The separation of Westmorland and Furness from Cumbria created the newest Healthwatch in England, launched on 18th October 2023. Squeezed between regulators, local authority scrutiny, and democratic organisational accountability, Healthwatch occupies an awkward position as both patient and consumer champion in the National Health Service (NHS). This awkwardness is amplified by Cumbria’s geography, which has distinct historical communities with differing service priorities to the north and south. Within the south, these are divided between west and east. This paper uses the creation of separate South West and South East Community Health Councils (CHCs) from 1974 until their unification in 1982 as South Cumbria to explore patient and community representation in the NHS.