Exploring the work and organisation of local Healthwatch in England: a mixed-methods ethnographic study

Giulia Zoccatelli*, Amit Desai*, Glenn Robert, Graham Martin, Sally Brearley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background: local Healthwatch organisations are an important part of the landscape of health and care commissioning and provision in England. They are a key means by which users of services are given voice to influence decisions about health and care commissioning and provision decisions.

Objective: to explore and enhance the operation and impact of local Healthwatch in ensuring effective patient and public voice in the commissioning and provision of NHS services.

Design: mixed methods including: a national survey (96/150 responses, 68%); ANT-inspired ethnographic data collection in five local Healthwatch (75 days fieldwork, 84 semi-structured interviews, 114 virtual interviews and observations during the COVID-19 pandemic and documentary analysis); and serial interviews about experiences during the pandemic with 11 Healthwatch staff and 4 volunteers who were members of a Healthwatch Involvement Panel (which also guided data collection and analysis). Finally, we ran 5 Joint Interpretive Forums to help make sense of our data.

Setting: our five Healthwatch case studies are of varying size and organisational form around England.

Results: we found significant variation in the organisation and work of Healthwatch nationally, including hosting arrangements, scale of operations, complexity of relationships with health and care bodies, and sources of income beyond core funding. Key points of divergence that were consequential for Healthwatch activities included the degree of autonomy from host organisations and local understandings of accountability to various constituencies. These gave rise to very different modes of operation, and different priorities for enacting the nationally prescribed responsibilities of Healthwatch locally. Large variations in funding levels created Healthwatch organisations that diverged not just in scale but in focus. As the Covid-19 pandemic unfolded, Healthwatch found new approaches to giving voice to the views of the public and formed effective relationships with other agencies.

Recommendations: we identified generalisable principles of good practice regarding the collection and communication of evidence. Policy implications relate to (a) the overall funding regime for Healthwatch and potential inequalities in what is available to local populations, and (b) the development of Healthwatch’s role given the evolution of local health and care systems since 2012.

Future work: Explore (a) the consequences for local Healthwatch of the development of ICSs, (b) Healthwatch in an international comparative perspective, (c) how the response to the COVID-19 epidemic has reconfigured the voluntary sector locally and (d) how Healthwatch respond formally and informally to a newly-emerging focus on public health and health inequalities.
Limitations: The survey only sought self-reported information on impact and we were unable to recruit a Healthwatch which hosted several contracts
Conclusions: the diversity of the Healthwatch network belies its otherwise unitary appearance. This diversity – especially in differential funding arrangements – has considerable implications for equity of access to influencing health and care planning and provision for residents across England.

Funding details: this project was funded by the National Institute for Health Research (NIHR) Health Services & Delivery Research programme and will be published in full in XXX Journal; Vol. XX, No. XX. See the NIHR Journals Library website for further project information.
Original languageEnglish
Number of pages225
JournalHealth Services And Delivery Research
Publication statusPublished - 22 Nov 2022


  • Healthwatch
  • Patient & Public Voice
  • Patient and Public involvement
  • Ethnography
  • Actor Network Theory


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