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FRONT LINE FIRST-SOCIAL SERVICES

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Look forward to looking into the NHS ...
Look forward to looking into the NHS
Many accept there is a need to modernise the systems for safeguarding patients' interests - particularly in light of the move towards integration with social services and the plans for making NHS governance more patient-centred.
Arguably the separation of the purchasing and providing functions of the NHS and the transfer of community care from the NHS to means-tested social services already questions the validity of a community health council model more than 25 years old.
The NHS plan clearly rendered this model obsolete, but the government has had difficulty in persuading enough MPs that the system replacing the community health councils is a step forward.
Health councils were established in the wake of the major NHS and local government reforms of the mid-1970s. Along with joint consultative committees, joint care planning teams and joint finance - all of which have now disappeared - they were established to ensure continuity between social services and the health services during the period of major transition. Health councils have proved to be very resilient and have survived several reforms of the NHS.
Councils in particular have been anxious to reduce health's democratic deficit. The potential of overview and scrutiny committees to monitor the performance of both health and social services is becoming increasingly popular with councillors, as opposed to a quasi-independent statutory NHS watchdog. This is particularly true where health councils are aligned with health authority boundaries spanning several councils.
Yet the government's alternative arrangements for dealing with patients' concerns have been unclear and this has fuelled suspicion that they lack bite.
The proposed patient advisory and liaison services to be established for each NHS Trust and primary care team or group has been particularly harshly criticised as being more of a tame poodle than a vigilant watchdog. There are doubts about how representative patients forums are. The precise role of the independent local advisory forums or patient councils is far from clear.
Genuine concerns about these elements of the government's proposals have detracted from the more exciting prospects offered by central funding for patient advocacy services and by councillors' scrutiny of the local NHS.
Admittedly councils will not enjoy the rights formerly enjoyed by community health councils to hold up major NHS changes while they are referred first to the region and ultimately to the secretary of state, but hopefully the new spirit of partnership between local government and the NHS, backed up by a robust system of backbench scrutiny replaces adversarial decision making with a more modern and civilised process.
Despite the decision to drop the abolition of health councils from the NHS Social Care Bill in order to get it through Parliament, it now seems likely this will form part of a new NHS Reform Bill scheduled for the next Parliament.
It is not possible, at this stage, to ascertain the likely implementation date for these changes, but this should not deter councils from getting on with the task of developing systems for scrutinising health services.
JOHN BEER
Director of social services, Southampton City Council
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