Health Bill (Thirteenth sitting)

Joe Robertson Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.

[Joe Robertson (Isle of Wight East) (Con)]

The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.

There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin—and that is being generous.

The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well.

A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point.

As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if there is a problem with the Care Quality Commission once HSSIB has become part of it? I think we rightly expected a fairly clear answer on that. The answer was a rhetorical response:

“‘What happens if the problem is this organisation or that one?’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]

That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.

If there is a problem with another organisation, HSSIB can investigate it; if there is a problem with the CQC now, HSSIB can investigate it; but when HSSIB becomes the CQC, there will plainly be a problem with investigating the CQC. When that question was put to the author of the report on whom the Government are relying, no answer was provided. The reply to my hon. Friend the Member for Farnham and Bordon was a rhetorical question.

I urge the Minister to reflect. There is a major issue here that has not been addressed. Until she, or those on whom she relies, can articulate the answer, I urge her to delay these proposals.

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

It is a pleasure to serve under your chairship, Ms Lewell.

The question is what will make patients more safe. Does incorporating the department that looks at safety into the organisation that inspects the services help? It might. Safety is not an add-on; safety must be at the heart of absolutely everything that we do. Safety is not a separate matter; it depends on those who work in our NHS and all of us all the time. That must be the culture. Let us not rely so much on inspections and litigations. At a time when we are unable to find jobs for newly qualified midwives, we spend more on obstetric litigation and compensation than we spend on obstetrics. I applaud what our Government are trying to do and their intention to improve things.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB.

Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety—in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here—and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully.

For people here and those reading our deliberations, what is difficult about the Bill—we understand this as legislators—is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us.

Among all the discussions, there are a couple of key questions that I want to address, including why I do this. Through the passage of the Bill, many people in the wider landscape have said to me, “Why are you bothering having a row about this?” I find that quite shocking as a riposte, because the answer is simple in the context. It is too important to not attempt to get this right and make changes to something that clearly is not working. I do not think I have heard anybody say that the current system is working.

As the right hon. Member for Melton and Syston noted, I said during the passage of the Health and Care Act 2022 that the functions of HSSIB are really important and must be built to the highest standard. I absolutely stand by that. It is not working; that is why we are changing it, but also why we are preserving the function within a new system, which we will seek to improve.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it.

To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report.

The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at.

Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape.

Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.

--- Later in debate ---

[Karin Smyth]

No.

There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that.

I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.

I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.

The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.

Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

For over 50 years, there has been a statutory independent patient voice in the health and care system. The creation of Healthwatch was, in part, a direct response to the issues raised by the Francis inquiry into Mid Staffs. In a 2024 Healthwatch poll, almost a quarter of NHS patients said that they had experienced poor care in the past year, but 56% of them—more than half—took no action. Of that 56%, 20% said that that was because they were scared that giving negative feedback directly to NHS services would affect their ongoing treatment. Women, people living in areas of greater deprivation, disabled people and unpaid carers were significantly more likely to give the fear of retribution as a reason for not speaking up.

The Government are stripping patients of their voice in our NHS. Rather than being able to go to an independent body and express how the NHS can work better for them, patients will now be able only to give feedback to the same organisation that might have failed them. I have had experience of that in the past few weeks. My partner Emma has endometriosis, which has been an ongoing condition. She was worried that speaking to the local hospital trust specifically about the treatment she received might affect her treatment going forward.

The Government have argued that the changes will bring patient insight closer to decision making, making it much more effective at securing change. The former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), stated that patients do not need “ventriloquists”. That blatantly disregards the vital role played by Healthwatch in advocating not only for vulnerable patients who, understandably, do not feel confident navigating health services with often complex or combative systems, but for whole communities with a pre-existing distrust of the system.

We believe that removing Healthwatch leaves the health service to mark its own homework, which creates a conflict of interest. It will significantly undermine public trust, as independence is removed. Will vulnerable people who have suffered harm or poor experiences in the health and care system really have faith in a system headed by a director in the Department of Health and Social Care, which is the very organisation running the system that caused them harm in the first place? On a local level, will they have faith going to the same ICB that oversees the providers that have failed them? One need only look at the long list of maternity failings in Mid Staffs to see that internal functions can fail catastrophically. We know all too well that the NHS default is sometimes to cover up. The public knows that, too, so independence is everything.

Healthwatch has been keen in spotting and exposing challenges in the health service, such as widespread failures in the NHS referral process, yet there will be no incentive for the new system to investigate such issues, which are invisible in the main NHS performance metrics. The system does not always know what questions it needs to ask, so an independent route for unsolicited feedback is important. We also think that the provisions disadvantage hard-to-reach communities and those who may have a distrust towards the NHS and public authorities, making it harder to gain the feedback and concerns of those communities. That risks inadvertently further baking in inequalities.

More widely, clarity has not yet been provided on how those functions will be funded. The reform is coming alongside major reductions in ICB running costs. Healthwatch currently receives almost £26 million a year; that is already 60% less in real terms than the original DHSC estimate to fund the network. There is a risk that the money will be absorbed into wider budgets and never spent on the patient experience infrastructure. If people want to see the value of Healthwatch, they need look no further than the Cabinet Office briefing notes on the King’s Speech, which reference a May 2025 Healthwatch report on missing medical records to make the case for the single patient record.

Fundamentally, the Government are conflating patient voice with patient involvement in decision making. While greater patient voice in commissioning and decision making is needed, it is not a replacement for the advocacy and other functions of Healthwatch, which helps vulnerable people to navigate a complex health and care system and performs signposting functions. Splitting local healthwatch functions across ICBs and local authorities once again separates health and care and reinforces existing gaps between them. As we know, many issues span both areas and need a joined-up investigative approach. How will the new model ensure a joined-up view of people’s experiences across the NHS and social care? We urge the Minister to reconsider this decision. We have seen overwhelming support for Healthwatch across the sector, and it is becoming increasingly clear that many people in the NHS and the medical profession think that this is a huge mistake.

Healthwatch England has played a central role in escalating the findings of local healthwatch organisations and in advocating nationally. We have three examples. The first is the call to publish research highlighting inequalities in waiting times for disadvantaged groups, and for a demographic breakdown of waiting lists, which the NHS obliged with last summer. The second example arose after Healthwatch Sunderland supported a patient with a learning disability who had received accessible screening information but risked missing care because of inaccessible follow-up letters. Healthwatch England raised that gap with national bodies and highlighted inconsistencies in communication, and, as a result, the national easy-read templates were introduced across the cancer pathway, which improved accessibility and reduced risk. The third example is that Healthwatch feeds back patients’ horrific stories of corridor care—including that of a pensioner who was left in a corridor—to NHS leaders, and lobbies for increased transparency and oversight when it comes to corridor care.

I have several questions in three forms. Is the Minister genuinely sure that a director of patient experience in DHSC will be eager to advocate for patients and flag issues at a national level given that they will essentially be flagging to their bosses where work is not up to scratch? Is she sure that the level of persistence that has so often been needed to advocate for change at a national level would be forthcoming from a director employed by DHSC? What will be the mechanism for escalating local concerns that indicate national or systemic issues?

Will the Minister explain where the Government envision the new director sitting in the DHSC structure, and what the reporting lines will be? How will the Government ensure that they have the resources and sense of operational independence to investigate and raise concerns nationally? Healthwatch England has often flagged issues to MPs and to the Health and Social Care Committee as a way of applying pressure on NHS leaders and Ministers to enact change.

[Joe Robertson]

I am a member of the Health and Social Care Committee, and the hon. Member is absolutely right to say that Healthwatch England raises issues with us. When the Department assumes those roles and functions, I very much doubt that it will be as keen to disclose such issues to the Committee.

[Dr Chambers]

The hon. Gentleman must have read the next line of my speech. We are concerned that a DHSC employee appearing before that Committee will not clearly and openly state whether DHSC is failing.

New clause 78

“would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care”

in 2013-14. We do not just want to protect Healthwatch; we want to strengthen it. As I mentioned, it receives almost £26 million a year, which is spread over 153 organisations. In real terms, that is about 60% less than the £43.5 million that DHSC originally estimated would be needed to fund the network. The Healthwatch network does such amazing work—I will not go through it all again—despite being underfunded compared with those original estimates. Imagine the work it could do if it was adequately funded.

Even more worryingly, there is still no clarity on how Healthwatch’s functions will be funded once they have been transferred to the new system. Given the ongoing constraints and cuts to ICB running costs, there is a real risk that the funding for Healthwatch will simply end up being incorporated into wider ICB budgets, and money for the patient experience infrastructure could end up being cut entirely. The new clause aims to ensure that the Healthwatch network is properly funded, but it also raises the point that, if this change is to go through, funding for patient experience infrastructure must be protected. Otherwise, the Bill risks not just weakening patient experience, but removing it altogether as the funding gets swallowed by wider NHS operational demands.

--- Later in debate ---

There are some problems. The new clause mentions complaints but, although I fell into this trap when talking a moment ago, Healthwatch does not really deal with complaints; it raises issues and systemic failures that can be brought up through the system. Likewise, I am concerned that nothing in the new clause covers what happens once the Government have done their impact assessment. Even if the impact assessment comes back and says, “Actually, this has been a terrible idea,” the Government cannot do anything and, to be honest, once they have abolished these things it will be extraordinarily hard to pull them back. I have a lot of sympathy for the new clause, but unfortunately it will probably not achieve what the hon. Member for Rugby and I want.

[Joe Robertson]

It is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone.

The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health. They should be the ones bringing patient voice to the heart of decision making—I am sure that they do, of course—and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that.

That different purpose is this: some of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that comes with an independent organisation providing patient voice. We have heard how the Select Committee and MPs, in their free-ranging Back-Bench function, benefit from hearing that voice through an independent organisation such as Healthwatch England, because it allows them to fulfil their scrutiny function. This is not just about decision making; it is also about scrutiny of decisions once they have been made. What will the Select Committee, MPs and journalists do when they no longer have the light shed by that independent voice?

As my hon. Friend the Member for Farnham and Bordon has pointed out, representatives who are employees in the Department of Health and Social Care rightly have other overriding primary duties to the employer—the Department itself. Let us ensure that patient voice is articulated by those who do not have a primary obligation to their employer, but have an obligation to an independent organisation with functions that serve solely to amplify and project the voice of patients.

There are a number of issues with the abolition of local healthwatches, but I will save that for the next discussion. I want to make the wider point that there is a centralisation issue here too. Whether the Government like it or not, this measure will centralise powers into the Department; it will take outside powers from Healthwatch England and bring them in-house. That is nothing short of a centralising measure. The Minister needs to address the justification for that, because the more negatives there are to this decision, the more we need to understand the positives. So far, they are light indeed, or she has failed to articulate them. I think that there is a reason she has failed to articulate the positives: they simply do not exist.

I look forward to the Minister’s response. I urge her to take some more interventions, because the arguments she has given to the Committee in her speeches at the end of each discussion have tended to raise more questions than they have answered. We can only deal with that by intervening on what she says.

[Karin Smyth]

I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell.

I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously.

I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different.

The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them.

The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention.

On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.

--- Later in debate ---

The Government have relied heavily on one review. The Committee has heard from those who work with patients, represent patients and speak for patients, and their message has been clear: “Preserve independence.” If Ministers believe that Healthwatch can be improved, please improve it. If they believe consistency can be strengthened, strengthen it. But let us not abolish the only statutory body whose sole purpose is to represent patients independently of those who commission and provide NHS services, because once that independence is lost, it cannot be recreated. For those reasons, I hope that the Minister will reconsider.

[Joe Robertson]

The Government’s proposal to abolish the independent voice of patients is a mistake. It is a backward step, and I have seen no compelling reason why it should happen. Apparently, the voice of patients is going to be realised through integrated care boards and local authorities themselves, but that is not an independent patient voice. The very point of independence is that that voice is represented through an organisation that has no other function—no other skin in the game other than to represent that voice. It is remarkable that the Government are taking this step.

I suspect the Minister will say—she has already given a number of reasons—that this is happening in order to bring the voice of patients closer to those who make decisions, but that is not the function of Healthwatch. If she wants to achieve those things, she can achieve them while maintaining Healthwatch as an independent patient voice.

That independent voice ensures not only better decision making, but more effective scrutiny of decisions that have been made, and it does it by ensuring there is no blending or conflict of interest within a certain organisation—the decision maker. It does it by ensuring that light is cast on the critique, the scrutiny and the voice of patients, and that that process takes place outside the closed doors of, in this case, the integrated care board, not behind them.

I suspect that the Minister will say that the system is not working, because there are too many good reports by Healthwatch that sit on a shelf and have not been implemented. I would far prefer for us all to be able to see reports that have not been implemented sitting on a shelf and try to do something about them than for the patient voice to be heard behind closed doors and not acted upon. That is the inevitable conclusion from this merger—this abolition of the independent patient voice.

I want to talk about my experience on the Isle of Wight of the important work that our local healthwatch does. It assists me in my role as a parliamentarian and representative of the people, which is to scrutinise the decision-making of my local integrated care board and others, by providing the objective and unfiltered voice of patients through data, statistics and records, all of which will be lost within the ICB when this abolition takes place.

Guess who is often on the sharp end, or who is often critiqued by the evidence provided by Healthwatch? It is the ICB itself. Therefore, it is no wonder that Professor Croisdale-Appleby, the chair of Healthwatch England, agreed with the characterisation that this looks like the ICBs or other bodies marking their own homework. They will get to decide which part of the patient voice is acted upon, and which part is ignored, without the public gaze or scrutiny that is provided by an independent report that decision makers, parliamentarians, local councillors and the independent media can also use.

I will give a particular example from the Isle of Wight. Not so long ago, the integrated care board for Hampshire and the Isle of Wight proposed to reduce funding for Mountbatten hospice on the island and to redistribute that money to the mainland—it was, in my view, outrageous. The integrated care board had all the information available at its fingertips to realise that that was a bad proposal, and it had all the patient voices and views that it could possibly come across to realise that it was a mistake. It did not first consult representatives, such as me, my neighbour the hon. Member for Isle of Wight West (Richard Quigley) or local councillors, before making its proposal.

It was then Healthwatch’s data on the views and voices of patients, which had already been gathered, that helped the hon. Member, local councillors and me to make an argument against the proposal, directly to the ICB, in the media and to councillors at county hall. Without the tools that Healthwatch provided, it would have been so much harder to make that case. The ICB backed down on that proposal, but, if all that infrastructure, and all the information that Healthwatch independently provided, had sat behind closed doors within the ICB, we would not have had the opportunity to make our case and reverse the decision. That is one of the many thousands of real-life examples across the country where the affected patient voice was aired and properly used to reverse a bad decision, and it is an ability that will be lost.

Another issue is the fact that the centralisation of powers will inevitably water down the patient voice. There are over 150 local healthwatch branches, but there are not 150 integrated care boards. In the case of the Isle of Wight—I use that as an example because it is my own patch, but it will be the same situation up and down the country—we have our own Healthwatch Isle of Wight, which represents the unique insight and views of patients on the island. If those powers go to the integrated care board, that will cover Hampshire and the Isle of Wight, a population nearly 10 times as big. Our unique patient voice will be watered down into the patient voice of Hampshire; while the Hampshire patient voice is equally valid, that will nevertheless reduce the unique insights of smaller populations all over the country by including them in something bigger.

Particularly unique to my constituency and Isle of Wight West is health travel—that is, the reality of having to cross the Solent on a ferry to access so many health services. That is something that Healthwatch Isle of Wight uniquely understands through its direct consultation and work with island patients. Indeed, the people who work for our local healthwatch and its trustees are islanders. They do not just get it because they hear it; they get it because they live it. If that entire function is taken up to the Hampshire and Isle of Wight level, that unique insight will be lost. The ICB may give some regard to the cost of ferry travel and the implications of the disruption caused by having to travel on a ferry in order to access a hospital service that is not available on the Island, but its decision making will be much devalued in weight if it does not have the unique, independent patient voice coming from the Isle of Wight via our Healthwatch.