Oral - Consultation on the future of Community Health Councils in Wales

The statement concerns the consultation on the future of community health councils in Wales, which began on 30 January and closed on 24 April.

The consultation was designed to generate debate on a number of important principles relating to CHCs and on how the interests of the public and patients are represented in the health service. The challenge facing CHCs is to demonstrate how they will develop a strategic relationship with the new local health boards, achieve far more local involvement within communities and with partners, ensure that they are involved in continuous engagement with service issues, and not just when there is a service change, scrutinise the way in which services are planned and delivered by local health boards, as well as those services at the interface of health and social care service provision, and, in challenging any proposed service change, consider the changes within the current priorities, resources, statutory frameworks, and governance structures, and make constructive and realistic contributions to the process.

At the closing date, 319 responses had been received. They will be published in full on the website. I received replies from all the CHCs in Wales and the CHC board, from Assembly Members, Members of Parliament, community and county councils, voluntary sector groups and members of the public. In addition, during the consultation period, my officials held 15 consultation events across Wales, and around 500 people attended in total. I am grateful to everyone who took the time to respond or to attend a meeting. The proposals have therefore received a thorough airing and have generated a considerable amount of debate, which is encouraging.

It seems clear from the replies that there is no real consensus on how CHCs should be structured in order to balance locally-held views with the need to engage with strategic issues, and the seven local health boards will need to address that issue. It came as no surprise that CHCs responded vigorously to the proposals, often in defence of their current arrangements. There was concern that having seven larger CHCs would represent a centralisation of power that would move decision making away from local communities. There was also considerable opposition to the idea of area associations.

In a number of responses, anxiety about a loss of local power and influence outweighed more positive engagement in responding to the changed landscape of the NHS in Wales. However, I was heartened by the supportive comments received from other respondents, including some current CHC members and staff, some former CHC members, and other organisations, who were clear on the need for change if CHCs are to continue to prove an effective way of representing the interests of the public in the restructured health service.

Overall, while there were differences about the practical action, the principle of strengthening the role of CHCs in order to give patients a more powerful voice in the world of the new LHBs received a great deal of support. That support, of course, still leaves open the discussion on how best to find a practical way forward in which CHCs can continue to represent the interests of local communities while also being able to operate effectively within the wider context of the new health boards.

Having listened carefully to what has been said, and in the absence of any strong consensus around any one particular model for change, and I am persuaded, for the time being, that CHCs should be allowed to develop proposals for joint working and be given time in which to demonstrate that they can work together. That will require the collaboration of those CHCs that lie within each proposed LHB area. I will therefore be asking all CHCs to come forward, by the end of July, with proposals for joint working that will be operational by October, and I will expect to see workable solutions. The CHC in Gwent will be able to carry on largely unchanged, as it is already working this way. Clwyd CHC operates with the same structure as Gwent, but it will need to work with the other CHCs in north Wales to determine a way forward in its relationship with the Betsi Cadwaladr University LHB.

I will also exempt the Powys CHCs from these immediate requirements because of the particular issues under discussion between the county council and the local health board, although I will expect them to continue to develop joint working as they would normally.

It will now be up to CHCs to develop the model that they feel will work in their area, whether through the creation of a joint committee or other mechanisms that can be accommodated within the existing legal framework. These proposals need to demonstrate that CHCs can deliver on the important principles that I outlined at the beginning of my statement, namely of striking a balance between the strategic and the local, systematically gathering a diversity of views, and scrutinising health service plans appropriately and proportionately. CHCs will have to draw on all their member and staff resources to achieve that, and I want them to be creative and imaginative in doing so.

We will also be looking at what help and support they may need in achieving those aims. I will review the arrangements after six months of operation to see whether they are working. During that period, I will expect CHCs to look for ways of working together more efficiently and to release funding, which CHCs should use more effectively to deliver their functions. If it is possible for administrative functions to be combined and provided jointly, it should be done. If offices can be merged, that should be explored. That is no different from our expectations of the NHS or the rest of the public service in these difficult financial times. Should I determine that these arrangements are not working, I will revisit the need to legislate for more the formal restructuring of CHCs, likely to be along the lines that we see in the Gwent area.

However, there are still changes that I propose to make arising from the recent consultation, on which it was evident that agreement was reached. In particular, there was support for the all-Wales board of community health councils to be made smaller and more manageable. I propose therefore to amend the regulations to reduce the number of members on the central board from the current 28 to 11. CHCs, acting jointly as we envisage, will send one representative to the board, making seven representatives in total from the CHCs across Wales. That will be an active demonstration of how successfully they are working together.

I will proceed with my plans to make the director a member of the central board. The director plays a key role in ensuring consistency of standards and performance within CHCs, and, as a consequence, needs to play an equal part in decision making. For now, I will delay my plans to appoint the CHC board chair and vice-chair, and I will put forward further proposals for CHCs to select them from the whole membership. However, I will expect those selected by the CHCs for these roles to show real leadership and visibility in bringing CHCs along within the new-look NHS. Following a further period of consultation, I will lay regulations before you in due course to cover these matters. I am grateful to all those who responded and look forward to a constructive period ahead.