Government proposals to abolish community health councils (CHCs) have proven more controversial than ministers could have imagined. Labour backbenchers are threatening a rebellion over the proposals, the London Assembly has come out in favour of maintaining CHCs and the health councils themselves are appealing strongly against closure.
The controversy over this move could scupper government plans, contained in the health and social care bill before parliament, to give councils the power to scrutinise the work of the NHS. MPs are primarily worried about the patient advocacy and liaison service, outlined in the same bill, which they believe could lack independence. But if the thought of a backbench revolt scares the government into a climbdown on abolishing CHCs, ministers could choose to defer, alter or scrap their entire package of NHS scrutiny reforms.
CHCs were set up 25 years ago as independent bodies with powers to take up complaints from patients. Their ability to highlight poor practice in the health service has since drawn the anger of successive governments, but CHCs as a whole have also been accused of patchy performance, and this has led to their planned abolition. Health secretary Alan Milburn claims his proposals will ensure greater independence of patient representatives from health trusts and boost patient power.
The Local Government Association (LGA) is this week emphasising that CHC abolition and council scrutiny do not have to go hand in hand. A report from officers to the association's ruling executive says: "Widening scrutiny responsibilities does not necessarily mean that CHCs have to be abolished. The two factors can be treated quite distinctly. Indeed, a refocusing of CHCs to become the voice of the patient and user while local authorities scrutinise the overall service would seem a sensible distinction."
The LGA report asks the association's leadership to consider throwing the association's weight behind a campaign to maintain CHCs in a different form. LGA chairman Sir Jeremy Beecham responded: "I don't think a campaign is what's called for. We've got to be clear about what we want doing in the area currently covered by CHCs. The question is whether the patient advocacy role is better based within the NHS or whether some sort of freestanding arrangement is needed. That may or may not be around some form of residual CHC."
The new scrutiny power is important to local authorities because it represents a vital tool in the government's "community leadership" agenda for councils. This is already seeing some authorities redefining themselves as all-purpose problem solvers for their residents. Local government argues that the new scrutiny role will help address the much-vaunted "democratic deficit" in the NHS, while simultaneously giving councils an opportunity to more powerfully represent the views of their communities.
Fortunately for councils, there has not so far been any sign of softening in the government's line toward CHC abolition. But that does not mean that every one of around 700 full-time health council employees faces unemployment. LGA health chair Rita Stringfellow says the government should ensure the expertise of those workers does not go to waste and suggests some could become external advisers to local authority scrutiny panels.
The idea will provide scant comfort for many of those working in health councils, but it does emphasise the LGA's message on this issue. As Sir Jeremy puts it: "It's too easy to blur the distinction between these issues. Whether we maintain CHCs is a different issue from council scrutiny."
