Finance and oversight of Local Healthwatch
Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch, while requiring the latter to account to it for its stewardship of the money. Transparent respect for the independence of Local Healthwatch should not be allowed to inhibit a responsible local authority – or Healthwatch England as appropriate – intervening.
- Healthwatch England has reported concerns about the adequacy and consistency of Local Healthwatch funding across different local authority areas. In its 2023-24 annual report, Healthwatch England noted that Local Healthwatch budgets vary significantly between local authority areas and that funding has declined in real terms since 2013, affecting the capacity of some Local Healthwatch organisations to fulfil their statutory functions (Healthwatch England Annual Report 2023-24).
- The government's response to the Francis Report in "Hard Truths" (Cm 8777, November 2013) stated that local authorities are responsible for ensuring their Local Healthwatch is adequately resourced but did not require ring-fencing of the central funding allocation. The government stated it would monitor the adequacy of Local Healthwatch funding through Healthwatch England (Hard Truths, DHSC, November 2013).
- Local authorities are subject to the "best value" duty under the Local Government Act 1999, which requires them to secure continuous improvement in the way they exercise their functions, having regard to economy, efficiency, and effectiveness. This provides a general accountability mechanism but does not specifically protect Local Healthwatch budgets from reductions in local authority spending (Local Government Act 1999).
How was this evidence gathered?
Response
Accepted in Part
Response
Accepted in PartThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.