Feature

Life in the old watchdogs yet

The NHS changes have brought change to every level of the service — including community health councils, says Dave Lee

Was there ever a golden age for community health councils (CHCs), a time when the mere sound of the CHC secretary’s footsteps was enough to strike fear into the heart of every area administrator?

More importantly, are CHCs now in greater danger than ever before of being blown off course by the harsh winds of the internal market?

The truth is that in some ways CHCs are a hangover from the 1974 re-organisation of the NHS. The NHS management executive’s attempt to draft guidance recognising that CHCs now relate to a world very different from that of the 1970s was, frankly, poor.¹ It is also already out of date and a further document has been promised for over a year. All that we have discovered is that the establishing bodies — regional health authorities — are to be merged and then abolished.

Some CHCs have come in for criticism for wavering from the one true path: unconditional opposition to the closure of any bed, any laundry or any box binder in the NHS. Barnet CHC merited a full page in the Guardian not long ago over accusations that they had been taken over by the Tories.²

Buckland has carried out a fascinating study which identifies five types of CHC:³

• ‘independent challengers’, which are often excluded from decision-making processes;
• ‘health authority partners’, which do not always take the side of the consumer;
• ‘independent arbiters’, not primarily interested in complaints and not necessarily on the consumer’s side;
• ‘patient’s friends’, working for individual consumers, not consumer rights, and usually excluded from decision making;
• ‘consumer advocates’which use existing structures and are partly involved in decision making.

Health authorities are now being encouraged to take on many of the roles previously associated with CHCs, such as doing surveys and visits, and gauging local people’s views.⁴ CHCs are no longer regarded as the sole legitimate representatives of local opinion and health authorities are looking to other organisations and individuals to provide them with information.

While many CHCs — especially in London — are deluged with ‘consultation documents’ the days of the old style consultation/CHC counter proposal/appeal to the Secretary of State are long gone. This process — however unsatisfactory — was the nearest that many CHC members got to feeling that they had some influence.

When the 1989 white paper Working for Patients was published there were fears that CHCs were on the chopping block. As well as the Poll Tax, there were other nasty plans the government planned to try out in Scotland first, and at one point Minister for Scotland Michael Forsyth seemed seriously to be looking at replacing Scottish local health councils with ‘directors of consumer affairs’. This never came to pass, and in fact CHCs have apparently found themselves in high regard at the centre since the early 1990s.

I attended an excellent conference last October organised by the Labour party’s Central Region, which involved a number of non-party delegates. I found that the image of CHCs among Labour party members interested in the NHS was quite poor. By and large, they regarded their local CHCs as having ‘gone native’, failing to represent local opinion for fear of losing influence. I pointed out that half of all CHC members are nominated by the local council, and asked what they were doing to improve the quality of nominations to CHCs. Unfortunately very few CHCs can claim to be representative of their locality in terms of the proportion of their members who are from ethnic minorities, have physical disabilities or are aged under 30, for example.

Now is clearly not the time for CHCs to become complacent. One particular question I think CHCs should ask themselves is what they can provide — whether to the community or to health authorities — which other organisations cannot. The list could be a long one, including invaluable experience in dealing with complaints and representing local views to health authorities.

So CHCs are not dead — far from it. Their existence has never been more important, even if, for example, we can no longer temporarily veto the closure of four plastic surgery beds at our local hospital. But what CHCs urgently need is an influx of knowledgeable and active members. Perhaps healthmatters readers could lend a hand?