The health sector is vast and often enough we have little understanding of what other colleagues are actually doing. We rely on brittle connections like upper management or software platforms in order to be able to work together. One of the aims of Vital Signs is to create more common knowledge about our conditions, e.g. what is it like to work and struggle as a hospital admin, a medical student, a medical engineer or a NHS IT worker. But we also want to think about how to strengthen the confidence of patients to speak up and demand better care. When patients feel isolated they often take their frustration out on the first health care person they see, on nurses, health care assistants or receptionists. We have to support each other and create collective ways of fighting for better conditions. The interview below with a friend who worked for Healthwatch sheds a light on the margins of the NHS and on the interaction with patients. 

I started working at Healthwatch during Covid. Healthwatch was set up by the Conservatives about 12 years ago and was meant to operate as an independent voice for patients across health and social care. We would go out and gather patient experience from the whole county. The results would then be put into reports that make recommendations to healthcare settings, which they’d largely ignore. Healthwatch itself was wildly inconsistent, down to the local level. We had 13 employees, some local units might have two employees or be completely run by volunteers. And the activity that people would do would be very different, some only doing ‘co-production’ of campaigns with patients, others only focus on patient feedback.  

A month after I left the job, the Labour government announced that they were going to scrap Healthwatch. Allegedly it was pretty ineffective. Half the funding for the organization and for my role in particular, was publicly funded. As an organization, we would then top the rest up by doing project work for various organizations, for example NHS Trusts. So ultimately it was also public money. The Trusts might want us to do a piece of consultation work or a survey about a particular new service or a new ward. Quite often these contracts came in at the end of the year and it seemed that they had some money to burn on external project work. 

Patient surveys

We would go to GP surgeries, care homes and hospitals, as well. Talk to people outside or in waiting rooms or on wards. It was interesting having quite open conversations with patients. The questions were pretty standard. We’d ask everyone to write and grade their experience between 1 and 5. And other than that, we try to not ask too many leading questions, unless it was like a commission piece of work.  

It was pretty eye opening in terms of the discontent amongst the public and patients when it came to healthcare. This was fairly universal. There were differences in attitudes depending on what kind of socioeconomic group you were talking to. In a well-to-do little village, peoples’ attitude was always more entitled, for example, about their inability to get appointments. The way they spoke about the staff was a lot worse. In deprived coastal towns people were also frustrated, but they seemed a lot more generous towards the staff. There are two things going on there. I think one is that there’s more of a shared class experience amongst the staff and the patients, but also that the poorer patients are just used to not getting good service.

The problem was that you heard about some really awful experiences that people had within the health system, but there wasn’t really anything you could do about it. As a result you felt like you were wasting your time and their time. You would give feedback that people were not happy with the lack of appointments at the GP surgery, but what can the GP do about it? They don’t have enough staff.

We would have only this one contact with the patients and that was it for the most part, which is something I really didn’t like about the work. I came from community development work where you’re really rooted in the community. Then those exchanges were obviously almost always based in negativity. The surveys would also be uploaded on to our website, which is publicly accessible. And a report would get sent to the surgery. It was never made clear to me what to do if something was particularly shocking. You would feed it back to more senior people in the organization, but it felt like nothing came of it. 

Healthwatch as an organisation and employer

I am not sure why the Tories set up Healthwatch, as it doesn’t seem like a Tory thing to do, at least on the face of it. It was like its precursor, which was called Community Health Councils. I guess previously these patient feedback structures were part of the NHS and then they became outsourced.

Healthwatch was part of the voluntary sector, but in each area the local Healthwatch group worked differently, even down to their governance structure. In our area there were 13 of us, and that included the chief exec and deputy exec. They basically turned everyone into managers because there was no other way of promoting people. So in the end each manager managed just one other person. With the micromanagement there was a bit of toxicness in the air, but nothing really extreme. We never had a union. There was an attempt to push the whole organization to adopt a four day week, which some of my colleagues got behind. The chief exec was positive about it but what he meant was condensing hours and intensifying the work. 

There was generally a pretty high turnover of people, as well. What I would say, though, is that the wages were pretty good for the voluntary sector. Especially for the work output that was expected. When I left in 2025 we were on £28k to £29k.

The Labour government decided to disband Healthwatch around the time when they said they would dissolve NHS England. I think one of the reasons was that Healthwatch is a Tory creation. I do think there’s a level of pettiness. Something that has been created by the rival party is replaced with your own thing, that maybe just performs the same function. It’s the same with the restructuring of the Integrated Care Boards. At least in my area, they’ve cut the staff by 50% and now they’re merging the two counties in my area. Perhaps they now want GPs or Trusts to do their own patient surveys, but for objectivity reasons, it would make sense to have an external organization that talks to patients. Or use the Family and Friends Test.

The impartiality thing is significant. When I was speaking to patients, as soon as they knew that I wasn’t with the surgery, they’d open up a lot more. The same happened at the hospital or whatever the setting was. Because people are worried that being honest about their grievances would have an impact on that care that they receive, especially in care homes. On the other hand, I feel that often these kinds of feedback are also a way to individualise patient discontent. And even patient discontent is contradictory, as sometimes it’s really like an entitlement, not taking into account the condition of care workers and of other patients.

Patient discontent and organising

There is a need for collective patient organising, but I think it would take a bit of work, because it’s generally against the cultural grain. The culture of individual complaints is partly reinforced by organisations like the one I used to work for. But there were examples of collective resistance, for example when they closed down a rehab unit in the community in a coastal town. That decision was made by the Integrated Care Board (ICB) or the county council. A lot of people in that area were quite up in arms about it, they were organising protests. More senior people in my organisation said that these protests would have no chance to change things. So it was interesting that the protests were then backed by local trade unions and the trades council in the area. It actually gathered strength. Like the defence of the women’s hospital in Liverpool, the dentist practice in St.Pauls in Bristol and other small examples. 

There’s the challenge of how these protests relate to the care staff. There were instances, especially in rural communities where everyone in the village knew each other. They’d call public meetings because they were so pissed off about the GP surgery and kind of gang up on them. Also as a result of that the GP couldn’t retain staff and the practice manager would be coming to these meetings saying “We’re trying our best, but your behavior is causing all the staff to quit.” It’s the extreme breakdown in relationships between local users and staff that feels newer to me. I think that aggravated during Covid. Covid threw so much into disarray and so much trust has been lost amongst the public, too. Most people you talk to have got some pretty grim story about themselves or someone they know: unable to get a doctor’s appointment; or maybe something quite serious has been missed; or have to pay private for a quite expensive surgery. 

Organising in that regard is difficult. You could do outreach in a radius around a GP surgery. But as soon as you go up a level in the layer of health care provision, even up to a community hospital, the catchment is so big that creating a network of patients becomes much more of a challenge.