The development of Local Healthwatch in Kent Part one: key findings

The development of
Local Healthwatch in Kent
Assessing readiness for Local Healthwatch
Part one: key findings

This project was funded by Kent County Council
and the Department of Health.
The project was supported by NHS Kent and Medway.
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Contents
Executive Summary........................................................................................ 4
Introduction and Aims..................................................................................... 6
Methods......................................................................................................... 8
‘Every Decision About Me, With Me’ workshop............................................ 12
Summary of Key Findings............................................................................. 16
Recommendations....................................................................................... 30
Acknowledgements...................................................................................... 40
Part one: key findings 3

Executive summary
This report describes a structured series of interviews, focus groups and
workshops in preparation for the development work to design Kent Local
Healthwatch (K LHW). Researched and written by the Centre for Public
Scrutiny, it provides an independent assessment of the readiness of statutory
and community stakeholders from across Kent to co-produce an effective
local Healthwatch organisation.
At the heart of the report is a description of the participatory workshop
that was held at the end of the process that brought together over 40
stakeholders from across Kent and from across a range of organisations and
roles. Titled ‘Every Decision About Me, With Me’ the workshop introduced
an appreciative inquiry approach to the key questions of what a local
Healthwatch organisation should do and how it should be organised to
achieve this. A series of key messages based on areas of consensus amongst
participants are presented, including:
• Acknowledging the strong interest and enthusiasm for K LHW across
Kent and the desire for it to be a successful and strong champion for local
people
• Highlighting that all parties believe that an informed and independent
organisation will be a powerful driver for effective commissioning and the
provision of quality services
• Building on the learning and experience from LINks
• Recognising that the local aspirations for K LHW and the new roles it will
play mean that different organisational forms and processes will need to be
considered
• Identifying the new skills and competencies staff and volunteers will need to
make K LHW effective
• Placing a commitment to engaging and involving diverse and seldom heard
groups from across Kent at the centre of how K LHW is developed and
how it works at a practical level
• Developing public and stakeholder credibility for K LHW by developing clear
roles and support for staff and volunteers
• Taking a whole system approach to the success of local K LHW and
recognising the role that all partner organisations including commissioners
and decision makers will play in this
• Ensuring that K LHW pays significant attention to social care and the
integration of services in Kent as well as to healthcare
• The importance of co-producing K LHW in a way that demonstrates and
models best practice that will be taken forward by the organisation
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

A range of suggestions and practical proposals have been collected about the
essential local elements for an effective K LHW:
• Ways to work across the scope and diversity of the county
• Tools and creative approaches for working with different stakeholder groups
• Possible organisational models and governance approaches
• Examples of the competencies, skills and knowledge that staff and
volunteers in K LHW are going to need and ways to support this by
harnessing existing training programmes in Kent
• Insights from seldom heard groups and ways to overcome exclusion
• Building on what is already working well in Kent in terms of engagement
activities across health, social care and the community and voluntary sector
• Approaches to communication
• Methods of collecting and aligning data and information about public views
with the work and timelines of commissioners and decision makers
• Aligning K LHW with health and social care structures to maximise influence
• Advice on how K LHW can form effective working relationships with
statutory bodies such as the Health and Wellbeing Board, Overview and
Scrutiny Committees and Clinical Commissioning Groups
• Identifying potential barriers and challenges and the strategies for
overcoming them
The report is divided into two parts. Part one ( this document) describes
the aims and methods used by the assessment and then offers a summary
of the key findings from the workshops, focus groups and interviews.
Recommendations are then provided to guide further development work
based on a consensus of views about what needs to happen next.
Part two compiles the data from the contributions of all the participants
and provides more detailed information about their thoughts, opinions and
perspectives. Contributions are honest and direct but were always offered
with the commitment to promote a collaborative approach to K LHW in Kent
based on reflection, learning and insight.
Kent is well placed to begin the transition to K LHW and has strong
commitment from a wide variety of stakeholders to ensure the process
is successful. The participation that has been achieved by the statement
of readiness assessment provides the foundations to maintain close
relationships during the co-production phase and continue the practical work
of turning local peoples’ vision into reality.
Part one: key findings 5

Introduction and aims
A local Healthwatch for Kent will be established in October 2012 subject
to the successful passage of the Health and Social Care Bill 1 . It will be the
independent consumer champion across Kent to promote better outcomes in
health and social care. The organisation will have a number of key functions
including acting as a point of contact for individuals, community groups and
voluntary organisations. It will promote the views of local people to influence
commissioning and will have a seat on the Health and Wellbeing Board
where key decisions will be taken. K LHW will gather views and experiences
of people using services in Kent to influence national health and social care
services through Healthwatch England (HWE).
As part of the transition from LINks to K LHW this report describes a
statement of readiness assessment to capture the views and insights of a
wide range of stakeholders to inform the development process.
The project is sponsored by Kent County Council and the Department of
Health, and supported by NHS Kent and Medway. It has been designed and
delivered by the Centre for Public Scrutiny. The Centre is an independent
charity that is recognised as a leader for promoting transparent, inclusive
and accountable healthcare and social care and for co-ordinating practical
national and local support to embed these principles in the implementation
of the health reforms. The Centre for Public Scrutiny has experience
of supporting the development of LINks across England and brings an
independent perspective to the statement of readiness. It has recently
published research on the development of Healthwatch titled ‘Smoothing the
Way: Developing local HealthWatch through lessons from Local Involvement
Networks’ (2011).
The assessment is designed to support Kent County Council’s role as set
out in the Health and Social Care Bill for local authorities to commission
arrangements for local Healthwatch organisations in partnership with local
stakeholders. The statement of readiness report describes the readiness of all
statutory and other stakeholders in Kent and is informed by exploring four key
questions:
• What should local K LHW do?
• What kind of organisation does K LHW need to be?
• What environment needs to be created for K LHW to flourish?
• What commissioning and procurement process will secure effective and
efficient K LHW arrangements?
1 As at November 2011 the Health and Social Care Bill was subject to Parliamentary approval
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

The assessment has engaged a wider variety of individuals and groups
including:
• Executive councillors and senior officers in Kent County Council
• Councillors on Overview and Scrutiny Committees
• Social care commissioners and providers
• Healthcare commissioners and providers
• NHS and social care patient and public engagement staff
• LINk members, governors and host staff
• Patients, carers and advocacy groups
• Voluntary, community and civil society organisations
• Representatives and experts working with seldom heard groups
A full list of participants is included in part two of the report.
The project took place against the backdrop of the public consultation about
‘Allocation Options For Distribution Of Additional Funding To Local Authorities
For Local Healthwatch, NHS Complaints Advocacy, PCT Deprivation Of
Liberty Safeguards’ which will be reporting later in the year. At the same time
the Health and Social Care Bill will be starting the process of being scrutinised
by the House of Lords and may be subject to changes and amendments as
the Parliamentary process continues.
Aims
The aims of the statement of readiness are:
• To explore levels of understanding, skills and capacity at individual,
corporate and community levels in relation to the development of K LHW
• To make recommendations to the Local Healthwatch Development Group
(LHWDG) for future action on the basis of evidence of readiness gathered
through the project.
Part one: key findings 7

Methods
Stage One: Developing an overall structure
Following consultation with the multi-stakeholder Kent Local Healthwatch
Development Group the project team captured a full range of possible areas
and questions relevant to the assessment. It was apparent from an early
stage that the topic of K LHW generated a lot of queries and issues for local
people and organisations and it was important to be able to place a structure
around these. It was also clear that key terms such as ‘information’ and
‘choice’ had different interpretations for people so it was essential to have a
method that would enable participants to share their understanding and vision
for what K LHW meant to them. This was written up as an assessment format
for the project and through an iterative process new issues and questions
were added. The format ensured that important issues could be held in
one place and addressed as the project developed. 11 broad themes were
identified from this work:
1. Vision for K LHW
2. LINks experience and learning relevant to the transition to K LHW
3. Function 1 of K LHW: a consumer champion
4. Function 2 of K LHW: information and signposting to support choice
5. Function 3 of K LHW: complaint advocacy services
6. Collecting intelligence and working with HWE
7. Alignment with partners – relationships, data and processes
8. Organisational form
9. Operational issues
10. Development
11. Commissioning and procurement
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

These themes formed the basis of key lines of enquiry and a range of
indicative questions were developed for each theme which could be used for
the design of the participation tools that would explore the themes in greater
depth with different stakeholders.
‘Representativeness’ was felt to be a crucial over-arching issue for all aspects of
Healthwatch. Therefore it was integrated into all themes to embed the issues of
diversity and inclusion rather than treating them separately. Identified questions
in each theme meant that ‘representativeness’ could be explored in context.
The assessment format tool is included in part two of the report along with
the ground rules of participation in the process.
Stage Two: Designing participation tools
Participation tools were designed based on the assessment format.
These were:
• Semi-structured interviews with senior staff from different stakeholder
organisations including LINks, the PCT cluster, the Local Authority
• Themed focus group discussions
• Solution focused workshops
Each interview and focus group prioritised a small selection of seven or eight
key questions from the wider assessment format that were felt to be relevant
to specific audiences. Responses from participants were then grouped
against the 11 themes.
Advisers from the Centre for Public Scrutiny also participated in a half-day
workshop on K LHW set up by LINks to capture the views of LINks members
and governors.
A set of participant ground rules was developed to outline the process and
how the information from the participation tools would be used.
To compliment the direct participation tools an opportunity was provided for
interested parties to also contribute thoughts and opinions by email.
Part one: key findings 9

Stage Three: Delivering the interviews and focus groups
During August and September 2011 the Centre for Public Scrutiny ran a
series of interviews with 18 individuals.
This was followed up by a series of four themed focus groups on the following
perspectives:
• Clinical Commissioning Groups
• Members of the public not part of LINks
• Community and voluntary sector
• Gypsy and Traveller community in Kent
Outputs from these pieces of work were written up and used to inform further
engagement with stakeholders as key themes emerged.
Stage Four: Reflecting on findings through
a participatory workshop
The learning from the interviews and focus groups was used to design a
one-day workshop for stakeholders to explore key themes from the work
so far and to prioritise issues for the future development of K LHW. Over 40
individuals attended the workshop representing a wide variety of groups, roles
and agencies.
The purpose of the workshop was to begin the process of jointly designing
aspects of K LHW. The day was called ‘Every Decision About Me, with Me’
illustrating the appreciative approach used. Four sessions focused on key
themes which had emerged from the interviews and focus groups.
Participants were individually invited to ensure there was a mix of people
who would relate to K LHW from all perspectives. For example there were
people from user groups, carers, people who might be part of K LHW,
council officers and politicians who might be involved in commissioning or
sitting on boards where K LHW will participate and others. Each workshop
provided an opportunity for dialogue. Using pre-drafted future or aspiration
statements, participants developed a shared sense of how they wanted K
LHW to operate. Some participants suggested areas they felt needed to be
developed in order to create the agreed future. Other participants joined them
in breakout groups to do some detailed work on the identified area. These
were written up and key points fed back.
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Stage Five: Reporting
The final statement of readiness report was produced by the Centre for
Public Scrutiny outlining the contributions and learning from all participants
and providing an assessment for the development of K LHW and
recommendations for the next six months.
The report is structured in two parts. The first part (this document) provides
a description of the aims and methods and then provides a summary of key
findings from the workshop and from the wider engagement with participants.
A series of recommendations are then listed that draw on the areas of
consensus and insight that have emerged. Part two of the report provides
the more in-depth data and evidence from the interviews, focus groups and
workshop.
Part one: key findings 11

Every Decision About Me, With Me:
Insights from the workshop
The day comprised of four sessions, two taking place simultaneously in the
morning and afternoon with over 40 invited participants who came from a
wide range of groups that have a stake in the future K LHW. The focus of
each session was identified from key issues which had emerged from the
interviews and focus groups. They were:
• Competent and skilled K LHW
• K LHW is hearing everyone; seldom heard groups a thing of the past
• Wow! My story makes a difference!
• K LHW an essential player at the table; a flourishing organisation with a vital
contribution to health and social care planning
Each session looked at a draft aspirational statement. These statements
described how K LHW might work at its best. Groups were asked to use the
statement to reach agreement about what they would jointly like to create in
relation to the workshop focus. Participants then identified areas they would
like to develop to establish this desired future. These areas became the focus
for breakout groups which other participants joined.
The focus of the breakout groups are given below for each session as well as
the key actions the whole workshop group agreed at the end of the session.
More detailed notes in relation to the future statements and breakout groups are
available as part of the wider dataset from this work (part two of the report).
Competent and skilled Kent Local Healthwatch
Breakout Groups:
• Develop Governance and Models, Roles & Responsibilities
• Clinicians and Clinical Commissioning Groups (CCGs) understand K LHW
and K LHW understands CCGs and clinicians
• Communication - accessibility and awareness
• Skills and Training
Key themes from the breakout sessions were:
• ‘A time of flux. A time of innovation and opportunity’.
• Maintain ongoing and open channels of communication and conversation
throughout and beyond the transition process; different stakeholder
and provider perspectives may result in different perceptions and
understanding.
• The process and purpose are defined and clear.
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

• A free-flow of information to enable K LHW to hold service providers to
account.
• Start connecting roles with functions now so that there is clarity about what
skills and experience are required to demonstrate capacity to deliver.
• Unique selling points of K LHW, CCG and other providers need to dovetail
/jigsaw with a complete understanding of what each provider contributes
to the richness of delivery; this should be clearly communicated to the local
community.
• K LHW builds on skills and competencies where they already exist and
develops a framework based on the new LHW functions described in the
Bill so that local capacity can be developed where necessary.
• Develop a communications strategy to raise awareness and accessibility of
K LHW now.
Kent Local Healthwatch is hearing everyone:
seldom heard groups a thing of the past
Breakout Groups:
• Set up and recruit to K LHW
• K LHW enables people to know that their ideas and suggestions are
seriously considered, and are told of the outcome
• Methods of engaging with seldom heard groups
• Define and engage with different seldom heard groups
Key themes from the breakout sessions were:
• LINk/Healthwatch to be more representative
• Value groups we want to involve – thank you/effective feedback
• Value volunteers – say thank you and give feedback
• The mission statement – K LHW will be modern and flexible
• Map existing information
• Innovative approaches e.g. develop a Healthwatch party tool, community
ambassadors
• Ensure that appropriate transition mechanisms are in place
• Information is up to date and communicated well
• Keep, encourage existing volunteers
Part one: key findings 13

Wow! My story makes a difference!
Breakout Groups:
• Co-operative Culture
• Making changes for small groups – ‘how can their stories be heard?’
• How to turn ‘stories’ into a real change for the better
Key themes from the breakout sessions were:
• People understand how the healthcare and social care systems work
and how to access them
• K LHW helps make the systems understandable to others
• Turn stories into something better. There may be things to learn from PALs
about ways to use stories more powerfully
• NHS Choices is very health specific; it could link up with organisations to
make them more accountable. There was a concern that LHW would not
be able to advertise NHS Choices
• Look at the journey and use what is working well, break down barriers
• We need a more co-operative culture; many voices are better than one.
Involving people at a local level can be a route for publicity and information.
A culture where people can ask for information, oppose changes they do
not want, promote effective spending
• Nominated liaison person to work with small groups – increase knowledge
background of groups and ensure small group’s confidence increased by
being heard
• Change the mindset of those involved in budgeting
• K LHW involved at every level of decision making. Information into
commissioning questionnaire - information from the right place to the right place
Kent Local Healthwatch an essential player at the table;
a flourishing organisation with a vital contribution to
health and social care planning
Breakout Groups:
• Kent County Council provides a clear statement of service requirements for
tendering based on the three functions, outcomes and impact.
• Well commissioned, well lead, well supported, well connected, well
informed, well integrated.
• Equality of outcomes and representation or being representative –
representative of user groups or an organisation.
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Key themes from the breakout sessions were:
• A dedicated Healthwatch R& D unit, called a Local Healthwatch
Observatory, separate from day to day running:
1. Analysing and sharing information,
2. Collating evidence from other sources,
3. Shaping services in outcome information, speaking with authority, not
just one voice, collating to enable people to make an informed choice,
seen as a credible organisation.
• Transparent criteria for commissioning and decommissioning. Robust terms
of reference, safety around K LHW’s independence e.g. if local authority
doesn’t like it.
• Commissioners are clear the K LHW is providing a service to health and
social care users.
• An asset is using and improving what is out there e.g. PALS, LINk. What
works well in the community? Parity of service e.g. currently services
offered in East and West Kent differ?
• Equity of outcomes: service specifications which ensure responsiveness
and equity, regularly monitoring service outcomes and impacts –
development benchmarking.
Part one: key findings 15

Summary of Key Findings
Detailed contributions from participants are provided in part two of the report.
This section provides a broad overview of the key findings and messages
from stakeholders.
Vision for a successful K LHW
Participants demonstrated a good general awareness of the proposals for
Healthwatch at local and national level. Many identified the need for more
detailed briefings on the content of the policy documents emerging from the
Department of Health and all wished to be kept up to date on the progress of
the K LHW.
Many participants commented on the value of the statement of readiness
process. They found that opportunities to participate in the interviews, groups
and workshops provided a reflective space to explore their own views and
positions on Healthwatch in more depth. Several participants commented that
engaging in a structured exercise helped to provide a focus to their emerging
views on K LHW. This opportunity enabled them to value the experience,
strengths and assets already available in Kent and to have a voice early on in
the process of developing K LHW before key decisions are finalised.
Healthwatch is welcomed by the vast majority of participants both in its local
and national forms. It is seen as a positive development of existing patient,
public and service user engagement work across Kent. Four aspects of the
Healthwatch proposals are particularly welcomed by participants:
• The vision of ‘no decision about me, without me’
• The concept of a consumer champion
• The focus on the needs and voice of diverse and different groups across
the community
• The ability to coordinate data on public experiences and opinions and
present it in an informed way
Participants were able to contribute many different elements to a vision
for what a successful K LHW looks like. Part two of the report lists these
elements in full. Most issues were complimentary to a wider vision and often
described similar themes in different language or from different perspectives.
The key areas of consensus for the vision were:
• K LHW must champion the service user and patient perspective in a
constructive way. It must be their voice and be an effective advocate for
their interests
• K LHW will need to be credible with three groups - the wider public, people
who use its services and with organisational stakeholders (in particular
commissioners and decision makers)
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

• All parties welcome informed challenge from the patient and service user
perspective
• It will need to be able to work with and champion diverse groups from
across Kent
• K LHW will need to be visible and accessible through clear communication
and effective branding
• It will need to be able to establish sophisticated and robust relationships
with commissioners and decision makers based on mutual respect and an
appreciation of the different roles that each stakeholder plays
• K LHW will need to work in a transparent and open way
• It will need to be able to demonstrate and evidence it’s impact on health
and social care services
For some participants their vision of K LHW focused on what it might prevent,
often citing the example of Mid-Staffordshire Hospital and the need for a
strong patient voice when things start to go wrong. They had a particular
concern with issues of patient safety and welcomed the potential of K LHW
to scrutinise and highlight concerns.
The credibility of K LHW was an important concern for many participants. If
K LHW was not credible then participants felt that its effectiveness would be
limited. Credibility would need to be established early on in the design stages.
The key features of a credible K LHW were:
• Independence
• Good governance
• The quality of relationships it is able to develop with commissioners,
decision makers and providers
• A skilled and competent team of staff and volunteers
• The ability to present a range of views and voices of local people
• An understanding of the health and social care commissioning processes
and decision making timetables
• The ability to present data and findings in an effective and influential way
• Accessibility to patients, service users and the public across Kent
• Clarity of communications with the public and stakeholders
• Transparency of internal processes, prioritisation, decision making and
impact
• Seeking and responding to feedback on the development and work of
K LHW
Part one: key findings 17

Things that were likely to damage the credibility of K LHW included:
• A narrow focus on single issues
• Being dominated by personal issues or agendas
• A lack of evidence
• Weak or distant relationships with commissioners and decision makers
• Failure to follow up or feedback on work
• Unrepresentativeness
• Tokenism
Participants were able to identify a range of barriers that would need to be
overcome to ensure K LHW is successful. Themes included:
• How local people may perceive K LHW in relation to previous health and
social care engagement initiatives such as LINks and Community Health
Councils. They may have particular associations with these groups and
may question the longevity of this new organisation
• The complexity of the health and social care systems
• The challenge of working at a local level across a county with the scale and
complexity of Kent
• The pace of change
Local expectations for K LHW are high amongst informed stakeholders.
They recognise that the transition to K LHW provides an opportunity to stop
and reflect on learning around public engagement and apply this to the new
organisation. It is important that the development process and the early
months of K LHW activity delivers concrete evidence of the potential of the
local organisation. Clear communications and definitions of role, purpose and
priorities are essential to properly manage expectations.
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Evolving from LINks
Participants’ contributions about LINks were varied and there was less
consensus about the key messages than for other elements of the ‘statement
of readiness’ assessment. Differences of opinion were often based on the
relationship a respondent had with LINks including their experience and
background knowledge of working together. Perspectives also varied based
on participants’ role within LINks itself.
Key areas of consensus were:
• An appreciation of the learning, experience and knowledge that LINks has
collected
• Building on this experience to ensure K LHW is effective
• Valuing the contributions of volunteers, members, governors and staff
• The importance of ensuring that the transition from LINks to K LHW is in
the best interests of local people
• Recognising the uncertainty for LINks volunteers and staff and ensuring
they have a voice and support during the transition
As LINks has developed and applied what it has learnt to the latest phase of
its work plan a number of positive themes have emerged:
• Finding new ways to work across Kent at the local, ward, district and
county levels
• Working in partnership with the Patient Participation Groups linked to GP
surgeries
• Building new relationships with GPs
• New initiatives to promote transparency within LINks including the setting of
priorities
• Developing the engagement of children and young people
LINks volunteers and host staff have been active in their support for
the ‘statement of readiness’ assessment and have provided significant
contributions, insight and practical support. It is important to recognise that
the transition from LINks to K LHW does represent an ending for this part of
peoples’ lives and also introduces uncertainty for the future. Research by the
Centre for Public Scrutiny identifies that a well managed transition to K LHW
is the best strategy to ensure that good volunteers are not lost to the process.
However, there were areas of difference about LINks and these emerge in
some of the data presented in part two of the report. This learning is valuable
as it articulates some of the challenges that public engagement initiatives face
and highlights learning that will need to be incorporated into the development
of K LHW. There was a general consensus that K LHW would build on the
Part one: key findings 19

learning from LINks and seek to overcome some the barriers to successful
public engagement in new ways. Key themes included:
• The limits to which LINks has been able to be representative of different
groups in Kent and to involve them directly in it’s work
• Limits to the general awareness of the role of LINks across Kent
• The need to strengthen relationships with commissioners
• The perception of a greater focus by LINks on health rather than social care
• The importance of providing feedback on LINks activities and their impact
• Ways to prioritise work in a transparent way
• Internal decision making processes
Most participants in the statement of readiness assessment felt that whilst K
LHW will build on the LINks experience it will be a different organisation with a
broader range of functions and as a consequence will draw on a wider set of
tools and methods.
Healthwatch as a consumer champion
The shift to the consumer model was welcomed by the majority of
participants as it complimented the commissioning perspective in health
and social care. There was a recognition that commissioners were spending
the money of local Kent people and that the public should be empowered
to be more aware of how this was taking place. There was also a universal
view that an informed consumer voice was in the best interests of effective
commissioning and that it could enhance the commissioning process with
intelligence from those receiving services from providers.
To be an effective consumer champion K LHW will need to:
• Identify and build relationships with consumers
• Recognise the diverse and different needs of people in Kent
• Provide mechanisms for them to share their views and experiences
• Provide them with clear and relevant information
• Coordinate individual consumers to enable them to act as a group and
have a collective influence
• Present their views and collective experiences in an effective way
• Be present and observe practice and performance in provider organisations
• Be representative in terms of the staff and volunteers involved directly in the
work of Healthwatch
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

K LHW will need to use a mix of communication methods to reach the public.
These include:
• Face to face
• Workshops
• Telephone
• Traditional mass media
• Web based communication
• Social media
The title of ‘Healthwatch’ has been well received and participants felt that the
branding was helpful in explaining the purpose of the organisation. An important
point was made by many participants that there would need to be a clear
distinction between this new initiative and the current Kent Health Watch.
As an effective consumer champion, K LHW will need to focus on:
• Quality of services
• Co-design and co-production of services
• Monitoring and evaluation of services
• Transparency of the commissioning process
• Accessibility of services
• Risk and patient safety
K LHW will need to understand where decisions are made within health and
social care organisations and ensure that it can promote local voices at these
distinct points. A mapping of decision making processes and timetables
would enable K LHW to coordinate its engagement activities.
Social care issues were very important to all participants and they wanted to
see a clear strategy from K LHW to address them. There was a recognition of
the tendency for health issues to take priority and it was important to balance
this in the design phase.
K LHW should be an advocate and driver for the integration of health and
social care issues. Working from the patients perspective K LHW will be well
placed to highlight the ways that services can be connected and provided in a
seamless way. For professionals working across health and social care there
was a strong desire to have a consumer champion who could drive this issue
and provide informed challenge to commissioners. There was a concern that
K LHW may replicate existing silos in the health and social care system and it
is important that this is recognised and avoided.
Part one: key findings 21

All participants shared an aspiration for K LHW to be effective in the way
it works with diverse groups in Kent. It was important that K LHW takes a
proactive approach to identifying groups it will engage, identifying the barriers
they face and developing concrete and specific strategies to overcome these.
K LHW should be able to evidence how it works with seldom heard groups
from across Kent.
Part two of the report captures a wide range of different groups that have
been proposed and championed by participants. A number of principles
emerged in discussions about how to identify and prioritise these groups:
• Data should be used from the Joint Strategic Needs Assessment and other
sources
• Data should be triangulated with insight from local community and voluntary
groups who have direct contact with groups
• Individuals stories and experiences are essential to inform the engagement
strategy
• It is important to recognise that some groups may be located in small parts
of Kent whilst others may be distributed across the county
• Health inequality data should be linked to equality and diversity data
• Where there are already existing networks for these groups across Kent K
LHW should make strategic contact with the network coordinators – for
example in the case of learning disability and cancer networks
• Different engagement strategies are needed with different groups
Participants provided many insights and local knowledge about diverse and
seldom heard groups in Kent. Data in part two of the report provides a long
list of groups but it is recognised that it is still not exhaustive and K LHW will
need to be constantly questioning itself and challenging assumptions about
diversity in Kent. The most frequently mentioned groups for K LHW to identify
and engage were:
• Children and young people
• Older people living in residential and nursing homes
• Older people with dementia and their carers
• Gypsy and Traveller community
• Young people with mental health needs
• People with learning disabilities
• Rural populations
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

It was felt that a proper understanding of all the diverse groups in Kent should
inform K LHW’s engagement strategy. Working in partnership with specialist
community and voluntary sector groups was identified as an essential way for
K LHW to reach all the different groups in Kent. They will need a varied set of
approaches as one approach will not suit all groups and will cause barriers to
engagement for some. Therefore K LHW will need to develop or adapt tools
to work with and get feedback on their success in this area.
K LHW should be held to account by Kent CC as ‘commissioner’ for its
impact in this area. To be credible K LHW needs to demonstrate a wide
participation of diverse groups.
There was a general view that people living in residential and nursing homes
were particularly vulnerable and unable to access other forms of service user
engagement in the community. K LHW would need to find ways to build
relationships with this group in their residential settings to champion their needs.
LINks work with young people has started to identify some key issues when
working with these groups:
• The importance of directly involving children and young people
• The experience that many health services are designed primarily with adult
patients in mind
• Understanding what makes a ‘young person friendly’ service
• Learning from young people initiatives, networks and groups across Kent
There also emerged from the participation work a sense that health and social
care consumers in Kent have at least four dimensions to their experience and
that K LHW would need to be able to work at each of these levels. These
dimensions were:
• The diversity and identity of individuals and their families – recognising that
people often have a number of different identity characteristics including
factors such as gender, ethnicity, sexuality and disability
• The local community where they live – which would also include the rural
and urban differences
• The services and providers that they access – which may be located in different
parts of Kent from where they live or may even be across county boundaries
• The health and social care conditions they may share with other individuals
in Kent – for example, long term conditions, being a cancer patient, carer
roles or having a young child
Participants identified opportunities for K LHW to support the personalisation
agenda by raising awareness and supporting individuals to become active
consumers.
Part one: key findings 23

Information and signposting to support choice
K LHW should review and learn from existing signposting and information
resources from other organisations in Kent and beyond. It is particularly
important to engage and involve staff from PALS, customer services and
complaints roles. The information function is seen as a professional role that
cannot be effectively delivered by volunteers. There may be opportunities for
volunteers to support professionals but there are limits to what they can be
expected to manage.
K LHW needs to be able to work with commissioners to identify the options
and opportunities for consumer choice so that it can signpost effectively.
Possible areas that participants identified where K LHW may support the
public to make choices include:
• Choice of GP practice
• Choice of nursing or residential home
• Choice of hospital for elective surgery
• Choice of support group
• Maternity choices
The quality of the information function is seen as central to the credibility of
K LHW and needs to be managed in a robust way with a clear identification
of risks.
As well as providing information to individual patients and service users,
K LHW would also be well placed to communicate general health and social
care information across Kent. It could be a powerful conduit for public
information and for awareness raising. Information could be adapted by
K LHW to ensure that it reaches diverse groups.
Complaints Advocacy
Complaints advocacy is seen as an integral part of a successful K LHW.
All participants were in favour of this option being actively pursued. There
were important debates about the definition of complaints advocacy and the
distinction with the wider complaints function. It was felt very important that
the role was clearly defined and communicated.
Data from the complaints advocacy function should be integrated into the
other data and insights that K LHW will collect. Triangulation of data and
patient experience was seen as a principle benefit of K LHW.
Kent already has a number of complaints functions located in Primary Care
Trusts, the County Council and providers. It is important that these functions
are properly mapped and understood. A number of advocacy functions exist
24
The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

and K LHW will need to collaborate with these and avoid duplication. The
work of ICAS should provide good learning opportunities.
Intelligence and Healthwatch England
The role of HWE is welcomed and participants felt it was essential that K LHW
was able to provide the detailed data and trends that the national body will
need to have an effective consumer voice at the national level. It was clear
that much more work is required to ensure K LHW can work in a mutually
complementary way with HWE going forward.
Many participants were concerned that the wider Healthwatch system should
be able to operate as an early warning system for when things go wrong for
patients and service users. Frequent references were given to ensuring that
the system was robust enough to respond to serious problems such as at
Mid-Staffordshire Hospital. Collating patient stories and experiences at the
local level would be essential to highlighting problems.
Alignment with partners: relationships, data and
processes
Participants felt it was essential that the development of K LHW took a whole
system approach and aligned its form and function to both the community
and stakeholder organisations in health and social care.
Key organisations identified by participants included:
• Health commissioners including the Primary Care Trust cluster and Clinical
Commissioning Groups
• Social care commissioners
• The shadow Health and Wellbeing Board
• Overview and Scrutiny Committees for health and for social care
• Provider organisations in the public, private and voluntary sector
• Community and voluntary organisations
There was also a recognition that the health and social care environment is
complex and in the process of change. The developing K LHW would need to
be able to understand this dynamic environment, build effective relationships
at both a senior and operational level, and be flexible enough to respond to
changes and developments. Many examples and insights have been provided
for how K LHW can align its data and reporting to have impact and influence
with stakeholders.
Part one: key findings 25

At the same time all participants felt that K LHW would need the skills and
insight to understand commissioner and provider data to be able to analyse
it and make informed challenge. This would also include an understanding of
the methodologies used to collect data.
There was a strong recognition from commissioners that an effective K LHW
would enhance their ability to commission, co-produce new services, decommission
where appropriate and monitor performance and quality.
Social care and health commissioners are well placed to use their
procurement and contracting roles to ensure that collaborations with K LHW
are built in to contracts with providers.
It was identified that further work needs to be undertaken with provider
organisations that so far have not been a full part of the statement of
readiness exercise. This could be taken up by the K LHW Development Group
in the next phase of its work programme.
Organisational form
Three organisational forms have emerged from participants as contenders for the
structure of K LHW as a ‘body corporate’. These would benefit from more detailed
exploration and development in the next phase of the development process.
From the ‘Every Decision About Me, With Me’ workshop a proposal for a
distributed model of K LHW where the functions of the body are embedded
in existing organisations across a range of themes, issues and seldom heard
groups in Kent. This could be achieved by locating K LHW champions in
organisations and networking them via a core body. Existing models of
practice such as the experience of Citizens Advice Bureaux may provide a
template for exploring this model.
A second form is a consortia model of a smaller group of local organisations
with differing specialisms to deliver K LHW across the county.
The third form is the more traditional hub and spoke model. This model
would have a single organisation at the centre that provides the coordination
of all the K LHW functions and also provides the governance role. The core
would then work with separate specialist units of the organisation for the
delivery of different K LHW functions.
Participants recognised that it would be very difficult for one single
organisation to have all the skillsets and specialisms required to deliver K LHW
on their own. It was also felt that one single organisation was unlikely to be
well placed to engage with the variety of seldom heard groups in Kent. It was
also felt very strongly that K LHW should work in a highly coordinated way
with organisations that already deliver similar functions rather than replicating
these functions or competing with other organisations. The latter was felt to
26
The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

e a risk as local people may get confused about where to go for information
and signposting.
Different proposals also emerged from the work regarding the legal form for
the body corporate including charities, incorporated charities, community
interest companies and social enterprises.
Operational Issues
As participants explored the operational issues for K LHW they were able
to offer a variety of insights into the range of issues that would need to be
considered including:
• Governance of the ‘body corporate’
• Accountability to commissioners of K LHW
• Management structures
• Roles of paid staff
• Roles of volunteers
• Status of members
• Relationships with affiliated organisations
• Internal policies and procedures
• Partnerships with other Healthwatch organisations
• Selection process of people in governance positions
• Representativeness
Learning from the experience of LINks and the Host organisation is important
for understanding the role and challenges of operating a public engagement
organisation in health and social care. Participants felt that the most important
starting point for developing an operational framework was to define roles,
competencies, skills and knowledge required of staff, volunteers and members.
Part one: key findings 27

Development
Participants were keen to see significant attention given to the development
programme for K LHW and felt that supporting staff and volunteers to have a
structured programme was essential to the success of the initiative. They also
recognised that development was a two-way process and that stakeholder
organisations would benefit from engaging with K LHW in an organised
programme. Participants were generous in offering their support and time as
well as access to in-house training opportunities.
A whole system programme of induction for K LHW is essential to build
relationships and raise awareness of the new body. A more detailed training and
development programme should compliment and build on the induction phase.
Participants felt that the development programme should be linked to work
on the roles and competencies required for K LHW and should be available to
staff and volunteers.
Commissioning and procurement
The commissioning and procurement process for K LHW should be managed
on the principles of co-production, informed by the following factors:
• The K LHW ‘body corporate’ will need to be well placed to coordinate any
distributed delivery of functions. It will need a clear central governance
structure to ensure accountability and clarity of role and functions.
• Different organisations may have the specialisms to deliver specific parts
of the Healthwatch brief.
• Local organisations are well placed to provide evidence, understanding
and insight into the needs of local communities and seldom heard groups.
• The need to align commissioning goals to the needs and interests of
health and social care consumers across Kent.
• The importance of identifying the types of evidence that commissioners
would need to measure the effectiveness of K LHW.
Participants welcomed the need for the commissioner to ensure that K LHW
could demonstrate and evidence its work with diverse and seldom heard
groups. This role should be strongly emphasised in the contract.
Some participants felt that it was too early on in the process to give concrete
views on the actual procurement process other than at the most general levels.
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Debates
During the statement of readiness assessment stakeholders were able to
articulate a number of debates and areas of potential tension within the
Healthwatch proposals. It was recognised that these issues would be
an inevitable part of any transition to a new organisation and that it was
healthy to identify and explore the themes in anticipation of any possible
disagreements. Participants felt that collaborative working at an early stage in
the development of K LHW could provide some joint solutions to these issues
or practical ways to respect and hold these tensions. The debates included:
• The accountability of K LHW to both it’s commissioner and to local people
in Kent alongside HWE.
• The dual relationship between K LHW and Kent County Council. K LHW
will be commissioned by Kent County Council and will also be working with
the authority to champion the voices of local people who use social care
services. In this role K LHW will be examining decisions and plans of Kent
County Council.
• The role of Kent County Council as the lead partner in the co-production of
K LHW as a new organisation and the process of how aspects of LINks will
evolve into K LHW.
• The role of K LHW on the Health and Wellbeing Board as both a champion
for local people’s voices and as a partner in strategic decisions that may
have unpopular consequences.
• The need for K LHW to represent the consumer voice and intelligence from
signposting and advocacy work across Kent when diverse groups may
have different views and priorities.
Part one: key findings 29

Recommendations
The following series of recommendations is based on the synthesis of
contributions from participants. The key forum for considering and managing
these recommendations should be the Local Healthwatch Development
Group established in June 2011. Each recommendation is followed by a
suggestion for the lead agency to deliver the proposal.
Involving stakeholders
1. All participants in the statement of readiness process should receive
a copy of the report and be invited to offer further comments and
reflections. These contributions should be incorporated into the work
of the Local Healthwatch Development Group. Suggested lead: Kent
County Council
2. All participants should form the core of a database of interested
parties in the development of K LHW. They should be kept informed
of progress and provided with further opportunities to engage in the
development of plans. The core database should be expanded to
include a wider group of stakeholders, services users and patients
and a communication plan developed. Suggested lead: Kent County
Council
3. A timeline for the development of K LHW should be developed and
shared with stakeholders. Suggested lead: NHS Kent and Medway
4. The commitment and interest amongst stakeholders highlighted by
the statement of readiness process should be used to continue to
take a whole system approach to the development of K LHW over the
next six months. The Local Healthwatch Development Group should
consider the use of toolkits from appreciative inquiry and ‘strengths
based approaches’ to inform its work. Suggested lead: All parties
5. LINks and other stakeholders including Patient Participation Groups
and CVS organisations should be invited to continue to collect and
share stories from patients and service users about their experiences
and what K LHW could mean to them. The stories will give further
insight about what an effective K LHW should do and how it would
help local people. The stories should be collated and used to inform
the co-production of K LHW. Suggested lead: LINks
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Healthwatch Development
6. The Local Healthwatch Development Group is well placed to lead the
multi-stakeholder development of K LHW in the county. All development
activities should be coordinated through this body to ensure consistency
of approach and clear communication with the public. The small core
group should consider ways to involve a wider group of stakeholders
and participants in regular development sessions and themed
workshops. Suggested lead: NHS Kent and Medway
7. The core group should use the statement of readiness report to review
its terms of reference and core membership. Task and finish groups
should be considered as a way to deliver the detail of the work plan.
Suggested lead: NHS Kent and Medway
8. Based on the data in this report, the Local Healthwatch Development
Group should develop and share a written vision statement for K LHW.
The vision statement could be linked to stories and case studies that
could provide examples of how K LHW will work in practice. The vision
statement should demonstrate how K LHW will be a credible and
effective organisation. Suggested lead: All parties
9. The development plan for K LHW should explicitly address ways to
promote the vision statement in practice and mitigate the risks and
barriers to success identified by participants in this report. The plan will
need to include a realistic assessment of available resources and ways
to provide appropriate project management. Suggested lead: Kent
County Council
10. The Healthwatch Transition Plan and Pathfinder work should be
aligned with the work of the Local Healthwatch Development Group
to ensure that efforts are coordinated and that learning and local
knowledge is embedded in the development of K LHW. It is important
that LINks volunteers and host staff continue to participate in the next
stages of the transition and are provided with clear information and
support. Suggested lead: LINks
11. Learning and experience from LINks and the host organisation should
continue to inform the development of K LHW. LINks should be invited
to provide a series of case studies about their impact and provide an
analysis of the key factors that have underpinned their successes and
the challenges and barriers they have faced. Evidence and advice
should also be invited from other organisations with specialist skills
including PALS and ICAS. Suggested lead: LINks
Part one: key findings 31

Organisational models
12. Building on the work of the vision statements and contributions
from the statement of readiness assessment, the Local Healthwatch
Development Group should create a local outcomes framework to
provide a high level overview of what K LHW should aim to achieve
and how it will measure this. Suggested lead: Kent County Council
13. The Local Healthwatch Development Group should co-produce
more detailed models of options for the organisational form of K
LHW. The Development Group should recognise the work already
completed during the ‘Every Decision About Me, With Me’ workshop
in September 2011 – in particular the development of the distributed
model put forward by participants. They should involve a wider group
of stakeholders through their networks in this process. The process
of co-producing these models will enable the Development Group to
capture the contributions of stakeholders and identify strengths and
weaknesses of each model. Support from a procurement specialist will
be essential to advise on supply side issues and explore opportunities
for pre-tendering exercises. Suggested lead: Kent County Council
14. Once the models have been developed, the Local Healthwatch
Development Group should facilitate a structured review process
of the models and explore them in terms of the procurement model
for K LHW. The models should be assessed on a number of factors
identified by participants in the statement of readiness:
• Ability to deliver the local vision of K LHW as set out in the vision
statement
• Credibility with the public
• Credibility with commissioners and decision makers
• Ability to work effectively with diverse and seldom heard groups
• Ability to work across the geographical area of Kent
• Ability to effectively collect, collate and present data on local voice
and experience
• Flexibility to align with the changing health and social care
environment in Kent
• The potential for clear and transparent governance
• Deliverability within organisational and financial boundaries
• Avoidance of unnecessary replication of existing initiatives and
projects Suggested lead: Kent County Council
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

15. In parallel with the development of the organisational models, the
governance needs of K LHW should be mapped. Consideration
should be given to the Centre for Public Scrutiny finding in wider
research about LINks that a lack of clarity around governance can
lead to uncertainty at the expense of delivering a work programme.
Governance development should cover:
• Legal duties and accountabilities
• Accountability to the Kent public
• Accountability to the commissioner of K LHW
• Internal roles and accountabilities
• Decision making and prioritisation systems
• Participation of diverse groups in governance
• Means of assurance
• Transparency and efficiency
• Responsibilities to the membership
• Code of conduct
• Conflict resolution Suggested lead: Kent County Council
16. The development of the information and signposting function should
involve individuals and organisations who already have expertise of
this role in Kent. It will be important to understand the nature and
frequency of existing requests for these services. It is also important to
identify best practice and potential barriers to overcome in designing a
successful service. Suggested lead: NHS Kent and Medway
Setting up
17. A clear set of summaries of the competencies, roles, skills and
knowledge for K LHW staff and volunteers should be developed and
shared. These should be based on the issues identified by participants
in the statement of readiness process and captured in part two of the
report. Suggested lead: NHS Kent and Medway
18. The development of K LHW should be based on a clear mapping
exercise of the key partners and organisations it will need to work with
to be effective. This mapping exercise should inform the development
of the organisational form of K LHW based on the functions it needs to
fulfil. As a minimum the mapping should address:
Part one: key findings 33

• Patient and service user groups
• Carers groups
• Community groups
• Commissioners in health and social care
• Clinical Commissioning Groups
• Shadow Health and Wellbeing Board
• Overview and Scrutiny Committees for health and for social care
• Providers
• Public health services
• Locality and district partnerships
• Community and voluntary sector groups
• Community champions
• PALS, complaints and other information and signposting
professionals Suggested lead: Kent County Council
19. The design of K LHW should be based on an appreciation of the
existing engagement work that is already taking place across Kent to
engage and support patients and service users. The development of
K LHW should seek to avoid duplication and address any concerns or
tensions that existing organisations, networks and projects may have
about its development. Suggested lead: NHS Kent and Medway
20. An assessment should be made of the opportunities and possibilities
to embed K LHW functions in key local areas of delivery identified by
participants. There is an emerging list of opportunities described in
more detail in the report. Consideration should include:
• Children’s Centres
• Kent County Council Information Gateways
• Patient Participation Group networks
• Pan-Kent patient and service user networks
• Community and voluntary sector organisations working with
seldom heard groups
• Gypsy and Traveller support services
• Colleges and Universities
• Existing advocacy services in Kent Suggested lead: Kent County
Council
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

21. It is important to recognise the scale and complexity of Kent. K LHW
will need to learn from the work of LINks and other participation
initiatives to engage people at the local, district, county levels as
well as in terms of their crosscutting health and social care needs.
Suggested lead: Kent County Council
Induction, training and development
22. A whole system induction programme should be mapped for K LHW
based on the opportunities and offers made by participants in the
statement of readiness work. This induction programme should have
four aims:
• To enable K LHW to understand the roles and functions of the
different agencies and bodies in the wider health and social care
environment in Kent
• To build relationships between K LHW and key leaders in
commissioning, decision-making, provider and scrutiny
organisations
• To raise awareness of K LHW
• To enable K LHW to ‘hit the ground running’ once it is formed and
quickly build strong and effective collaborations Suggested lead:
NHS Kent and Medway
23. A more in-depth training and development programme should be
developed for K LHW staff and volunteers to compliment the induction
process. The programme should cover the range of issues and needs
identified by participants in the statement of readiness process. It
should avoid replication of development efforts by drawing on the
existing training available in house through Kent health and social
care organisations and others which have been offered to K LHW by
participants in the statement of readiness process. The training and
development programme should be tailored to the needs and learning
styles of participants and recognition given to making the programme
accessible to seldom heard groups. Suggested lead: NHS Kent and
Medway
Part one: key findings 35

Working across the new landscape
24. Development work should be supported between the shadow Health
and Wellbeing Board and K LHW to develop a shared vision for their
partnership and the terms of engagement. Consideration should be
given to running a simulation or role play exercise for members of both
shadow groups to explore ways to work together effectively and to
identify strategies to overcome any potential barriers or challenges.
Suggested lead: Kent County Council
25. Similar work should be explored with the Overview and Scrutiny
Committees for health and for social care. Suggested lead: Kent
County Council
26. The Local Healthwatch Development Group should seek to work with
Dover District shadow Health and Wellbeing Board to promote their
participation in the development of K LHW and identify any specific
issues for how the two bodies will work together. Of particular interest
will be the management of health and social care issues that crosscut
the district and county levels. Suggested lead: Kent County Council
27. Commissioners, the shadow Health and Wellbeing Board and other
decision makers should be invited and supported to identify a set of K
LHW friendly processes and behaviours to enable them to contribute
to the environment in which K LHW can flourish. Suggested lead:
NHS Kent and Medway
28. The social care role of K LHW should be given as much priority as the
health role in the development of K LHW structures, training and plans.
Social care issues need to be embedded in K LHW from the start and
training provided to both K LHW and social care commissioners to
raise awareness of this purpose of the organisation. Suggested lead:
Kent County Council
29. K LHW should reflect on potential opportunities to champion the
integration of health and social care services in Kent. The development
and induction of K LHW should assess opportunities to promote
integration. K LHW’s own internal processes should avoid replicating
health and social care silos and provide internal challenge to support
an integrated vision. Suggested lead: Kent County Council
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The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Inclusion
30. A written strategy for engaging diverse groups across Kent should be
developed. Identification of groups should be based on the collation
of existing community mapping exercises and county level data such
as the Joint Strategic Needs Assessment. It will also be important
to identify groups that have not already been included in this work.
Evidence based engagement strategies should be developed to meet
the specific needs of different groups with a clear appreciation of the
barriers and challenges they face. K LHW should work in partnership
with the local groups and networks that support these communities
already. The contributions of participants to the statement of readiness
should be used as a starting point for the identification of seldom
heard groups. Suggested lead: NHS Kent and Medway
31. Where possible K LHW should seek direct access to the knowledge
and expertise of members of diverse and seldom heard groups and
their organisations to inform K LHW strategy and practical work.
These groups should be directly included in the co-design of plans.
For example, Kent citizens living in residential and nursing homes are
one group identified by the report. Suggested lead: NHS Kent and
Medway
Complaints Advocacy
32. It is essential to clearly distinguish between independent complaints
advocacy and the complaints functions that will remain embedded
within commissioning and providing organisations. A clear definition
of complaints advocacy needs to be agreed by local stakeholders and
used as the basis for the development of these advocacy activities.
Suggested lead: Kent County Council
Healthwatch Observatory
33. Explore the possibility of a sub-regional Healthwatch Observatory
to coordinate information and data on patient and service user
choice to support the local information and signposting role for local
Healthwatch organisations. The purpose of the Observatory would
be to provide a locus for expert skills in the collation, analysis and
presentation of patient and service user data to support K LHW. It
would also apply these skills to analysing and giving insight to data
and information produced by commissioners and providers. By sharing
the resource between a number of Local Healthwatch organisations
Part one: key findings 37

across a sub-region it will be possible to pool expertise in an efficient
and informed way and recruit the appropriately skilled staff for this
specialised role. Other options should also be explored for the delivery
of this function. Suggested lead: NHS Kent and Medway
34. To enable K LHW to be able to collate and present its findings and
the consumer voice effectively to commissioners and decision makers
some initial work should be commenced to explore the format and
reporting tools that it could use. Stakeholders from public health, the
shadow Health and Wellbeing Board, commissioner and provider
organisations, overview and scrutiny and Clinical Commissioning
Groups should be invited to co-design an outline methodology and
format with the Local Healthwatch Development Group. It is also
important to identify the reporting expectations of HWE and the Care
Quality Commission in this work. Suggested lead: NHS Kent and
Medway
Using this report
35. The statement of readiness report should be used as a tool to engage
and begin an informed discussion with provider organisations in
Kent about the role and functions of K LHW. Suggested lead: Kent
County Council
36. The Assessment Format for Healthwatch developed as part of the
statement of readiness project and included in part two of this report
should continue to be used to inform the development process. It is
important to recognise that the Assessment Format is not a static
document and new questions and areas should be added to it as
the work progresses. The Assessment Format could also be used
to review progress on the development of K LHW in six months time.
Suggested lead: Kent County Council
37. The report and methodology is intended to provide a ‘live’ case study
for the Department of Health. It is anticipated that the issues raised in
this report can inform and support LHW development in other areas.
Tools developed for this process can be accessed via the Department
of Health and Care Quality Commission channels for broader use. All
partners in Kent, and in particular the Local Healthwatch Development
Group, should be encouraged to share their learning with the wider
development of local Healthwatch across England. Suggested lead:
NHS Kent and Medway
38
The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

38. Ensure the video of the ‘Every Decision About Me, With Me’
workshop is shared widely with stakeholders in Kent and those with
a Healthwatch development role elsewhere in England. The video is
designed to be a learning and development tool. Host the video on
appropriate websites to ensure it is accessible. Suggested lead: NHS
Kent and Medway
Part one: key findings 39

Acknowledgements
The K LHW Statement of Readiness project has been funded by Kent County
Council and the Department of Health. The project is supported by NHS Kent
and Medway. It has been led locally by Lorraine Denoris, Director of Citizen
Engagement and Communications, NHS Kent and Medway and coordinated
by Tish Gailey, Health Policy Manager, Kent County Council.
Three expert advisers from the Centre for Public Scrutiny formed an
independent team to design and deliver the participative research activities
and produce this report. They are Paul Cutler, Judith Emanuel and Sally
Brearley. The Centre for Public Scrutiny is an independent charity (registered
number 1136243).
The project was actively supported by the Kent LINks and their host Kent and
Medway Networks Ltd. Particular support was provided by Brenda O’Neill
and Richard Beckwith.
The project was also supported by members of the Kent Local Healthwatch
Development Group.
The project team wishes to thank the following individuals for their support
and contributions to the project:
Ann Sutton, Chief Executive, Kent and Medway PCT Cluster
Colin Tomson, Chair, Kent and Medway PCT Cluster Board
Councillor Roger Gough, Kent County Council Cabinet Member for Health
Reform
Councillor Graham Gibbens, Kent County Council Cabinet Member for
Public Health
Sarah Andrews, Director of Nursing, Kent and Medway PCT Cluster
Carol Cassam, Associate Director Nursing & Quality (East) and Lead for
Safety and Patient Experience
Cathi Sacco, Director of Strategic Commissioning for Families and Social
Care (Interim), Kent County Council
Kent and Medway PCT Cluster Non Executive Directors
Anne Tidmarsh, Director of Older People and Physical Disability, Kent County
Council
Dr Meradin Peachy, Director of Public Health, Kent County Council
Councillor Jenny Whittle, Kent County Council Cabinet Member for
Specialist Children’s Services
Liz Coleman, Head of Customer Services, Kent and Medway PCT
Councillor Nick Chard, Chair of Kent County Council Health Overview and
Scrutiny Committee
40
The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

Julie Van Ruyckevelt, West Kent Primary Care Trust
Members of the Clinical Commissioning Groups across Kent
Representatives of the Community and Voluntary Sector across Kent
Members of the Health Matters Reference Group
And finally thank you and acknowledgement to all those who participated in
the Every Decision About Me, With Me workshop and in the interviews and
focus groups.
Part one: key findings 41

42
The development of Local Healthwatch in Kent: assessing readiness for Local Healthwatch

The Centre for Public Scrutiny
Local Government House
Smith Square
London SW1P 3HZ
Tel 044 (0)20 7187 7362
www.cfps.org.uk
CfPS is a registered charity no 1136243
November 2011
L11-656