Bigger isn't always better - Community Health Councils could be the future of an open and accountable NHS

Written by Jenny Randerson and published in Western Mail on Sun 3rd Aug 2008

In the dying hours of the Assembly term, the Health Minister made a startling announcement. The initial stages of her consultation into plans to reconfigure the health service had come back and there seemed to be one thing that almost all respondents agreed with, that Local Health Boards did not have a future. LHBs were set up during the Welsh Lib Dem/Labour partnership agreement at the beginning of the decade. I am happy to put my hand up and say that I supported their creation at the time. The NHS had become too unwieldy and distant from patients. Decisions were being made in a way that was completely unresponsive to local needs, at a great distance from patients and in a way that took no account of varying concerns of patients from one end of a Health authority to the other. The other great strength of the LHB system has been the sharing of boundaries between LHBs and Local Authorities which has allowed much better joint working to plan services and reduce bed-blocking.

I readily accept that LHBs have not achieved everything that was hoped and after a lot of reflection, my own submission to the consultation argued that they should be removed. As a Liberal Democrat, I was desperate to find a way to ensure that any change in system with bigger health organisations did not completely destroy any chance of local voices being heard in a democratic and accountable way. For me, there is a clear way of achieving this vision under the proposed new system. Wales' 22 Community Health Councils or CHCs have consistently achieved a high level of community and patient involvement in planning and providing NHS services. CHCs were created in 1974 to provide a voice for patients and the public across the NHS. They were abolished in England in 2003, with very little debate or discussion, but Wales has fortunately gone its own way in choosing to keep the organisations.

Edwina Hart has indicated that she is in favour of keeping CHCs, and despite calls to cut the numbers by the Tory assembly group, it seems that she will avoid this action. Despite their pretence of supporting patient and community representation, it appears the Welsh Tories still have a long way to go to distance themselves from their English Cousin's mantra of "cuts, cuts, cuts".

We must accept that the NHS will face difficult challenges in the coming decades. An ageing population coupled with the arrival of ever more expensive, life-saving drugs will make its sustainability an increasing challenge. I believe the only way that these challenges can be met is by moving to a system more responsive to local needs and demands. If we allow further centralisation of the NHS, it could lead to the great organisation being irrevocably holed below the waterline.

CHCs are essential, now more than ever in stopping the centralisation of health services. I would like to see patients voices strengthened through the CHCs. This will require more powers for CHCs, and , it will also require more personnel and resources to use those powers effectively. The Labour/Plaid Assembly Government has proved itself over the last year to be an instinctively centralising force, what better way to try and disprove that theory than by using the reconfiguration to once and for all, make the NHS a genuinely open and accountable service based on local needs. The way to achieve this is through Community Health Councils.