The demise of the Community Health Council what will replace it?

There has been a CHC in Bristol since the early 1970s. The present CHC was founded in 1993 by the amalgamation of 4 smaller CHCs. It eventually became the biggest CHC in the country. Funding was via the Department of Health. The CHCs were abolished on December 1st. 2003.

The CHC was set-up to represent patients. Until recently there were 30 lay members. Some were nominated by 3 local authorities (political nominees). Others represented local voluntary sector organisations and some were appointed directly by the Secretary of State for Health via the regional office. The CHC had a budget of £235,000

Three or 4 years ago there was a feeling that there needed to be more attention to the changes in the NHS. The NHS Plan, published in July 2000, abolished the CHCs. However, there was no blueprint at that time and no clear idea of what any replacement organisations would do or would look like. The new structures have been partly designed to satisfy parliamentary dissatisfaction in the current structure. After much discussion we have ended up with a jigsaw. During the last 3 years there has been planning blight and the CHCs have had little opportunity to influence events.

The new organisations are largely untested. Mr Jones was not aware of any pilot studies. \"The new scheme looks as if it has almost been drawn up on the back of an envelope.\"

In the past, the NHS had a duty to consult the CHCs about major changes. If the CHCs were not satisfied they had a right to approach the Minister of Health.

The new changes may be summarized briefly as follows:-

The responsibility for expressing opinions on proposed changes has now been taken over by the Local Authority which has health overview and scrutiny committees. Thus, for Bristol any proposed changes by the Strategic Health Authority (SHA) will be scrutinised by the Bristol Health Overview and Scrutiny Committee of the Council. If it is unhappy about what is proposed, it can refer the matter to the Secretary of State for Health via the Independent Reconfiguration Panel. This consists of a mixture of medics, lay people and managers who will write a report for the Secretary of State for Health. Tony Jones thinks that this plan may work. However, the crucial factor will be the delay involved. Good public involvement takes a lot of time. The previous arrangement whereby the CHC had the power to refer the matter to the Secretary of State direct was quick. The present arrangement is likely to be much more cumbersome.

The Reconfiguration Panel has a General Practitioner Chairman. There was an interview with him in the Health Services Journal - 6 months ago.

a) Every Trust will now have a PAL (Patient Advisory and Liaison Service). This is really a troubleshooting service. The idea is to get complaints settled before they are embedded in a formal complaints mechanism. There have been pilot studies which show good patient satisfaction with this procedure. At the moment the UBHT has one full-time PALs Officer and others who work with her. The NBHCT has 3 PALs staff. Their background is mainly in mediation and counselling. Mary Adams is the PALs Manager for North Bristol Health Care Trust .

Tony Jones felt that altogether this was a good initiative.

b) If the complaint cannot be resolved it can be referred to ICAS Independent Complaints Advisory Service. This has no relation to the NHS. It is now recruiting staff. It will support patients with their complaints and go through the process with the patient.

The Claimant can still go to Law at any point. Tony Jones emphasised that this process is evolving.

Until now Trusts have not been compelled to consult the public. They must now do so. TRUSTS MUST BE ABLE TO DEMONSTRATE THAT THE PUBLIC HAVE BEEN CONSULTED BEFORE ANY PROPOSALS ARE FINALISED. They are also required to consult them when proposals are being formulated. This is thought to be a powerful lever for change within the NHS. However it is totally untried (the appropriate legislation was contained in the Health and Social Care Act of 2001 which is apparently the key Act in regard of all the above matters).

From December 1st 2003, each NHS Trust will have a Patients Forum. This will be a statutory body and it will be composed of lay people. Its functions relate to scrutiny and monitoring of Trust activities. It can visit and inspect every part of the Trusts premises and it can look across a wide range of Trust activities which may be of relevance to patients. Members will be appointed by the Commission for Patient and Public Involvement in Health whose head office is in Birmingham. It will also have local offices.

The new organisation will provide more comprehensive public input than existed with CHCs. It is unclear as to whether or not it will mesh. For instance, it is unclear who will do the campaigning if patients do not like what is planned. At the moment, the Patients Forum is the only body that can do this. The problems with the new system can be summarised as follows:

The system is untried. It is complicated and the bits may not work together. It could greatly slow down decisions making. It could produce major tensions between different organisations and groups.

A report of the CHC 2001-2002.

A summary of the new changes proposed by the Commission for Patients and Public Involvement in Health. {RLH notes this seems to be a very valuable document.}

Dying with dignity Palliative Care in Bristol May 1999.

Childrens services in Bristol August 1998

Experiences of older people being discharged from Weston General Hospital January 2000

A review of day case surgery in Bristol May 1996

Developing appropriate health services on the Bournville Estate in Weston-super-Mare.

Perceptions of health care from people with learning difficulties and their carers September 1998.

Moving people from hospitals to houses January 1997.

Health Services for children with severe disability/illness living in the community December 1996.

The review of cancer services in Avon July 1997.

A variety of news letters.