Health Bill (Thirteenth sitting)
Clause 64 abolishes Healthwatch England, which I believe is a mistake, and introduces schedule 9 to facilitate that. The impact assessment talks about the roles of local healthwatch and Healthwatch England, with local healthwatch obtaining views, making reports and recommendations, promoting and supporting public institutions, signposting to advice, and giving views to Healthwatch England nationally; and Healthwatch England then providing leadership, guidance and support to local healthwatch, escalation to the CQC, which we have heard a lot about already, and advice to the Secretary of State or NHS England. Members may be familiar with the term “nothing about us without us”—the idea that policies should not be decided and services should not be shaped without the participation of those who will use those services or be affected by the decisions that are made. As a medical practitioner, I believe that is an important principle. Patients must have a voice, because it is they who have the lived experience of their conditions and know their needs better than any civil servant in Whitehall. They know what is working and what needs to change. Let us look at the history of patient voice. In the two decades after the NHS’s inception, the provision of care was really quite paternalistic. Patients did not really have any role in shaping the services that they received. That changed in 1974 with the establishment of community health councils, made up of volunteers. They carried out research, conducted visits to inspect standards and represented communities when changes were proposed. They also helped the public with information about local services, including how to make complaints—very similar processes. The Labour Government abolished community health councils in 2003, although a cursory trip to Hansard reveals that the Government repeatedly stated before the publication of the NHS plan that at that point they envisaged no immediate changes to community health councils, but they did go on to do that. That is reminiscent of what we are discussing today, because abolishing Healthwatch was not in the Labour party manifesto. In 2003, the community health councils became patient and public involvement forums, and five years later they became local involvement networks. The names and structures have changed, but the principle of patients having an independent voice remained. Healthwatch is the latest iteration. To be precise, Healthwatch England was established initially as a committee of the Care Quality Commission in 2013. It operates a hub-and-spoke model with more than 150 local healthwatches spread across local authority areas. Healthwatches play a vital role in exposing problems in the health service. Indeed, even the King’s Speech contained a reference to Healthwatch England. According to Healthwatch England’s May 2025 report, “nearly one in four…adults have noticed inaccuracies or missing details in their medical records”, such as inaccurate personal details and inaccurate records of medicines, diagnoses, treatments and conditions. I note that the Minister herself has relied on Healthwatch when bringing problems facing her constituents to the House. She said: “In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling.”—[Official Report, 10 February 2022; Vol. 708, c. 484WH.] So Healthwatch is valuable. I invite Members to look at the impact that Healthwatch had in 2023-24. More than 925,000 people used their local healthwatch to get advice and information about their health and care. More than 329,000 people shared their experiences to help improve services. Healthwatch England helped to secure changes to Royal Mail so that NHS letters are delivered to patients on time. It also led new NHS guidance so that patients commencing cancer treatment have priority access to NHS dentists. A piece of Healthwatch research indicated that millions of eligible adults may be missing out on social care. Recently, my local branch, Healthwatch Lincolnshire, produced a report on the challenges facing carers nationally. Healthwatch has influenced the future of attention deficit and hyperactivity disorder care, encouraged the uptake of cervical cancer screening and so much more. That is why the public and health experts are alarmed by the Government’s plans. As for HSSIB, the success of Healthwatch is due to its independence, but the Government want to do away with that. Their policy paper commits to replacing Healthwatch with a new patient experience directorate, which will sit inside the Minister’s Department. Instead of having organisations embedded in communities sitting on local health and wellbeing boards, the public will need to interface with the Minister’s Department. How can she guarantee the independence, and the perception of independence, of the new directorate? How can she be sure the public will trust it? I remind Members of what Councillor Dr Wendy Taylor of the Local Government Association said: “The current proposals to disband Healthwatch and allow health and social care services to gather and respond to feedback, rather than being challenged by an independent voice, risks organisations being seen to mark their own homework.” When Healthwatch conducts surveys, it often solicits information that proves problematic for the Government of the day. How can the public have confidence that the new directorate’s process will do the same? What will stop the Secretary of State deciding what questions get asked and what data gets published? From my reading of the Bill, the answer is nothing. The Government have made it clear that, alongside the new directorate, ICBs will take over several patient voice functions. I appreciate that this strays slightly into the subject of the next group of provisions, Ms Lewell, but it is difficult to separate Healthwatch from local healthwatches. The Patients Association has warned: “Splitting local Healthwatch between ICBs and local authorities risks creating a patchwork of accountability with no single body responsible for ensuring patients are heard”. If responsibility to deliver those functions is shared between different parts of the health system, who becomes accountable if it is not funded? Who is accountable if people fall through the cracks? If accountability is divided, it often means that accountability is somewhat diminished. Members also need to ask whether it is financially feasible for ICBs to deliver patient voice. In its evidence, the Health Foundation wrote: “Moving the NHS functions of local HealthWatch organisations into newly enlarged ICB footprints could also result in the loss of a more nuanced local understanding of the public’s priorities and needs, with particular implications for seldom heard or more vulnerable communities.” We know that ICBs are under financial pressure because of decisions by the Labour Government; they have had to slash operating costs by 50%, and many are pencilling in cuts to frontline services. Against that backdrop, how can they afford to deliver patient voice functions? Ms Lewell, your guess is as good as mine. We have not heard about any additional funding from the Government for the purpose of patient voice. Healthwatch England was provided £3.3 million in 2025-26, and local healthwatch £14.1 million. How much of that money will be redirected to the patient experience directorate and the ICBs? I tabled a written question about the benefits to the public purse of abolishing Healthwatch. The Minister’s response was as follows: “The potential savings from abolishing Healthwatch England and Local Healthwatch are dependent future policy decisions regarding the approach taken to collecting user experiences post-abolition.” She set out an intention for “future policy decisions”, but there was, and still is, an absence of a plan. That is something we have heard again and again in relation to health, in Committee and throughout the two years that this Government have been in power: the absence of a plan for how things will be achieved. They have lofty aims, and understandable and sometimes really good goals, but no understanding of how they are going to get there. It is not just the Opposition who are concerned; I will give some examples of Government Members who are, too. The hon. Member for Birmingham Erdington (Paulette Hamilton) said: “One of my biggest concerns about the Bill is the reduction in independent patient representation, including the abolition of Healthwatch structures.”—[Official Report, 1 June 2026; Vol. 786, c. 921.] The hon. Member for York Central (Rachael Maskell) said: “Replacing Healthwatch will mean that, ultimately, patients will not have confidence in the commissioners.”—[Official Report, 9 June 2026; Vol. 787, c. 136.] The hon. Member for Blaydon and Consett said: “I understand that the Government’s real intention, through the Bill, is to strengthen the patient voice and the ability to raise issues, but there is real concern that an organisation inside the Department of Health and Social Care will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and…with the ability to pull the levers”?—[Official Report, 1 June 2026; Vol. 786, c. 944.] We have also heard concerns from the Health and Social Care Committee. But the Member that the Minister may be most interested in is the right hon. Member for Makerfield (Andy Burnham). He wrote to the former Secretary of State last year saying: “People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.” Does the Minister agree? If so, why does she want to remove the independence of patient voice? The right hon. Member for Makerfield also said: “The independence of resident and patient voice is a necessity. Without it, we risk losing the trust of the public, the richness of lived experience, and the ability to challenge and improve the system from within, particularly during this time of significant system reform”. My plea to the Minister is this: think again about the importance of the independence of patient voice. People will give their views when they think they can do so independently and safely—a principle that was echoed in the debate this morning. Removing the independence does not seem necessary, and I do not understand why the Minister thinks that it will improve patient care and thereby patient safety. It is clear that Members not only on the Opposition Benches, but right across the Government Benches—in fact, potentially the new Prime Minister from next week or the week after—may think the same. I encourage the Minister to reconsider this step.