carefully their decision. It is treating Healthwatch as ‘service provision’ rather than ‘community representation’. It is promoting division rather than unity. It introduces costs and delay of doubtful benefit. Far better to encourage and support a unified, inclusive, locally based movement, bringing the whole community together to truly represent the voice of local people.
Footnotes:
[1] Letter from David Behan, to Chief Executives and others, 2nd March 2012, http://healthandcare.dh.gov.uk/files/2012/03/behan-letter.pdf
[2] The idea that there are some areas where markets are not appropriate is set out in Michael Sandel’s book, ‘What Money Can’t Buy’ (http://www.guardian.co.uk/books/2012/may/17/what-money-cant-buy-michael-sandel-review). I intend to get it as soon as it’s out in paperback!
[3] Source, National Audit Office, http://www.nao.org.uk/sectors/third_sector/successful_commissioning/toolkit_home/sourcing_providers/what_about_grant-in-aid.aspx
