For the first time, patients will have a place at the top table

Rarely have I read such an ill-informed piece of journalism as Anthony Browne's article "Milburn eats up patients' rights" (19 February). Browne cites the government's plans to abolish community health councils (CHCs) as evidence of a determination to undermine patients' rights. When most people say there is a need for patients to have more rights, Browne bizarrely defends the status quo. It is precisely this form of complacent conservatism that put Labour on the back foot throughout the 1980s and 1990s.

It is true that the local CHC did help parents at Alder Hey when the scandal about retained organs broke in 1999. The problem is that, by then, the scandal had been going on for a decade or more. Because patients had a strong voice only on the outside of the local NHS, rather than on the inside, nothing was done.

Community health councils deal with a complaint only after the event. By then, it is often too late. New patient advocacy services are needed instead in every trust to nip problems in the bud before they occur. And where a complaint cannot be sorted out on the spot, the Health and Social Care Bill says there will be independent advocacy services to help patients in every area.

The bill will also ensure that patients are better represented within the NHS. All trusts will have a statutory independent patient forum made up of local patients. They won't be appointed by me - unlike some CHC members - but by a new, independent appointments commission.

The forums will be able, for the first time, to appoint a patient to the trust board - so giving patients a seat at the top table in every community. The forum will have rights to call snap inspections - to check that wards are clean, for instance - and the trust will have to show it has responded.

Browne says the forums were an afterthought. In fact, we announced them last July in the NHS Plan.

The plan also set out new rights for patients, and greater representation for patients - not just in local trusts, but on the General Medical Council, the Commission for Health Improvement and the new independent national bodies dealing with appointments to NHS bodies and changes in local NHS services.

So should Anthony Browne be trusted? You would be better off trusting Hannibal Lecter to cook your dinner.

Alan Milburn
Secretary of State for Health

Community health councils were set up in 1974, and both society and the NHS have moved on. While CHCs indulge in playing the role of the self-righteous victim, committed consumer activists are clear that they have had their day. Many find it ironic that their current high-profile campaign doesn't concern patient issues, focusing instead on self-preservation. And, contrary to Anthony Browne's assertions, the independence and legal rights of CHCs have always been minimal.

All CHC officers are accountable to civil servants in the regional offices of the NHS Executive. CHCs have never had national terms of reference, agreed core services or developed national quality standards. Their limited remit does not stretch to primary care, where 90 per cent of patient encounters with the NHS take place. At least the proposed patients' forums will have new powers in this area.

Arguing that CHCs played a pivotal role in the Bristol, Harold Shipman and Rodney Ledward scandals is disingenuous. These situations festered on for years, due to the past inertia of the Royal Colleges and the General Medical Council. I'm no fan of state centralism, but patients have never had real rights. So two cheers for Alan Milburn. But no cheers for Browne, who needs to do his homework.

Annabelle May
London W12

In mounting the sustained assault on patient and citizen power in the NHS in England, which Anthony Browne describes, Alan Milburn made a mockery also of the internal processes of the Labour Party in England. Between the annual conferences in 1997 and 1999, there was an extensive process of consultation on health policy, which culminated in a final document being agreed in Bournemouth. That document committed the party to review community health councils with a view to enhancing that role.

So we are left with the remarkable situation where coalition administrations in Cardiff and Edinburgh appear to be more willing to carry out agreed Labour Party policy in this instance than does a Labour government in London with a huge majority in the House of Commons. What price "Partnership in Power" now?

Donald Roy
London SW15

This article first appeared in Please, sir, we girls want some more

2001-02-26