Challenges Facing Healthwatch, a New Consumer Champion in England

Document Type : Debate


Department of Health Sciences, University of Leicester, Leicester, UK


This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people’s views.


Commentary Published on this Paper

  • Consumers or Citizens? Whose Voice Will Healthwatch Represent and Will It Matter?; Comment on “Challenges Facing Healthwatch, a New Consumer Champion in England”

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Main Subjects

  1. Hudson B. Public and patient engagement in commissioning in the English NHS: an idea whose time has come? Public Management Review. 2014;17(1):1-16.
  2. Taylor J, Tritter JQ. Local Involvement Networks: Learning From the Early Adopter Programme Final Report. Coventry: Warwick University; 2007.
  3. Martin G. The third sector, user involvement and public-service reform: a case study in the co-governance of health-service provision. Public Adm. 2011;89(3):909-932.
  4. Dent M, Pahor M. Patient involvement in Europe–a comparative framework. J Health Organ Manag. 2015;29(5):546-555. doi:10.1108/JHOM-05-2015-0078
  5. Martin GP. Representativeness, legitimacy and power in public involvement in health-service management. Soc Sci Med. 2008;67(11):1757-1765. doi:10.1016/j.socscimed.2008.09.024
  6. Newman J, Clarke J. Publics, Politics and Power. London: Sage; 2009.
  7. Peckham S. Accountability in the UK healthcare system: an overview. Healthcare Policy. 2014; 10:154-162.
  8. Skelcher C. Jurisdictional integrity, polycentrism, and the design of democratic governance. Governance. 2005;18(1):89-110.
  9. Department of Health. Local Healthwatch: A strong voice for people - the policy explained. London: Department of Health; 2012.
  10. Department of Health. The NHS Constitution for England. London: Department of Health; 2013.
  11. Petsoulas C, Peckham S, Smiddy J, Wilson P. Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past. Prim Health Care Res Dev. 2015; 16 (3):289-303. doi:10.1017/S1463423614000486
  12. Tritter JQ, Koivusalo M. Undermining patient and public engagement and limiting its impact: the consequences of the Health and Social Care Act 2012 on collective patient and public involvement. Health Expect. 2013;16(2):115-118. doi:10.1111/hex.12069
  13. Barnes M. Alliances, contention and oppositional consciousness: can public participation generate subversion? In: Barnes M, Prior D, eds. Subversive Citizens. Bristol: Policy Press; 2009.
  14. Coleman A, Checkland K, Segar J, Mcdermott I, Harrison S, Peckham S. Joining it up? health and wellbeing boards in English local governance: evidence from clinical commissioning groups and shadow health and wellbeing boards. Local Government Studies. 2014;40(4):560-580.
  15. Smiddy J, Reay J, Peckham S, Williams L, Wilson P. Developing patient reference groups within general practice: a mixed-methods study. Br J Gen Pract. 2015;65(632):177-183. doi:10.3399/bjgp15X683989
  16. Light K, Stirk L, Wright K. Patient opinion. J Health Ser Res  Policy. 2010;15(3):190-192. doi:10.1258/jhsrp.2010.010020
  17. Lupton D. The commodification of patient opinion: the digital patient experience economy in the age of big data. Sociol Health Illn. 2014;36(6):856-869. doi:10.1111/1467-9566.12109
  18. Scott JC. Seeing Like a State. New Haven: Yale University Press; 1998.
  19. Gilbert H, Dunn P, Foot C. Local Healthwatch: Progress and Promise. London: The King's Fund; 2015.
  20. Healthwatch England. Understanding the Legislation: An overview of the legal requirements for local Healthwatch. Http:// Published 2015.
  21. Carter P. Governing welfare reform symbolically: evidence based or iconic policy? Crit Policy Stud. 2011;5(3):247-263. doi:10.1080/19460171.2011.606298
  22. Barnes M, Newman J, Knops A, Sullivan H. Constituting ‘the public’ in public participation. Public Adm. 2003;81(2):379-399. doi:10.1111/1467-9299.00352
  23. Department of Health. NHS five year forward view. Accessed May 20, 2015.
  24. Clarke N, Cochrane A. Geographies and politics of localism: The localism of the United Kingdom’s coalition government. Polit Geogr. 2013;34:10-23.
  25. Dixon-Woods M, Minion JT, McKee L, Willars J, Martin G. The friends and family test: A qualitative study of concerns that influence the willingness of English National Health Service staff to recommend their organisation. J R Soc Med. 2014;107(8):318-325.
  26. Foot C, Gilburt H, Dunn P, et al. People in Control of Their Own Health and Care. London: The King's Fund; 2014.
  27. Baggott R, Jones K. The big society in an age of austerity: threats and opportunities for health consumer and patients' organizations in England. Health Expect. 2015;18(6):2164-2173. doi:10.1111/hex.12185
  28. Pfeffer J, Salancik GR. The External Control of Organizations. Redwood: Stanford University Press; 2003.
  29. Martin GP. 'Ordinary people only': Knowledge, representativeness, and the publics of public participation in healthcare. Soc Health Illn. 2008;30(1):35-54. doi:10.1111/j.1467-9566.2007.01027.x
  30. TDA, Monitor, NHS England. Making local health economies work better for patients. London: NHS England; 2014.
  31. Buetow S. Getting the balance right: thick and thin approaches to harmonizing state particularism and the human right to health. Health Expect. 2012;15(4):441-448. doi:10.1111/j.1369-7625.2011.00666.x
  32. Haugh H, Peredo AM. Critical narratives of the origins of the community interest company. In: Hull R, ed. Critical Perspectives on the Third Sector. Bradford; Emerald: 2011.
  33. Barnes M, Newman J, Sullivan H. Discursive arenas: deliberation and the constitution of identity in public participation at a local level. Soc Mov Stud. 2006;5(3):193-207.
  34. Gamsu M, Chapman J, Miller S. Developing Quality Statements for Local Healthwatch. Leeds: Leeds Beckett University; 2015.