LONDON – The Local Government Association (LGA) has warned that the planned abolition of Healthwatch will create a “significant step back” in the accountability of health and social care services.
The organization expressed concern over the absence of a structured alternative to the independent body, which currently monitors and challenges the NHS and community care providers based on public and patient feedback.
The move is a central component of the NHS Modernisation Bill, which seeks to centralize the management of health and social care by abolishing NHS England and transferring its authority to the Department for Health and Social Care.
Shift in Oversight Responsibility
Under the current legislative proposals, the functions previously held by Healthwatch will be transferred to local authorities and integrated care boards (ICBs). This shift means that the entities providing the services will also be responsible for managing the feedback and complaints regarding those same services, from primary care access and hospital discharge to social care assessments.
The LGA argues that removing an independent intermediary eliminates the necessary friction required for effective oversight and risks blurring the line between those who deliver care and those who speak for patients and service users.
“Without an independent, locally rooted voice to challenge and represent communities, there is a risk of duplication and gaps in accountability,” the LGA said, warning that vulnerable groups could find it harder to have concerns heard when decisions are taken about service changes or closures.
The association is urging the government to “work with local government” to establish a “clear and workable model” that preserves the core functions of Healthwatch while ensuring its independence from the providers it monitors. It is also calling for clarity on how any new arrangements would be funded and how they would report publicly on performance.
The NHS Modernisation Bill
The proposed restructuring is part of a broader strategy to streamline the administration of the UK’s healthcare system and recast lines of ministerial accountability. The legislation introduces several fundamental changes to the institutional architecture of the NHS and to how patient voice is embedded in decision-making.
According to the bill, which would amend the core statutory framework underpinning the health service set out in the National Health Service Act 2006, the reforms would:
- Abolish NHS England: Removing the arm’s-length body to bring operational control directly under government ministerial oversight.
- Centralise power: Move the running of health and social care services into the Department for Health and Social Care, consolidating budgetary and strategic authority.
- Reassign Healthwatch duties: Transfer patient advocacy and challenge roles to ICBs and local government, with local systems expected to design their own mechanisms for capturing and responding to complaints.
The government has defended these measures, stating that the reduction of bureaucratic layers will allow more resources to be redirected toward frontline healthcare services and enable faster national responses to performance problems. Ministers insist that statutory duties to involve patients and the public will remain in place, even if the institutional vehicle for delivering them changes.
Governance and Accountability Concerns
Critics within local government say the changes risk weakening the checks and balances that have developed over the past decade, during which Healthwatch organisations have used lay evidence to challenge service reconfigurations and scrutinise quality of care. They argue that placing both commissioning and patient representation within the same structures could create perceived conflicts of interest and make it harder for the public to understand where to take concerns.
The LGA has asked for explicit safeguards to be written into the legislation, including requirements for any replacement arrangements to publish independent reports, escalate systemic failings, and engage with Health and Wellbeing Boards and overview and scrutiny committees at local level.
Legislative Timeline
The NHS Modernisation Bill is currently progressing through parliament. The legislation is scheduled for its second reading on Monday, June 1, where members of parliament will debate the main principles of the bill before it moves to the committee stage for detailed line-by-line scrutiny.
If approved by both Houses, the reforms would sit alongside existing NHS constitutional commitments to patient involvement set out in the NHS Constitution for England, but with a markedly different institutional landscape for how those rights are exercised in practice.
