Healthwatch Friend or Foe?Managers’ Quality Networking Forum

Sue Baknak, Engagement Manager

Sarah Bailey, Enter & View and Volunteer Co-ordinator

Wednesday 23rd September 2015

What is Engaging Communities (ECS)

Evidence and Insight

Community Engagement

Information and Signposting

Complaints Advocacy

Independent Persons Panel for Children’s Social Care Complaints

ECS Services

What is Healthwatch?

QUIZ!

What is Healthwatch?A national and local consumer champion to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided

• An independent body with Statutory Functions

• Set up by the Health and Social Care Act 2012 and made up of

• Healthwatch England (influences national policy and guidance and provides leadership, guidance and support to local Healthwatch

• Local Healthwatch

What is the purpose of Healthwatch Staffordshire?

• Place on the Health & Wellbeing Board

• Enable local people to share views and concerns

• Alert Healthwatch England, Care Quality Commission or OFSTED to concerns about health and social care services

• Provide people with information about choices and what to do when things go wrong

• Signpost people to information about local health and care services and how to access them

• Feedback to organisations responsible for commissioning or delivering local health and social care services

What is Enter and View?

Legislation

Health and Social Care Act 2012: Part 5, Public Involvement and Local Government

Established through legislation under Part 6, Section 4 of the NHS Bodies and Local Authorities (Partnership

Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulation 2013

The Local Authorities (Public Health Functions and Entry to premises by Local Healthwatch Representatives)

Regulations 2013 (SI 2013/351)

What is Enter and View? Enter and View is the opportunity for Authorised Representatives:

• To go into health and social care premises to hear and see how the consumer experiences the service

• To collect the views of service users (patients and residents) at the point of service delivery

• To collect the views of carers and relatives of service users

• To observe the nature and quality of services - observation involving all the senses

• To collate evidence-based feedback

• To report to providers, CQC, Local Authority and NHS commissioners and quality assurers, Healthwatch England and any other relevant partners

• To develop insights and recommendations across multiple visits to inform strategic decision making at local and national levels.

Your Turn….Where do you think Enter and View applies

Exclusions: where do you think Enter and View does not apply

Where does Enter and View Apply?Guiding principle: where health and social care is funded from the

public purse.

Legislation allows Enter and View activity to be undertaken with regard

to the following organisations or persons:

• NHS Trusts

• NHS Foundation Trusts

• Local Authorities

• A person providing primary medical services (GPs)

• A person providing primary dental services (Dentists)

• A person providing ophthalmic services (opticians)

• A person providing pharmaceutical services (community pharmacists)

• A person who owns or controls premises where ophthalmic and pharmaceutical services are provided

• Bodies or institutions which are contracted by Local Authorities or the NHS to provide health or care services (e.g. adult social care homes and day care centres)

Exclusions: where Enter and view does not does not apply The duty to allow entry does not apply in the following circumstances:

• If the visit compromises either the effective provision of a service or the privacy of a service or the privacy or dignity of any person

• If the premises where the care is being provided is a person’s own home

• Where the part(s) of premises are used solely as accommodation for employees

• Where the premises are non-communal parts of care homes

• Where health and social care services are not provided at the premises (such as offices) or where they are not being provided at the time of the visit (when facilities are closed)

• If, in the opinion of the provider of the service being visited, the authorised representative, in seeking to enter and view its premises, is not acting reasonably and proportionately

• If the authorised representative does not provide evidence that they are authorised

• The duty does not apply to the observing of any activities which relate to the social care services to children

Key Benefits of Enter and View

To encourage, support, recommend and influence service improvement by:

• Capturing and reflecting the views of service users who often go unheard, e.g. care home residents

• Offering service users an independent, trusted party (lay person) with whom they feel comfortable sharing experiences

• Engaging carers and relatives • Identifying and sharing ‘best practice’, e.g. activities that work well• Keeping ‘quality of life’ matters firmly on the agenda• Encouraging providers to engage with local Healthwatch as a ‘critical friend’, outside

of formal inspection• Gathering evidence at the point of service delivery, to add to a wider understanding of

how services are delivered to local people• Supporting the local Healthwatch remit to help ensure that the views and feedback

from service users and carers play an integral part in local commissioning• Spreading-the-word about local Healthwatch.

An inspection

• Other parties – especially the provider – may well think of ‘Enter and View’ as an inspection

• We need to work with all parties to dispel this myth

• One of the key strengths is that enter and view offers is a layperson’s perspective (e.g. like the 15 Step Challenge), rather than in-depth training in formal inspection methodology

A standalone activity

• ‘Enter and View’ is just one tool available to local Healthwatch for collecting evidence for a defined purpose

• Authorised Representatives’ role is to work with other organisations and bodies to bring about service improvement

Not a last resort nor a first choice option

•‘Enter and View’ is planned, with a clear purpose

Enter and View is not.....

Who can carry out Enter and View• Only Authorised Representatives (AR) with this specific remit

• Only for the purpose of carrying out the activities of Healthwatch Staffordshire

• ARs will be identified through Healthwatch Staffordshire’s recruitment, selection and training processes

• ARs will be required to undergo a DBS Check

• A ‘nominated person’ from Healthwatch Staffordshire must consider, and be satisfied by the DBS certificate

• Healthwatch Staffordshire must make publicly available a list of all ARs

The duty to allow entry does not apply if: • The visit compromises effective provision of services or the privacy/

dignity of any person

• The Authorised Representative is not acting reasonably or proportionately in seeking to enter and view the premises

• The Authorised Representative does not provide the evidence that they are authorised to view services in accordance with the Regulations

Purpose of the Enter and View VisitThe purpose of the Enter and View Visit will fit into 3 areas of activity:

1. To contribute to a wider local Healthwatch programme of work

2. To look at a single issue across a number of premises

3. To respond to local intelligence at a single premises

Your Turn…What ‘purposes’ would

prompt an enter and view visit

to be conducted?

Examples of an Enter and View Purpose • A local Healthwatch is undertaking an engagement exercise to

understand the experience of individuals with dementia and their carers, as consumers of health and social services. In addition to engaging with carers forums, carrying out surveys and working with local dementia support groups, there is a clear purpose of enter and view to engage with those individuals and carers in a care home setting.

• To engage with residents in 10 care homes, to identify good practice in providing choice of food

• To respond to a number of contacts received from members of the public regarding insensitive communication by care home workers at a specific care home.

The Benefits of a Clear Purpose of a visit

• A clear purpose for a visit leads to clear decisions about who should visit, when, using what process

•Providers will be more accepting of a visit if they understand its purpose

•A purpose should not be over-ambitious

•Involving other organisations, when specialist knowledge may be required to help clarify the purpose, can be useful, e.g. other health and social care voluntary organisations (Approach – dementia care)

•A clear purpose leads to effective reporting

Enter and View Visit…. The Authorised Representatives will look at the following areas: • External physical environment• Internal physical environment• Observe the delivery of services – environment and culture• Patient or Resident feedback on their experience(s) of

services• Feedback from carers and relatives• Feedback from staff• Overall Lasting Impressions

Reporting Recommendations Recommendations need to be:

• Clearly stated • Primarily related to purpose • Self-evident from findings • Proportionate• Achievable• Small in number – for maximum impact and focus

Below are a couple of examples of possible recommendations:1. The findings indicate that not all hot meals are reaching the resident at the correct

temperature. We recommend a review of your procedures to ensure that all residents get their meal at the right temperature and inform us of the actions taken.

2. The report has highlighted excellent practice regarding the quality of your meal service and we recommend that with your approval we share this good practice.

Service Improvements

• Enter and View is a valuable tool for collecting evidence, especially capturing the voice of service users, carers and families

• Visit reports should be shared to maximise their effectiveness• In isolation ‘Enter and View’ activity may only accomplish small

scale changes• Large scale changes will require the combined influence of a range

of health and social care organisations and statutory bodies, as well as local Healthwatch, including:

• Regulators – such as the Care Quality Commission (CQC)• Commissioners – such as Local Authority commissioners, Clinical

Commissioning Groups (CCGs) and NHS England• Planners – such as the Health & Wellbeing Board and local scrutiny

Service ImprovementsThe sum of all evidence across multiple local Healthwatchactivities and multiple organisations should:

• Persuade providers to implement change• Contribute to short, medium and long term planning and commissioning• Influence national policy through escalation to Healthwatch England and/or through analysis of trends by Healthwatch England

Strategic partners with whom local Healthwatch should work to achieve service improvements

Organisations and statutory bodies with whom local Healthwatch should work to’ achieve service improvements

.

Regulation Delivery

Commissioning Planning

local Healthwatch

Safeguarding

Commissioningand QualityAssurance

CareQuality

Commission

Serviceproviders

Safeguarding AdultsBoard

ClinicalCommissioning

Group/s

Overview& ScrutinyCommittee

Health andWellbeing

Board

Local AuthorityAdult Services

Local healthand social carevoluntary sector

HealthwatchEngland

Visit planning, reports and

recommendationsWide-ranging

concernsVisit planning, concerns and

reports

Visit planning and recommendations

Significant concerns and

recommendations

Strategic needs and

plans

Advice and strategic

views

Significant concerns and needs, and

reports

Safeguarding concerns

Significant concerns and

needs, and reports

NHS England

Significant concerns and needs, and

reports

Quality Surveillance

Significant concerns and

needs, and reports

Public Health

Strategic needs and

plans

Local Education

& Training Boards

Strategic needs and plans

Quote from Highfield Court:  “Both Representatives were very professional and knowledgeable about what was expected from the service. They talked openly with the managers and appeared very friendly towards the service users. They were very interested in what the service users and staff had to say. Staff at Highfield Hall will endeavour to always act in the service users best interests. Recommendations are noted and we will continue to maintain and improve services where required. All aspects of the visit worked well and all areas covered in a very open and honest review.”

Service Provider Feedback

Any Questions?