Many of the watchdog’s local organisations are yet to establish sufficient credibility with their health economy partners. Some of the blame must lie with the national body.

As we report this week, Healthwatch England have written to Jeremy Hunt complaining that clinical commissioning groups are excluding patients and service users from consultations on service reconfigurations. It is good to see Healthwatch beginning to flex its muscles.

One of the reasons that CCGs are likely to feel comfortable in not involving the watchdog’s local organisations is that many of them have yet to establish sufficient credibility with their health economy partners. Some of the blame for this must also lie with the national body, which has punched below its weight.

Chief executive Anna Bradley’s direct challenge to commissioners and impending government legislation appears to mark a more robust approach.

However, perhaps the most significant aspect of the Healthwatch challenge is that it springs from perfectly understandable behaviour by CCGs - the desire to make decisions across wider areas than that covered by a single group.

‘Perhaps the most significant aspect of the Healthwatch challenge is that it springs from perfectly understandable behaviour by CCGs’

This, of course, speaks directly to the key conundrum in service reconfiguration - that the best results are often achieved at a scale which makes local involvement the most problematic.

The noise around public involvement in health service changes will grow as the election nears. Labour, for example, are exploring the creation of a new agency for running public consultations.

All options, however, seem doomed to fail unless the government and the NHS are successful in reframing the conversation as one which, first, sets out clearly the likely outcomes if change does not occur and, second, how a national endeavour like the NHS will inevitably mean trade-offs between regions, patient groups and organisations if it is to remain sustainable.