The future of patient voice: learning from the Healthwatch model
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This project has been jointly funded by Healthwatch England and The King’s Fund. However, this output has been independently developed and written by The King’s Fund.
Background
Since 2013, Healthwatch has operated nationally and locally to gather the views of people using the health and care system in England. Its primary role has been to support improvements to services by reporting people’s experiences, which it has done by working with communities across England, collecting feedback on health and care services, and sharing this information with government bodies and local systems to inform policy and service development.
On 27 June 2025, the government announced plans to close Healthwatch England and the network of 153 local Healthwatch organisations. In line with recommendations from the Dash review of patient safety, the government plans to transfer the strategic functions of Healthwatch England to the Department of Health and Social Care (DHSC), and the statutory functions of local Healthwatch organisations to NHS integrated care boards (ICBs) on health care and local authorities for views on adult social care.
In light of these planned changes, this research explores what can be learned from the Healthwatch model, including what has worked well, what the challenges have been and how this can inform the government’s planned changes to how patient and service user experiences are collected and used. The King’s Fund reviewed existing evidence, conducted interviews and carried out two workshops with local and national stakeholders.
What did we learn from our research?
Healthwatch’s independence has ensured it’s been seen as credible by communities and allowed scrutiny of issues the health and care system may overlook. Independence from government and services has enabled local Healthwatch and Healthwatch England to provide objective, impartial and trusted advice and guidance to help people navigate the health and social care system and understand their rights.
The ‘hub and spoke’ structure, which successfully combined local reach with national influence, allowing insight from communities to shape policy debates. Strong local relationships – especially with people less likely to engage with statutory bodies and those affected by health inequalities – were also key to the model’s strength.
Healthwatch has also collected significant volumes of qualitative and quantitative feedback since it was first set up, including unsolicited insight not always captured elsewhere. This has helped the health and care system capture emerging issues that mattered to patients, service users and local communities, and helped place issues such as NHS admin failures and access to GP and dentistry higher on the national policy agenda.
However, because of its limited statutory powers and policy levers to directly drive change, Healthwatch had a limited ability to move from insight to action: it could report on issues but could not hold the health and care system to account for addressing them. Some participants also noted that the large volume of Healthwatch reports and recommendations could at times leave the health and care providers and commissioners unsure where to focus or how to respond.
Local Healthwatch did not, at times, feel like ‘equal partners’ in the face of better resourced parts of the system. This became more pronounced with the move from clinical commissioning groups to integrated care boards (ICBs).
While these dynamics were exacerbated by the increasingly unequal footprint, there were also deeper, longstanding issues rooted in the unequal power balance between the NHS and local Healthwatch, and in the lack of importance that patient and public voice has generally been afforded in the NHS over time.
The relationship between Healthwatch England and local Healthwatch could be strained at times and tensions arose over the extent to which Healthwatch England could direct what local Healthwatch worked on, how they collected the data and how it was reported.
The overall Healthwatch budget, particularly at a local level has also fallen over time, placing limitations on its impact and effectiveness. Due to the local commissioning model, funding received by each local Healthwatch also varies significantly, contributing to variation in capacity and capability across the network of local Healthwatch.
Implications for the future
Whatever replaces Healthwatch must build on the core conditions that enabled it to have a positive impact: a voice independent of government and services; the capacity to gather unsolicited, varied and rich community insight, including from seldom heard groups; and a geographical scale that supports both local insight and system or national-level influence.
Healthwatch has operated alongside a range of other patient and service user feedback mechanisms. The abolition of Healthwatch creates a pivotal moment to review all the ways that people share their views and provide feedback to ensure patient and public voice is central to how services are both commissioned and provided.
Any future model must enhance – not weaken – the system’s capacity to hear, understand and respond to people’s experiences. It needs to maintain a level of independence from the health and care system to ensure that whatever is put in place can speak truth to power and raise difficult messages where necessary.
The merging of ICBs and workforce reductions raise concerns about their ability to engage communities meaningfully at scale. A hub and spoke architecture for any future model should remain, but there should be clarity on how this aligns more deliberately to local government, new ICB clusters and neighbourhood structures and footprints.
The government should provide clarity on what comes next and must manage the transition carefully to retain expertise and avoid losing trusted relationships built over many years. This means engaging with local Healthwatch and system partners quickly and meaningfully to understand how and when the full range of its functions that extend beyond gathering feedback and include helping people navigate the complex health and care system and understand their rights will transfer to new bodies as part of the proposed reforms.
The new Director of Patient Experience role in the DHSC has the potential to give patient experience the prominence it needs, but only if it carries sufficient authority and the ability to hold others to account across government and the health and care system.
Any new model needs to reflect the importance of partners listening together and acting on what they learn. There should be a renewed focus on ensuring that patient and service user voice is central to how the health and care system operates – this will rely on leadership and organisational cultures that genuinely prioritise the experiences and perspectives of those who use services.
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