{"id":1236,"date":"2026-07-29T07:00:09","date_gmt":"2026-07-29T07:00:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1236"},"modified":"2026-07-16T09:09:43","modified_gmt":"2026-07-16T09:09:43","slug":"the-health-bill-mends-one-link-in-the-complaints-chain-and-weakens-another-by-vsevolod-shabad","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2026\/07\/29\/the-health-bill-mends-one-link-in-the-complaints-chain-and-weakens-another-by-vsevolod-shabad\/","title":{"rendered":"The Health Bill mends one link in the complaints chain and weakens another. By Vsevolod Shabad"},"content":{"rendered":"

A patient’s complaint could change something only if four things hold together: it is easy to raise, it is handled properly rather than lost, the body that receives it has a reason to act on it rather than bury it, and someone independent can check that it did. The <\/span>Dash Review of patient safety<\/span><\/a>, published one year ago, is right that the first link is broken: the system is “highly fragmented”, patients face “a confusing landscape where they do not understand who to complain to and how”, and more than 70 different types of channel or organisation now offer a place to leave feedback. Clearing that clutter is the right repair. But the current <\/span>Health Bill<\/span><\/a> works on the link already getting attention and leaves the rest alone. Worse, its restructuring weakens another: the incentive to act when a complaint is about the body’s own commissioning decisions. So, the question that matters is not how many channels a patient must navigate, but <\/span>what makes an organisation act on a complaint about its own choices, rather than quietly set it aside?<\/span><\/i><\/p>\n

Dr Dash does not ignore the other links. She finds that most NHS boards, unlike other consumer-facing organisations, have no executive director for patient or user experience, and recommends one within the Department of Health and Social Care to improve how complaints are handled. She proposes the external check too: that the Care Quality Commission assess whether every ICB and provider is listening. And she makes a deliberate choice about where the listening should sit: Recommendation 5 folds Local Healthwatch’s healthcare functions into the engagement work of ICBs and providers. What her review does not do is test how that choice affects the reason a body has to act. Once the ICB is the body doing the listening, the complaint most likely to be set aside is the one about the ICB’s own commissioning.<\/span><\/p>\n

The risk is specific, not universal. Most complaints are about the care a provider gave, and those routes do not change here. It is the smaller, higher-stakes stream, feedback that names an ICB’s own commissioning or prioritisation choice, that loses its independent carrier. (Staff safety reporting has the same shape: in my <\/span>Rapid Response<\/span><\/a> in April, I argued that more reporting pipelines never cure a failure at the filter.)<\/span><\/p>\n

The Health Bill, now before a Public Bill Committee, enacts that choice: it abolishes Healthwatch England and Local Healthwatch and moves the local healthcare listening role into the ICBs (and providers) that commission and deliver care. Independence was only one of several imperfect checks on why a complaint goes unactioned (capacity, culture, legal caution, sheer volume). External routes do remain (the Ombudsman, the CQC, judicial review), but they act late and at a distance; none is a real-time carrier of the local, commissioning-critical feedback that Healthwatch was there to move. Removing that carrier does not prove conflict of interest will dominate. It does leave conflict as the residual explanation that is hardest to rule out whenever commissioning-critical feedback stops at the executive layer and never reaches the board.<\/span><\/p>\n

This is structural: no bad faith is required. Any organisation that both makes a decision and receives complaints about it will tend to settle those concerns internally, before they travel far. ICBs do have non-executive directors and quality committees whose role is to challenge. But a quality committee sees a summarised assurance pack, not the raw account that names a commissioning choice the board itself signed off. The instinct to fix a concern quietly and locally is a good one. It is also what can stop a board from ever learning that a pattern exists.<\/span><\/p>\n

Dr Dash anticipated part of this. Her review asks the CQC to test whether ICBs are “listening effectively”. But where that is scored mainly on the engagement materials an ICB prepares, it can rate an ICB well and still never be able to trace whether the feedback most threatening to those ICB\u2019s own decisions ever reached the people accountable for them.<\/span><\/p>\n

For the boards reading this, the first move needs no new law. Raw complaints cannot be published: they are given in confidence, and that confidence is the basis on which anyone raises a concern at all. But they do not need to be published. What a board needs is for its non-executives to see the commissioning-critical substance before the executive has summarised it away. The way to stop that from becoming another labelling exercise is to take the definition out of the executive’s hands: the audit or quality committee, not the engagement team, sets what counts as commissioning-critical, with a default that anything naming a board-approved commissioning or prioritisation decision is in scope unless a non-executive agrees it out. Those non-executives hold a standing right to a small random sample of the raw feedback (a handful of cases a quarter, not casework), so they check the log against the material rather than take it on trust. In public, the board reports the anonymised themes and confirms the sample was done. That is the difference between assurance and intelligence.<\/span><\/p>\n

Two further controls matter. Non-executive sight is internal: it is how a board refuses to let the conflict hide in the executive summary, but it is not the independent carrier that Local Healthwatch was. That external role is the one Dr Dash already named. The CQC’s assessment should trace a sample that the ICB cannot pre-select (either feedback tagged to a named commissioning decision or drawn at random from raw submissions) through to the board papers to see whether it arrived and what followed. And Parliament should ask, before the transfer, which of today’s reasons for inaction the new structure makes worse, and which control is meant to catch each, with an owner and a review date rather than a paragraph of reassurance. None of this removes the conflict; a body cannot be made fully independent of itself. It makes the filter visible and puts someone accountable for it.<\/span><\/p>\n

The clutter is real and clearing it is worth doing. But mending one link in a chain does not make the chain hold. Simplifying how feedback is submitted and testing how an organisation acts on bad news about itself are two different tasks, and the Bill has addressed only the first. <\/span>If your non-executives cannot, without the executive’s permission, see the last three pieces of feedback that criticised a commissioning choice the board signed off, the listening function has already been filtered, whatever the Bill does to the channel map.<\/span><\/i><\/p>\n

Author\u00a0<\/strong><\/p>\n

Vsevolod Shabad<\/strong><\/p>\n

\"\"<\/p>\n

Vsevolod Shabad is a Fellow of the BCS, and a researcher affiliated with the University of Liverpool. He specialises in governance failure and decision-making in complex organisations, with experience across critical infrastructure, healthcare systems, and regulated sectors. The views expressed are those of the author in a personal capacity. Advisory enquiries via <\/span>www.vshabad.com<\/span><\/a>.<\/span><\/em><\/p>\n

Declaration of Interests<\/b>
\nNone.<\/span><\/p>\n

Generative AI and AI-Assisted Technologies in the Writing Process<\/b>
\nDuring the preparation of this work, the author used Claude (Anthropic) to improve readability and language quality as a non-native English speaker. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the publication’s content.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

A patient’s complaint could change something only if four things hold together: it is easy to raise, it is handled properly rather than lost, the body that receives it has a reason to act on it rather than bury it, and someone independent can check that it did. The Dash Review of patient safety, published […]<\/p>\n

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