At last year's conference, I outlined a key strategic objective: to address the sustainability and variation within the Healthwatch network—something many of you highlighted when I first joined Healthwatch England.

With a general election on the horizon, we knew we had to be ready to make our case for change and seize any potential legislative opportunities.

Since then, these discussions have been both necessary and, at times, challenging. You've shared firmly held views rooted in your conviction and experience – including those at odds with the proposal preferred by our National Committee with Healthwatch England as commissioner, referenced in National Committee member Jane Laughton's blog.

We all agree on the scale of our challenges: unsustainable, inequitable funding and negative variation, often driven by factors beyond individual Healthwatch control, such as commissioning.

Without change, some Healthwatch will become unviable, leaving communities without a public champion and eroding the collective influence we've worked hard to build.

However, we didn't foretell the Dash Review, which now examines local Healthwatch and Healthwatch England alongside patient safety organisations.

These tough conversations have prepared us for any changes from the review. We are committed to supporting it, enabling local Healthwatch to have a voice in the process and putting forward our case for change.

Your views have been crucial in shaping our thinking. We've heard about the critical role Healthwatch plays in your communities, the importance of local decision-making and the deep relationships you hold with local people, groups and stakeholders.

The case for local Healthwatch in every area has been heard. There's consensus that we must maintain and strengthen relationships with local authorities while carefully keeping what's working well in certain areas. There is much more work to be done on what this looks like.

Is the proposal fully developed? No, it remains a high-level proposal as part of our broader case for change. 

In any case, we are committed to presenting all the models we've explored and their respective advantages and risks. Ultimately, if we succeed in making our case, it will be up to government decision-makers to shape our future, including decisions on our funding. A full implementation and transition plan will be required.

Healthwatch provides significant value, with even greater untapped potential. Reading your annual reports and hearing about your impact on my visits to your communities has been inspiring.

From your insight into driving national change to individual Healthwatch contributing to select committees and collaborating to influence ICB decision-making, we achieve far more than our size suggests.

For just a penny per person per week, we deliver incredible value—and we know we can achieve even more.

In the wake of the Darzi Review, much attention has focused on fixing the NHS. We’re poised to play our part in helping to shape the 10-Year Plan for the NHS with the involvement of local Healthwatch.

We believe social care needs the same focus—a message we will continue to champion. As the public's health and care champion, Healthwatch must be central to any revitalised system—where lived experiences, particularly from those facing inequalities, drive improvement and accountability.

This is key to ensuring a more equitable system with better outcomes for all.

I joined the Healthwatch England Committee in September 2023 to bring the voice of local Healthwatch to committee discussions and decisions. At the time I was the Chief Executive Officer (CEO) of Healthwatch Nottingham and Nottinghamshire, a post I held for five years until I stepped down at the end of 2023. 

I believe passionately in the value of local Healthwatch. We achieve some amazing things locally and nationally. But as a Healthwatch CEO I faced issues that many of you will have experienced:

• How to fulfil our huge remit across health and care with poor levels of funding (Healthwatch Nottingham and Nottinghamshire are some of the lowest-funded Healthwatch in the country based on pence per head of population). This was more difficult because of increasing multiple needs in our local communities, especially those with no voice and those experiencing health inequalities.
• Our contracts were for only three years, creating challenges with long-term planning for our strategy and impact.
• Increasing numbers of partners and groups to connect to, including four place-based partnerships and the integrated care board. These were important partnerships, but they generated yet more meetings to attend. 

Like many Healthwatch, these issues limited our capacity to empower local people to have a voice and hold local NHS and care organisations to account. They limited the number of communities and providers where we could make a difference with in-depth investigation, so we could not always achieve as much impact as would have liked. 

Why we need to change 

Local Healthwatch are crucial. We are the only organisations with the independence and statutory power to hold health and care services to account for listening to their communities. If their voices are not heard, services will be commissioned in a way that does not work for them or excludes them altogether. 

Individual local Healthwatch make their own decisions about how to prioritise, which leads to an inconsistent approach across the local Healthwatch network. As King’s College London said in its report on Healthwatch: “The diversity of the Healthwatch network … has considerable implications for equity of access to influencing health and care planning and provision for residents across England”. This affects our brand and profile.

Despite consistently raising this issue with the previous administration, Healthwatch funding has continued to decrease. Under the current economic climate this is unlikely to change. The risk is that we reach a point where delivering Healthwatch England and Healthwatch becomes financially unviable.

The total resource for Healthwatch England and the local Healthwatch network is £28m, £25m of which funds local Healthwatch. How can we work differently to achieve more and deliver a more consistent local Healthwatch offer across England, without additional funding? 

What needs to happen now

Healthwatch England has led a 12-month engagement process during which chairs, lead officers and staff representing 101 local Healthwatch have contributed their views and debated the issues. A working group of representatives from ten local Healthwatch representatives has had further detailed discussions. With 153 Healthwatch it is no surprise that differing views exist. However, the need for change is something we all recognise. We now need to decide how we are going to change.

There are some things that must not change, such as our independence, and our statutory power to hold commissioners and providers to account. We have also agreed that we must not lose the localism of local Healthwatch.

Any decisions about a future Healthwatch model will be made by the Department of Health and Social Care. Healthwatch England will present the range of views to them, acknowledging the range of views within our network. 

However, after carefully reviewing the options, the Healthwatch England Committee supports the model where Healthwatch England assumes the role of commissioner – a solution we heard loudly during our conversations with the Healthwatch network. 

What is the annual survey?

Every year, we collect key data from every Healthwatch, which we use to inform how we can best support you, inform our national work and make the case for further investment in Healthwatch.

The data gives us an understanding of what's working on the ground for you, supports new partnerships and collaboration and contributes to the Healthwatch England annual report, which we present to Parliament.

We want all Healthwatch to complete the Annual Survey so we have an accurate picture of the network.

Deadline for completion

Please complete the survey, which should take around 30 minutes, before Monday 30 September.