The Conservatives created them in England and Wales without appreciating their full potential. Labour neglected, belittled, callously fragmented their functions and then destroyed them in England as an afterthought in the NHS Plan, despite widespread agreement that they could and should have been reformed and refocused. But in Wales , Community Health Councils (CHCs) survived.
It’s time England learned a lesson about this. As Carol Jones, Director of the Board of CHCs in Wales wrote recently in the Cardiff Western Mail, CHCs have never been more vital as that country embarks on a new approach to its heath services .
A Welsh lesson would be timely with a new Government on the horizon. MAC believes now is the time to recover our inheritance, dust off the organisational memory and move on. In effect reinvent CHCs for England. This isn’t a homage for just doing things as before. First and foremost, we must keep the expanded health and social care remit of LINks, which is the one good thing to come out of Labour’s chaotic “reforms” of patient and public involvement.
England needs unified geographical authorites to integrate local commissioning of health and social care. We also need local statutory consumer bodies mirroring the health and social care commissioning spectrum. Their job would be to co-produce, enable, articulate and advocate based on the views of the public, users, clients and carers. To start fleshing out this role, we’ve identified the following chacteristics of “CHCs Mark 2”:
- comprehensive strategic and collaborative remit with NHS and local authorities balanced with attention to quality and detail of service delivery which matters to patients, clients and carers
- professional staff to continuously engage with their communities, co-produce intelligence for action and support their members
- sufficient real budgets including recognition and reward for lay people’e time carrying out public duties
- access to all premises and services where publicly-funded patients and clients go
- one stop complaints and redress advice across health and social care
- visibility on the high street as well as the web
- national operational standards and an independent regulator and auditor to ensure probity and compliance
- independence in governance and funding from the services scrutinised
- democratic control and accountability to local people for their policies and actions
- access and rights of referral to overview and scrutiny bodies and ministers when issues cannot be resolved locally.
Rights and influence are the trade off for responsible and accountable behaviour. We want new-style CHCs in England to be the informed and critical friends of the statutory services. Too often in some places in the past they were allowed to become the neighbours from hell in confrontational relationships with local services. A governance approach reflecting the suggestions above would go a long way to ensure that did not happen again.
MAC would like to see people elected to new-style English CHCs as independent members without party affiliation for the individual contribution they could make because of their knowledge, skills, local networking and other attributes. Public money should fund election hustings and “town meeting” type events where candidates would be voted on to CHCs and where on a regular basis reports would be made back to the public about the body’s activities. It is good that the NHS in England now has a statutory duty to listen and engage, but without a stronger voice the listening ear is just an appendage. Let’s try some real localism for a change, because centralism doesn’t work when it comes to getting things down “down our way”.
As Carol Jones rightly observed, “If we want to avoid another Mid Staffordshire catastrophe, learning from the Welsh experience and building on it for the English NHS and social care system seems an obvious way to go.” Let’s not quibble over names; it is roles that matter. Whether it is called “Healthwatch” or something else, a new-look English CHC rose by any other name would smell as sweet, so long as it was up to the job.