• HSJ investigation establishes Healthwatch England’s role and independence have been “downgraded”
  • Healthwatch England’s chair and chief executive have left in recent months - the chief executive will be replaced with a “national director”
  • Its leaders will report to the CQC instead of directly to DH
  • Norman Lamb says patient voice “diminished” by changes

The role and independence of the NHS’s official patient champion organisation is being “downgraded”, an HSJ investigation has established.

A series of government changes to Healthwatch England include making its chief executive report internally to the Care Quality Commission rather than, as at present, directly to the Department of Health, HSJ has learned.

The organisation has seen both its chair and chief executive leave in recent months, and the moves have sparked concern from former health minister Norman Lamb.

Our investigation has found:

  • Healthwatch England is for the first time reporting to the CQC, rather than directly to the Department of Health;
  • Healthwatch England’s chair will become accountable to the CQC chair;
  • the DH has decided not to replace Katherine Rake, who stood down as Healthwatch England chief executive earlier this month, with a new chief executive;
  • instead the DH is recruiting a “national director” who will directly report to the chief executive of the CQC; and
  • the executive team responsible for supporting the HWE committee is to be “embedded” in the CQC’s organisational structure. Previously it was separate.

HWE was created by the Health Act 2012 as a statutory committee of the CQC, but the coalition government said at the time it should be independent, and gave it direct reporting lines to the DH. Its role is to champion the patient and consumer interest nationally and support local Healthwatch branches.

Norman Lamb

Norman Lamb

Norman Lamb: ‘It goes against the purpose of the legislation in having a strong public voice in the system’

A senior source with knowledge of the changes now being made told HSJ they represented a significant reinterpretation of the act. They could potentially reduce Healthwatch England’s control over its resources and limit its ability to decide its own agenda, the source said.

Another well placed senior NHS source told HSJ the organisation was now being “embedded” in the CQC and the changes felt like a “downgrading”.

Norman Lamb, who as care minister until last year was the DH’s ministerial point of contact with HWE, told HSJ he was concerned by the changes.

“It’s hard to escape a… sense that this does amount to a downgrading of the organisation… and therefore potentially a diminished voice of the patient and public in the system,” he said.

“Even if it’s not against the letter of the law, it goes against the purpose of the legislation in having a strong public voice within the system.”

Mr Lamb said he suspected the changes were an attempted “rationalisation” of Healthwatch England with the CQC in a bid to save money.

Malcolm Alexander, a board member of Healthwatch Hackney who sat on the DH programme board that created Healthwatch, said he thought the moves were designed to “undermine” Healthwatch England’s independence.

“Can you imagine the next [Healthwatch England] chair… in front of the television cameras saying the organisation that I’m accountable to, the CQC, is not up to the job… impossible isn’t it?”

Mr Alexander said he worried about Healthwatch England’s future in light of the changes to its senior staff.

“To lose the chair and chief executive of an organisation is a good way of chopping the head off an organisation,” he said.

Former health minister Lord Howe, in a Lords debate on Healthwatch England in November 2012, stressed it would be able to “act independently… in a very real sense” because it would “set its own strategic priorities, separate from the CQC; it will have its own operational and editorial voice, again separate from the CQC; and it will develop its own business plan and take responsibility for managing its own budget”.

A Healthwatch England spokeswoman said: “Healthwatch England’s role as patient champion is written into statute.

“Our sole focus is to report the views and experiences of people who use health and social care services across the country – this will not change as we continue to deliver our statutory functions.”

A CQC spokesman said the changes would not affect HWE’s “statutory remit, responsibility to speak out and act on behalf of people who use services, or how local Healthwatch work with CQC”.

A DH spokeswoman confirmed the changes were taking place, but said they were “small governance changes” which would not alter HWE’s statutory functions.