Changes to Healthwatch and Patient Voice

The new Health Bill proposes major changes to how patient voice and public involvement will work in the NHS in England. The same bill applies to adult social care, moving the function in house.

The Bill would abolish both Healthwatch England and Local Healthwatch organisations. This means Local Authorities would no longer be required by law to commission a Local Healthwatch service.

The Government says the aim is to simplify NHS structures and place responsibility for patient engagement directly within the NHS system. Under the proposals, Integrated Care Boards (ICBs) would become responsible for gathering public feedback about health services, patient experiences, and service improvements.

The Bill introduces new duties requiring:

• The Secretary of State to promote patient involvement in decisions about care and treatment.
• The NHS and ICBs to involve patients and the public when planning or changing services.
• ICBs to seek views about service quality, patient experience, and local health needs.

However, while engagement duties remain, the independent statutory patient voice role currently carried out by Healthwatch would largely disappear.

At present, Local Healthwatch operates independently from the NHS and local commissioners. It has legal powers to:

• Represent patient and public views.
• Challenge NHS organisations.
• Escalate concerns.
• Carry out Enter and View visits.
• Provide independent advocacy and scrutiny.

The proposed replacement arrangements do not create a new independent organisation with equivalent powers. Instead, the NHS system itself would lead patient engagement activity.

This creates both opportunities and risks.

Potential benefits include:

• Simpler structures.
• Reduced duplication.
• Stronger integration between engagement and NHS planning.

Potential concerns include:

• Reduced independent scrutiny of NHS services.
• Loss of a recognised public watchdog role.
• Weaker accountability mechanisms.
• Fewer protections for vulnerable communities whose voices may otherwise go unheard.

The most significant concern for many stakeholders is that the system may move from “independent patient voice” to “NHS-led engagement”, meaning the NHS would largely be responsible for collecting and responding to feedback about its own services.

Although the Bill removes statutory Healthwatch structures, it does not prevent:

• Councils,
• ICBs,
• Voluntary sector organisations,
• Charities,

from commissioning or developing independent patient voice functions voluntarily.

Additional notes in the Bill

A recurring theme in the Bill is the removal or simplification of external oversight structures.

Examples include:

• Abolition of Healthwatch.
• Abolition of NHS England.
• Removal of some consultation and governance requirements.
• Stronger central powers.

Taken together, this suggests a shift toward a more centralised NHS structure with fewer independent bodies.

The replacement consultation duties for ICBs are broader and less prescriptive than the current Healthwatch arrangements.

The Bill says ICBs should obtain views and consider them, but it does not:

• Specify how engagement should happen.
• Guarantee independent challenge.
• Require independent reporting.
• Replicate Enter and View powers.

There may therefore be variability in how meaningful engagement becomes across different systems.

New “Neighbourhood Health Plans”

The Bill replaces existing Joint Health and Wellbeing Strategies with “Neighbourhood Health Plans”.

The positive aspect is that the Bill specifically says local people must be involved in preparing these plans. However:

• There is no independent body identified to support or challenge this engagement.
• Involvement duties are weaker than having an independent statutory patient voice organisation.

Abolition of Integrated Care Partnerships (ICPs)

The Bill abolishes Integrated Care Partnerships and Integrated Care Strategies.

These structures were intended to bring together:

• NHS organisations,
• Councils,
• Voluntary sector partners,
• Communities.

Their removal may reduce formal partnership spaces where community voice and wider determinants of health were discussed.

Increased central control by the Secretary of State

The Bill gives the Secretary of State much stronger powers over Integrated Care Boards (ICBs), including the ability to:

• Direct how ICBs exercise their functions.
• Intervene where performance is considered inadequate.
• Take over functions temporarily.
• Direct leadership changes in some circumstances.

This could significantly reduce local autonomy and may affect how local public concerns influence decision-making.