FINDINGS FROM HEALTHWATCH BUDGET RESEARCH
- There were significant differences in the value of Local Healthwatch contract when we compared former English regions between 2008/2009 - 2013/2014.
A 77% increase in contract values in London and a 68% increase in South Central and South East, whilst at the other end of the scale there was a tiny 2% increase in contract values in Yorkshire and Humberside and just 15% in the North East. Eighteen local authorities were not able clearly or fully answer our questions, but we are still extracting some of the incomplete data. We have not adjusted the figures for inflation but will do so in a future report.
- There are 23 LHWs where the local authority’s budget for Local Healthwatch is lower than for the comparable LINk budget for 2008/9 (Table 2). Eight of these were in London, and three of these had been LHW Pathfinders. There were 6 other pathfinders across the country that had suffered budget cuts.
- It is particularly disappointing that LHW Pathfinders, which had led the way in the development of LHW should have suffered such severe budget cuts.
- The most severe cuts were in Manchester (72%), North Yorks (47%), Hackney (40%), Newcastle upon Tyne (40%), Durham (39%) and South Tyneside (36%).
- The 40% budget cut in Hackney since 2008-9 has been explained by Hackney Council as follows:
The text from Cabinet report stated: Only indicative figures are available from central Government for potential Local Healthwatch funding. No confirmed figures are expected until December 2012. It is proposed for 2013/14 and 14/15 to continue with the current allocation process which is £50,000 in the base budget for Healthwatch Hackney to undertake the functions set out in paragraph 3.6. There will be an additional £150,000 set aside in a specific reserve over the 2 financial years 2013/14 and 2014/15 to be allocated to Healthwatch Hackney by the commissioning Corporate Director as required throughout 2013/14 and 2014/15, in liaison with the Corporate Director of Finance & Resources. I am pretty confident the full amount will be allocated.
This would appear to be a major challenge to the independence of Hackney Healthwatch. Thus, the body being monitored is withholding the budget of the monitoring organisation until it decides to allocate the money!
6. The massive budget cuts in Manchester, North Yorkshire and Newcastle affect some of the most deprived parts of England. The 19% budget cut in Staffordshire is surprising in view of the tragic history of Mid Staffordshire Hospital and the recommendations of the Francis Report.
7. Local authority retentions are equivalent to the difference between the local authorities allocated Local Healthwatch (LHW) budget and the contract price agreed with the LHW contractor.
8. Retentions by local authorities are often difficult accurately to assess, because funds are sometimes retained for contract monitoring (for LINks this was about 10%) and sometimes for other purposes, e.g retaining a part of the budget pending a review of effectiveness – the ‘Hackney model’.
This latter approach formally removes the independence of LHW, as LHW is expected to operate in a way that meets the expectation of one of the bodies that the LHW is expected to monitor.
9. The number of retentions were particularly high in London (15/33) South Central/East (11/18) and North West (11/23), whereas the number of retentions were low East Midlands 0/9 and East of England 2/11. The actual amounts retained varied enormously Durham (128,741), Kent (100,000), Southampton (87,382), Birmingham (73,000) and Oxfordshire(69,096), retaining amounts that would be enough to provide up to 5 additional members of staff for the LHW. The £14,000 retention from the tiny Isles of Scilly LHW was the most surprising (out of a budget of £66,185) and compared badly with Liverpool £14,376 (out of £510,218).
10 Fifteen local authorities told us that they had made a retention of funds, but did not disclose the actual amounts.
11 The good news is that 86 local authorities reported that they did not retain any funds from their LHW budget for their own contract monitoring activities. This data may need closer scrutiny as the use of non-ring fenced ‘formula funding’ can sometimes create confusion over budget headings.
12 Contract duration data showed that 76 out of 151 LHW have contracts for 2 years and 49 for three years. Four LHW had contracts for more than 3 years and 17 local authorities contracted for a one year contract. Six local authorities could not tell us the length of the contract. Very short contracts create insecurity and uncertainty and lead to a focus on short term targets rather than genuine development goals that meet the needs of local people and lead to the creation of powerful LHW, that can hold health and social care commissioners and providers to account.
13 Most local authorities (128) did not deduct VAT from the payment they made to the Local Healthwatch contracter. But it is worrying that 14 local authorities have deducted 20% of value of the Local Healthwatch contract for VAT and that 7 local authorities did not know the answer to the question.