An attempt by Conservative peers to reform and strengthen community health councils rather than allow the government to abolish them failed after Liberal Democrats changed the stance they had maintained for two years and decided to abstain.
The defeat in committee stage of the Tory amendment on the most controversial part of the National Health Service Reform and Health Care Professions Bill - by 117 votes to 90 - means the CHCs will be replaced by a clutch of new organisations, some staffed by NHS employees, others appopinted centrally and some based on local authorities. This, said Conservative health spokesman Earl Howe, meant the independence and transparency of the present system would be lost, confusing patients and the public.
Earl Howe's amendment would have meant the health secretary, after consultation with appropriate organisations, laying regulations before parliament for the reform and strengthening of CHCs to ensure patients had an independent voice and watchdog within the NHS. CHCs required modernisation because, while some worked well, others did not. However, they provided the best model so far seen for patient representation with the potential to do an effective job.
He said government proposals were fragmented among new types of body - including in-house patient advice and liaison services in acute hospitals; in each trust there would be a patients forum; and the local authority overview and scrutiny committees, who would perform the scrutiny function of the existing CHCs. But to make a complaint people had to go to the independent complaints advocacy service, which will not be a unified service, said Earl Howe, but provide by a range of separate NHS organisations.
But drawing everything together and overseeing patient involvment nationally, and reporting to the secretary of state, will be the new Commission for Patient and Public Involvement.
Liberal Democrat health spokesman Lord Clement-Jones said he had a great deal of sympathy with Earl Howe's criticism of the government's proposals. Forums will not be independent of trusts and membership would potentially be too much under the control of ministers, and they will have limited powers compared with CHCs. Even the cost of the system had been estimated to be 10 times that of the current system.
Eighteen months ago Liberal Democrats might have supported the amendment, he explained. Some people might still prefer CHCs to be reformed, rather than being abolished and having something new in their place.
'We believe that patients, the public and the staff of the CHCs would be better served by agreement on definite proposals in this Bill, rather than waiting for a scheme to be devised over the next 12 months', added Lord Clement-Jones.
'One-fifth of the membership of the CHCs has fallen away. Staff morale is getting lower by the day. We need to make decisions soon about the new patient and public consultation and representation structure, otherwise valuable expertise will be lost to us'.
He said during the Bill's continuing committee stage, Liberal Democrats would explore whether the government could agree with opposition parties on a scheme to establish patient councils as a one-stop shop for patients and public, and as a powerful voice in the NHS for the local community.
Hansard 11 Apr 2002: Column 531-591;609-672