Government plans to scrap two independent NHS watchdogs face fresh patient safety warning

Plans to abolish two organisations responsible for representing patients and investigating safety concerns in England’s health service are facing renewed criticism, amid warnings that the reforms could weaken independent scrutiny.

The Health Bill proposes abolishing Healthwatch England and the existing statutory arrangements for local Healthwatch services, while also abolishing the Health Services Safety Investigations Body (HSSIB) as a standalone organisation. However, the Government says the reforms are intended to reduce bureaucracy, strengthen accountability and improve the way patient experience and safety concerns lead to action.

Healthwatch England currently acts as the national independent champion for people who use health and social care services. Alongside the national organisation, local Healthwatch services gather people’s experiences of health and care and help ensure patient and public views are heard by those responsible for commissioning and delivering services.

Under the Government’s proposals, Healthwatch England and the existing statutory arrangements for local Healthwatch would be abolished. Rather than removing patient engagement altogether, the Government intends for patient voice functions to be incorporated into the reformed health system.

Government impact assessments state that health-related functions currently undertaken by local Healthwatch would move into integrated care board arrangements, while social care-related functions would sit with local authorities.

The Government argues that bringing patient voice closer to organisations responsible for services will give people’s experiences greater influence over decision-making and make providers and commissioners more accountable for responding to them.

HSSIB is an independent organisation that investigates patient safety concerns across NHS-funded healthcare in England. The Health Bill would abolish HSSIB as a separate organisation and transfer its investigation functions to the Care Quality Commission (CQC).

The Government says the change is intended to create a more streamlined patient safety system and strengthen the link between identifying safety problems and ensuring action is taken.

HSSIB’s 2025/26 annual report confirms that the organisation is expected to transfer into the CQC as a discrete unit, although it said the timeline for the move was currently unknown. The Government has therefore not proposed simply ending national safety investigations. Instead, the significant change is that the function would no longer sit within HSSIB as an independent standalone organisation.

Critics are concerned about what the structural changes could mean for independent patient representation and patient safety investigations.

The proposals have already been challenged during the Bill’s passage through Parliament. During parliamentary debate in June, concerns were raised about abolishing both Healthwatch and HSSIB, including the importance of maintaining confidence among NHS staff who raise safety concerns.

Professional organisations have also raised questions about the changes. In written evidence submitted to Parliament, the Royal College of Pathologists said it was concerned about the proposal to abolish HSSIB as a separate organisation and transfer its functions to the CQC. The College acknowledged the Government’s intention to streamline England’s patient safety landscape but warned that the move carried risks.

The debate has intensified again this week, with Liberal Democrat health spokesperson Helen Morgan criticising the proposed changes and warning about their potential implications for patient safety.

The Liberal Democrats have described the reforms as a potential “bonfire of patient safety” and called for changes to the legislation. Morgan has argued that the reforms could undermine accountability, transparency and patient safety and urged the Government to reconsider the measures.

These claims represent the Liberal Democrats’ position on the Bill rather than an established consequence of the reforms.

The Government’s position is substantially different. Ministers say the wider Health Bill is designed to improve patient safety and patient experience while reducing national bureaucracy and giving frontline NHS organisations greater responsibility.

The proposals affecting Healthwatch and HSSIB form part of a much larger programme of NHS reform. The Health Bill includes measures intended to restructure national health administration, abolish NHS England and redistribute responsibilities across the Department of Health and Social Care and other parts of the health system.

For Healthwatch and HSSIB, the central debate is likely to remain one of independence. The Government believes bringing patient voice closer to decision-makers and HSSIB’s investigation expertise into the CQC can create a more effective and accountable system. Opponents fear that removing standalone independent organisations could weaken some of the mechanisms designed to challenge the health system when things go wrong.

For patients and healthcare workers, the practical impact will depend on the final form of the legislation and how the transferred functions are implemented.

For now, Healthwatch and HSSIB continue to operate, while the proposed changes remain part of legislation progressing through Parliament.

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