Bring back Community Health Councils

Press release 3/5/06

The Government are expected to announce proposals on Patient Involvement by early June. The SHA has learned some of the details of what is proposed:

Section 11 of the Health and Social Care Act 2001 – the duty of consulting the public – is to be widened to include social care and a list of things which must be subject to consultation is to be included. The consulting body is to be obliged to make a public response to the consultation.

The various health and social care regulators – Healthcare Commission, CSCIE (And perhaps other bodies like the GMC) are to be shown to be regulating on behalf of users and mechanisms are to be provided where users are to be involved in the regulating (not clear how exactly)

Patient and Public Involvement Forums as we know them will not survive. The new bodies – perhaps to be called Local Involvement Networks – will not have powers of scrutiny or inspection, because other bodies already have those powers.

These new Networks will essentially be voluntary organisations. They would have some rights. They will have members, who may be individuals or local organisations, and be run by a management committee. There could be conflicts of interest for organisations providing services – or hoping to be doing so – but this can be managed on the basis that there would be many competing interests. They will be funded directly (not clear who by – perhaps by some other Government Dept) at a level of around £150,000 pa. The money would be managed by one of the member organisations – perhaps the local CVS. This would be enough to have an office and some staff. We think there will be one Network for each of the new PCTs, of which there will be 131, with populations ranging from 131,000 in Torbay to 1.25 million in Hampshire.

The Director of the SHA, Martin Rathfelder, said “It is now clear that the abolition of Community Health Councils was a mistake. The elaborate and expensive machinery which replaced them has not delivered an effective voice for patients. It would be a good move for the Government to show that it understand this by calling the new organisations which are to be set up Community Health Councils. That was a term which more people understood. Bringing the term back into use would be mark a sensible apology to the thousands of volunteers who devoted a lot of time and energy to protecting the NHS from 1974 to 2003 and an invitation to them to come back and join this renewed organisation. The Government must learn that volunteers cannot be ordered about. If they want the 5000 members of Patient Forums to join the new organisations they are proposing they need to show a little humility.

There is a lot to welcome in these proposals. It is very important that there is a credible independent local body to speak for patients in every area. Although Patient Forums have done some very good work the way they are organised means that they are almost invisible. They don’t have an office or a telephone to call their own and they don’t control their own budget. There are so many of them that most individual forums are very small and weak, and there is no regional or national structure to enable them to share experience or come to a common view. Most importantly there is no national voice accountable to patients, so self appointed bodies like The Patients Association can claim that they speak for patients, when actually they are only speaking for themselves.

We hope that the Government will make the development of a credible independent national voice for patients an important part of its strategy. That way there will be someone to back Patricia Hewitt up if she wants to claim again that the NHS has had its best year ever. The people who are now claiming the NHS is in crisis are the staff, and their view of the NHS may not be the same as the view from the receiving end. But this strategy demands genuine independence. No-one will believe a patients organisation if it is under the control of the Department of Health, so it is important that the money and any management support for Networks is insulated from political pressure, and that regional and national organisations are accountable to local Networks, and not the other way round.

In a more market based NHS the local Networks are likely to be crowded with local organisations looking for contracts to run services. The same Nolan Principles which apply to other public bodies should apply. There will need to be clear rules governing their constitution. We suggest that the first is that every person who is a member must reside in the PCT area. That will make it harder for large organisations with paid staff to dominate the Networks.

We would like to see proper reports of information about complaints going to the local Network – making it clear what is being complained about while maintaining the complainants confidentiality.

The local Network will need to work closely with the local Council’s Scrutiny Committee and should have the power to take action if the Committee’s responses are inadequate. It should not be assumed just because Scrutiny Committees are filled with elected politicians that their operation cannot be challenged. The work of the Committees, like that of the NHS, is often excellent but sometimes poor.