Wales to abolish Community Health Councils – can it avoid the mistakes made in England?
On Monday, the Welsh Government published its long-awaited Bill to abolish Community Health Councils (CHCs). The Health and Social Care (Quality and Engagement) (Wales) Bill replaces 40-year old CHC machinery for patient and public involvement with a new ‘Citizen Voice’ for health and social care.
Insofar as the replacement body will cover both the NHS and social care, the change is very welcome, but if the ‘abolition of CHCs’ sounds familiar, it is because fifteen years ago, the English tried the same trick. Managers were fed up with those they saw as local interfering busybodies inspecting NHS facilities (unannounced – what affrontery!) and generally being unco-operative when it came to service changes, that the then Labour Government was persuaded to wind them up. What followed was a case study in how not to manage change. First they invented Public & Patient Forums, which were not Forums but Committees, only for them to be castrated in infancy and replaced by something called Local Involvement Networks – called LiNKS – which were Forums – but actually couldn’t be called that!
LiNKS was hobbled from the outset. Ministers decided not to specify how these new creations would work. Each one therefore spent about eighteen months trying to work it out, and some never managed it. In no time, they were gone – to be replaced by Healthwatch, which seven years later, are still just about finding their feet. For about five years, the NHS was not subject to effective public/patient (as opposed to Council) scrutiny. It is this mistake that the Welsh Government risk repeating.
This is because no-one quite knows how the new ‘Citizen’s Voice’ body is meant to work. It will have 7-9 members – all appointed by the Government, and with as vague a general power as can be written into legislation! Indeed it can “do anything which is calculated to facilitate, or which is conducive or incidental to, the exercise of its function.” Just as well, because abolishing CHCs leaves some significant gaps in the checks and balances needed for the NHS (and now, social care) to retain public support.
One of these has been to act, in effect, as a statutory consultee for substantial changes to services. The current Guidance for engagement and consultation on changes to health service in Wales specifies in great detail the powers of the CHCs and their right to challenge Local Health Boards’ proposals for change. Instead the new national body merely has the right to ‘make representations’, whatever that becomes. Another potential gap is the local representation which was built into the CHC model. Will members of the CHC in South west Wales, including elected members from its Councils, feel confident that the interests of local people in Maenclochog will be sufficiently heeded by the 7-9 national members of the new body in Cardiff, and be sure that it will make adequate ‘representations’ to whichever body is about to take an unpopular decision.
Critics of the change will naturally focus on the irony of Ministers appointing those to act on behalf of the public. The arrangements for CHCs were not much better, but at least local Councillors were also members. The bigger worry is that responsibility for consulting the public becomes even more blurred.
Unless the Welsh Government has up its sleeve a cunning plan to repeal the requirements to involve and consult the public, the statutory duty to consult still rests with Local Health Boards. They are the decision-makers, and they have to conduct a lawful consultation – not always easy; witness the procession of claimants to the High Court arguing that such exercises have been unfair. There still is no exact parallel requirement for social care. Yet a key feature of the Bill is to require the new ‘Citizen’s Voice’ body itself to engage with the public and ascertain its views. The Explanatory notes to the Bill are quite effusive about it:-
This body will have to use the full suite of engagement tools that will be at its disposal to ensure that it reaches large numbers of people to seek their views about health and social services matters. These tools could include online tools such as polls and consultations; engaging with the large number of third sector organisations that also have interests in this area and face to face meetings with citizens. (per Par 102 on p30).
The Body will be able to use all modern methods of engagement, in particular online tools such as online consultations, polls, discussion groups and deliberative polling. Alongside more traditional engagement methods such as face to face meetings and cross-sector working this should ensure the Body reaches citizens in far greater numbers, which is a key goal of these reforms, to maximise the authenticity of the citizen voice. (per Par 108 on p33)
The CHCs could also have undertaken this role (strictly speaking, secondary consultation – meaning that a consultee seeks views from its own members etc in order to respond to a consultation) but never had the budgets or the skills to do so. Is the Welsh Government serious about funding the new body so as to be able to undertake these expensive activities? And dare the Government appointees ask the public’s views on a really controversial service change like centralising Maternity or Accident & Emergency services?
None of these reservations are, of themselves, fatal to the new regime. They can be fixed if the Government is serious about making the new arrangements work. Supporters of the old CHCs should accept that their abolition is inevitable and seek to make the best of the new legislative framework. Nevertheless Ministers should be careful saying ‘Goodbye’ to several hundred sincere, public spirited people who have tried hard to represent their communities for years on local CHCs, only to be replaced by a small Government-appointed quango. There are suggestions that the new body will recruit local volunteers and maybe establish local committees, but none of this is in the Bill, and is left for the new Body to decide for itself.
That’s where the parallel with the ill-fated LINKs is most exact. Let’s hope history will not repeat itself.