I, along with many others, am awaiting the production of the Health Reform Bill which will introduce the new legislation required to carry forward the abolition of Healthwatch. Hopefully it will also bring greater clarity about the proposed arrangements for ensuring that Patient Voice and Patient Experience will continue to impact upon the decision-making processes in the commissioning and provision of health and care services in the future.
We have recently been informed of the intention that the Bill will be introduced in April 2026 with a view to gaining Royal Assent in April 2027. This would then be followed by a short transition period of a few weeks until the new arrangements take effect.
The case for retaining Healthwatch as an independent patient champion has been made a number of times and I will not repeat that case here. Healthwatch was established precisely because of the risks involved in asking providers and commissioners to effectively “mark their own homework”. I hope there will be risk management strategy so that the gains that have been made, particularly with those patients and service users who are most frequently ignored, will not be lost in the turmoil of restructuring
There are many major risks. Community concerns that are currently being gathered and articulated by Healthwatch may go unaddressed. In turn this may lead to a loss of meaningful Patient Engagement, a dampening of Patient Voice and decreased trust in services. My fear is that the absence of a trusted independent voice will see engagement reduced to a box ticking exercise by services under severe pressure.
I have never believed that NHS and Care staff do not want to listen to patients. It is just that meaningful engagement is a messy, potentially time-consuming process and there is real tension between the demands of effective engagement and the tight transformation timetables that are so often imposed on local providers. I suspect that the way in which that tension is addressed will determine whether any engagement is going to have a real impact.
The loss of an independent voice and insights may also compromise the ability of health and care systems to address the issues of health inequalities and health equity. This particularly applies to those groups whose needs are not properly known and who feel most frequently ignored. Without these community driven insights, it may be difficult to design services that meet the needs and to properly evaluate the impact of policy and practice on all local communities
There will, no doubt, continue to be many examples of engagement across the system – some of it may be very good. My fear is that the overall impact might feel disjointed, leading to a scenario where the whole is less than the sum of its parts. The effect on policy, practice and culture may end up being cumulative. There could be a risk of duplication, inconsistency and silo-based practices which may hinder the development cohesive engagement strategies and practice.
My priority over the next year or so will be to keep raising these and other risks and to work with the ICBs, Local Authorities and VCFSE sector to explore ways in which they can be addressed. At the end of the day I am convinced that we all have the same objectives, to ensure that the voice and lived experiences of patients and service users continue to have real impact on the design, provision and review of health and care services. To ensure that health inequalities and inequities are addressed and that the voices of those who are most frequently ignored are heard and impactful.
That is our task. Let us set to it.
Chris Bain 