Local government scrutiny committees Health authorities will have a duty to consult local councils on "proposed major changes to service development" - hospital closures, ward closures, and so on. County and unitary councils (which have responsibility for social services) will "lead" on the scrutiny committees, although ministers have promised that district councils will be "involved". Guidance will be issued to ensure that scrutiny is properly coordinated where a health authority covers two or more councils. Scrutiny committees will have representatives from all parties. Where the committee decides that health authority proposals are "not in the interests of local people" it can refer them for a ruling to a new independent national reconfiguration panel (made up of clinicians, patients representatives and NHS managers).
Patients' forums Each NHS trust and primary care trust will have a patients' forum with powers to "monitor, review and inspect all aspects of local health services from the patient's perspective", including hospitals, nursing homes, private hospitals, and GP and community services. The forums will be statutory bodies made up of both individual patients and representatives from patient groups (for example, the Multiple Sclerosis Society) and voluntary organisations (for example, Age Concern). All members will be appointed by an independent NHS appointments commission. Each forum will have the power to appoint a non-executive director to the board of the organisation it monitors. According to health secretary Alan Milburn, patients' forums will be "wholly independent". He said: "Patients' forums will not be managed by the trust, they will not be funded by the trust and they will not be answerable to the trust NHS trusts will have to answer to the patient forums."
Patient advocacy and liaison services (PALS) These services - described by Mr Milburn as "an entirely new tier of service in the NHS" - will be run by patients' forums. PALS will have "the knowledge and clout to sort out problems" for patients (such as filthy wards, discharge arrangements, or mix-ups over waiting lists) before they "escalate into serious complaints". PALS will have the power to take concerns directly to trust chief executives, and the "power to negotiate immediate solutions". Although PALS will be a part of the trust, the patients' forum will be able to recommend that advocacy services are run independently from the trust.
Patient councils Labour backbencher David Hinchliffe persuaded the government to accept amendments to the health and social care bill which would enable the creation of what he calls patient councils. These would act as umbrella bodies to co-ordinate individual patient forums (see above) in order to provide, in Mr Hinchliffe's words, "a comprehensive overview of the work of the (NHS) trusts." Patient councils would also host independent patient advocacy services (see above) where patient forums decide that they should not be run by local NHS trusts. Patient councils will also have the right to scrutinise primary care - a right not held by CHCs.
A new complaints system Unlike the current procedure, where complaints are handled by the body being complained about, there will be "when necessary" an independent advocacy service in each area to support complainants, possibly provided by local authorities. The complaints system is under review, but ministers are keen to make it more responsive to patients and "less adversarial" with the aim of reducing the number of negligence complaints against the NHS.
National patients' organisation Not in the NHS Plan, but backed by Mr Milburn, the national patients' organisation will act as an "umbrella body" for patients' organisations, with a brief to train patient representatives on local patients' forums, to spread good practice and lobby government on issues affecting patients - a kind of NHS confederation for patient groups. Feasibility work is being carried out by three patient and consumer groups: the Long term medical conditions alliance; the patients' forum (no relation to the proposed new NHS patients' forums); and the College of Health. Funding is expected to be supplied by the Department of Health.
