Healthwatch Rutland warns that Equality assessment for NHS 10-Year Plan overlooks loss of independent patient voice
The EQIA, published on 17 December, refers extensively to “patient voice” and “patient feedback”, but largely frames these through digital tools such as the NHS App, surveys and experience metrics. Healthwatch Rutland says this risks confusing data gathering with authentic, independent patient insight and engagement, particularly for people who already face barriers to care.
“Patient voice cannot be considered independent if its collection is owned and controlled by the very system it is meant to scrutinise,” said Dr Janet Underwood, Healthwatch Rutland Chair.
Local Healthwatch organisations have provided independent oversight of local health and care services for over a decade, gathering intelligence from communities through engagement, research and direct visits to services. They use this evidence to influence change, hold providers accountable and guide members of the public to access the services they need. This includes building relationships and communicating with people from marginalised communities, those who have experienced poor or unsafe care and people who lack confidence in formal or digital systems.
When poor care damages trust, people are often too unwell or anxious to raise concerns directly with their healthcare provider. Healthwatch is part of the community and can reach those whose voices are most easily missed - something an app cannot replace.
National evidence supports these concerns. Healthwatch England’s most recent complaints research shows that while almost a quarter of people experience poor NHS care, fewer than one in ten go on to make a formal complaint, and more than half of those are dissatisfied with the process or outcome. This points to deep-rooted issues of trust and confidence that cannot be addressed simply by expanding provider-controlled feedback mechanisms.
The need for an independent patient voice was emphasised by the Francis Report (2013). This followed the Mid Staffordshire NHS Foundation Trust scandal when patient safety and quality of care were severely compromised by a poor Trust culture which was unreceptive of concerns raised by patients and their families. Local Healthwatch has consistently facilitated that independent patient voice.
While proposals suggest that the functions of local Healthwatch will be absorbed into Integrated Care Boards and local authorities, there is currently no clear model for how independence, transparency or external scrutiny would be preserved. The EQIA instead places significant emphasis on the NHS App as a primary feedback route, despite longstanding concerns about digital exclusion.
Healthwatch Rutland is urging the Government to meet its legal duties under the Public Sector Equality Duty by fully considering the equality implications of losing independent patient voice as NHS reforms progress. This is essential to ensure that changes intended to improve patient experience do not inadvertently widen health inequalities.
