The Health Bill Committee - What are we saying?

A key argument put forward for abolition is that the current system is crowded, with too many organisations involved in patient voice and safety. Reform is being presented as a way to reduce duplication and simplify structures. However, local Healthwatch services are delivered by independent community-based organisations, distinct from national bodies and accountable to the communities they serve. Locally, patient voice is not fragmented. Each local Healthwatch covers a defined area, is rooted in its community and has its priorities set by that community. Local Healthwatch is the only statutory service with a specific role to seek out people’s experiences of health and care services, on their terms,  to share what it hears with NHS bodies and local authorities, and make recommendations for improvement.

What is fragmented is not the public voice, but the way the system listens to it.

Local Healthwatch also provides information and advice to help people navigate complex health and care services often across multiple needs. No other local body has this role, and the Bill does not create a replacement. Splitting Healthwatch functions between Integrated Care Boards and local authorities could make the system harder, not easier, for people to understand.

Another argument is that Healthwatch produces too many reports and recommendations, without enough evidence of impact. But if recommendations are not acted on, the issue is not that they were made, it is that the system has not listened and acted. Around 20,000 local Healthwatch reports nationally over 13 years equates to roughly 10 reports per local authority area each year, covering a wide range of services including GP practices, hospitals, care homes, dentistry, dementia support and carers’ services. This is not an overwhelming volume for any one organisation.

In many cases, local Healthwatch works with providers to co-produce practical recommendations based on what people using services have said. Where change does not follow, the problem is more likely to be a lack of action and accountability rather than too much public feedback.

It has also been suggested that patient feedback does not influence decisions because organisations such as Healthwatch sit too far from decision-makers. In reality, local Healthwatch is already embedded in local decision-making structures, including Integrated Care Boards, Health and Wellbeing Boards, subcommittees, strategy groups and working groups. Often, it is the only voice in the room focused solely on the experiences of patients, carers and people using services.

Having an independent public voice does not stop decisions being made. Defensive cultures, siloed working and inconsistent responses to feedback do.

The proposal to move patient voice functions into Integrated Care Boards and local authorities is being presented as a way to improve coordination and ownership. But it also creates a clear conflict of interest. If the system becomes responsible for both providing services and assessing how people experience them, there is a risk that challenging and difficult feedback is diluted, dismissed or deprioritised. 

This matters for public trust, particularly for people who already face barriers to being heard and who may rely on independent support to raise concerns about health and social care.