Policy paper

Health Bill: patient voice - fact sheet

Published 19 May 2026

Applies to England

Introduction

This document outlines the proposed legislative changes to the way patient and public voice is listened to and acted upon within the health and care system. As the 10 Year Health Plan for England made clear, we will be far more ambitious in ensuring that patient and public voices are heard where decisions are made. This means changes for:

• national leadership: the Department of Health and Social Care (DHSC) will be responsible for overseeing the collection of more informed feedback from patients and carers (implemented through a new director of patient experience)
• local accountability: we are putting the voice of people, patients, carers and their representatives at the heart of shaping services, through the transfer of local Healthwatch functions into integrated care boards (ICBs) and local authorities. This will ensure those responsible for commissioning services will hear from patients, service users and local people directly

This document also explains how our proposed legislative changes fit into and reinforce broader non-legislative plans to give patient and carer voice a greater profile and a greater impact on the work of central government.

National leadership

The 10 Year Health Plan set out ambitious plans to bring patient voice ‘in house’ to give it a greater profile at the national level within a reformed department. Taken together, these plans will lead to a major change in how DHSC considers patient experience as an ongoing part of national policy-making.

The patient experience directorate

We will appoint a new national director of patient experience, responsible for overseeing the collection and analysis of feedback from both patients and carers and making it publicly available.

This change will sit alongside provisions in the Health Bill (‘the bill’) to abolish Healthwatch England, the current statutory body for users of health and social care services to share feedback with. The voice of patients will instead be embedded in central government through the new patient experience directorate.

The bill will ensure that there are clear responsibilities at all levels of the system for collecting, analysing and acting upon patient experience and feedback. The new patient experience directorate will also be tasked with significantly improving the complaints process across the NHS.

While we recognise the important work Healthwatch England has delivered over the years to gather and report on user experience, bringing patient voice in-house will not only strengthen the impact it has on decision-making and policy design, it will also help the healthcare system to prioritise improvement actions. NHS organisations are faced with thousands of new recommendations every year, but the new directorate will be empowered to influence how DHSC prioritises and acts on findings - for example, the director for patient experience will be a member of the revamped National Quality Board, whose role includes prioritising existing and new recommendations.

NHS England already considers around 25 million pieces of patient feedback each year. The end goal of the patient experience directorate is to make that feedback more directly relevant to the formulation of policy in the restructured DHSC and to the delivery of improvement to patients, carers and the public.

The patient experience directorate will ensure the experiences of seldom heard from groups and diverse communities feed into the design and delivery of services. This will, in turn, help to improve experience and outcomes and reduce inequalities.

The creation of the patient experience directorate also presents an opportunity for the system to become a world leader in the use of digital approaches to ensure patient voices and experiences directly inform decision-making. NHS England has taken early steps to make more of feedback from machine learning tools and data science, and there are emerging tools already being used within NHS trusts to analyse complaints, incidents and concerns, which are supporting efforts to identify themes and patterns more effectively. We plan to make greater use of these to enable swifter understanding of people’s experiences and help identify emerging issues earlier.

While not set out in the bill itself, the functions of the new patient experience directorate will be to:

• develop a clear, high-quality approach for gathering, interpreting and acting on feedback across the NHS, at all levels - including under-represented and seldom heard from groups - and considering how best to make experience data publicly available
• lead patient voice initiatives and policies on complaints, feedback and engagement
• ensure national oversight and performance frameworks include relevant measures of experience
• provide internal improvement advice and challenge, including staff training
• be a centre of expertise and a guardian of quality on voice and experience
• actively engage with external patient experience stakeholders, with a particular focus on engaging seldom heard groups who may not provide feedback on their experiences as a matter of course

Oversight

Patient experience is also one of the most important aspects of the NHS oversight framework, ensuring public accountability for how the voice of patients and service users is used by DHSC to drive improvement within systems and providers. The framework includes a range of experience-related metrics covering inpatient services, general practice, mental health and staff advocacy. 

We are committed to ensuring that the oversight approach aligns with the ambitions of the new patient experience directorate, using high quality data to allow us to understand variations in experience and how to reduce them. This demonstrates how we are building patient experience and voice into our oversight accountability framework and we plan to strengthen it further in future versions.

Patient and carer involvement

Involving individuals in decisions about care supports patients to manage their health and wellbeing and to be involved, as far as they wish or are able, in decisions about their care, with appropriate choice and control.

The bill transfers a duty to the Secretary of State for Health and Social Care to promote the involvement of patients and users of services (including their carers and representatives), when making decisions about a patient’s illness, care or treatment. This replaces the existing equivalent duty which currently sits with NHS England.

Patient choice duties

The bill will also transfer to the Secretary of State the duty to act with a view to enabling patients to make choices about health services. The bill preserves the existing patient choice requirements, transferring patient choice duties including the power to enforce compliance with patient choice requirements to the Secretary of State. This aligns with wider non-statutory changes to maintain and enhance patient choice, for example through the patient choice charter committed to in the 10 Year Health Plan and patient-centred developments of the NHS App.

Transparency

Separately from the bill, we are already developing tools to measure impact from the patient perspective in the form of patient reported outcome measures (PROMs) and patient reported experience measures (PREMs). NHS England has commissioned the future of patient feedback project to:

• design a new model for holistic data collection, including PREMs
• define the required data flows to turn raw data into insight
• establish presentation of this data for different audiences (such as local teams, ICBs and regions)

While there is a lot of patient experience data currently in the public domain, it takes time to find it and use it. In future, we envisage that more insight will be brought together for ease of use. For example, the future of patient insight project is looking at platforms for the presentation of data from different sources, which will make triangulation easier.  

Taken together, these changes - both legislative and changes to process and guidance - represent a significant reform to public involvement in the health and care system at the national level, which will also serve to support and empower local systems to deliver better and more impactful patient engagement.

Local accountability  

The renewed clarity of accountability and leadership for patient experience feedback at the national level will be reinforced by measures that will improve accountability and transparency at the local level - again through a combination of legislative changes in the bill and non-statutory reforms.

Placing patient voice at the heart of commissioning

The bill will help achieve a more transparent system by ensuring those responsible for shaping services - ICBs and local authorities - are directly responsible for gathering patient and user views, and clearly accountable for embedding them into strategic planning. Specifically, the proposed changes in the bill will: 

• transfer all social care engagement functions of local Healthwatch to local authorities
• transfer all healthcare engagement functions of local Healthwatch to ICBs and provider engagement functions

While local Healthwatch organisations have done important work to gather the views of health and social care users, the new model will improve on the response to feedback - taking action to address concerns and improve services - by ensuring patient and user voice is part of, rather than separate to, decision-making. The new approach will also not only ensure better understanding of what is going wrong, but will better enable us to identify strong performers, which will also enhance learning.

Reinforcing statutory duties

To reinforce these changes, we will also ensure ICBs and local authorities are held more firmly to account. For example, the bill will also introduce:

• a requirement on the Secretary of State to oversee and provide guidance to ICBs and local authorities on best practice for obtaining the views of people who use health or social care services, and other members of the public on their needs for, and experiences of, health and social care services
• an equivalent duty on ICBs and local authorities to have regard to this guidance
• a new requirement on ICBs and local authorities to be responsible for obtaining and considering public views on services
• a requirement on ICBs to provide an annual statement about how they have fulfilled these duties, which will be considered as part of each ICB’s annual assessment. Both ICBs and local authorities will be required to provide information about engagement on request of the Secretary of State

The new system will retain local autonomy of approach while being clear on accountabilities. Where previously local authorities had to use local Healthwatch organisations, the new system will also allow more flexibility in how ICBs and local authorities fulfil this duty. For example, if local areas consider they can best fulfil their statutory duties in-house or by commissioning equivalent organisations to the local Healthwatch in the future, there remains flexibility to do so.

Strategic commissioning

As set out in the 10 Year Health Plan, ICBs have been asked to focus on strategic commissioning. The strategic commissioning framework makes clear this will require ICBs to have a deep understanding of their local populations’ current and future needs. To undertake this, they will draw on insights from patient and staff reported experience gathered in partnership with community forums and groups. They will combine these insights with other data sources such as outcomes and clinical safety markers and use the findings to evaluate how well the services they have commissioned are meeting the needs of their population.

NHS foundation trusts

The 10 Year Health Plan committed to remove the requirement for NHS foundation trusts to have a council of governors. This will be taken forward through the bill, providing more dynamic arrangements for patient involvement.

All NHS trusts and foundation trusts will continue to be expected to put in place effective arrangements for engaging patients, staff and local communities, as set out in section 242 of the NHS Act 2006. The changes to the statutory framework to remove governors will allow for the delivery of these expectations more flexibly than at present, giving greater autonomy to local organisations to innovate and tailor their approach to their local communities, with a focus on what matters to local people over uniformity of process. NHS foundation trusts will have the option to retain aspects of their engagement model where it is working well but can take a different approach if needed. To ensure their effectiveness, we will test providers’ engagement arrangements as part of ongoing assurance processes including provider capability assessments, Care Quality Commission-led assessments and the assessment process for advanced NHS foundation trust status.