Community health councils are furious about being shut out of the national plan consultation process. Lynne Greenwood reports from ACHCEW's conference

How public is public involvement in the national plan for the NHS? Patient watchdogs are not impressed. The experience of Donna Covey, director of the Association of Community Health Councils for England and Wales, sheds some light on her organisation's input into the plan.

ACHCEW was assured that its views, as representative of the public interest in the health service, 'would be particularly helpful' in discussing the project's first phase. The NHS Executive set a deadline of 12 June.

With three days to go, Ms Covey logged on to the national plan's website to e-mail the substantial submission put together after much hard work by CHCs and ACHCEW. The message she received, dated 9 June, read: 'The online consultation for input into the national plan has now ended.

However, we are still interested to hear your views.'

Ms Covey told the story at ACHCEW's annual conference in Harrogate last week to delegates already disappointed to learn that junior health minister Gisela Stuart had cancelled her speech because of 'Whitehall commitments'. Although ACHCEW and individual CHCs have been involved with interviews and meetings at various stages in the national plan's development , Ms Covey said they alone did 'not constitute public involvement'.

Cynical observers might suggest the plan could target CHCs as ripe for reform; successive governments have revamped the rest of the NHS many times, but the councils are mostly unchanged since 1974.

Ms Covey wants CHCs to be at the heart of regulating the health professions. A major motion called on the government to introduce an effective system of measuring doctor performance, to end self-regulation by doctors and to introduce a system of independent public scrutiny on the outcome of their work.

Proposed by David Owen, chief officer of Tameside and Glossop CHC, in whose area mass murderer Dr Harold Shipman practised, the motion also called for GPs' independent contractor status to be replaced by a salaried system within the NHS.

Mr Owen said: 'Rebuilding public trust in doctors must emphasise that patients have the right to be critical.

The message that goes out from government about the NHS should be, 'It is right to tell'.'

While the motion - minus its original wording 'in light of the issues raised by the Shipman murders' - was passed, an amendment requesting that the government consider the ending of single-handed GP practices, described by one delegate as 'dinosaurs', was defeated.

Discussion centred on their value in rural communities in particular and to patients who prefer the security of one doctor's long-term knowledge of their health. The debate also dwelt on the difficulty of ending independent contractor status at a stroke, rather than the more practical 'phasing in' of new, young salaried doctors.

CHCs are keen to muscle in on primary care groups, and part of their submission to the national plan suggested that CHCs be given statutory responsibility for carrying out the public function on behalf of PCGs, primary care trusts and local health groups (in Wales) or at least have the right to receive reports on what public involvement work has been carried out.

The same submission highlighted the need for the private sector, whose role in reducing waiting lists is under discussion, to be open to the same scrutiny as the public sector.

And of course that should include access to information for CHCs. What else would ACHCEW say?

Brave hearts: suing the NHS The health service complaints system deters all but the bravest souls, according to ACHCEW director Donna Covey. Now the threat of legal action from health professionals is creating yet another barrier to smooth passage through the minefield.

A survey of CHCs found that almost one in five had faced the threat of a defamation case, the majority involving GPs, opticians and dentists.

The ACHCEW report Fair Comment: how the threat of defamation undermines the NHS complaints system includes details of the cases of one GP who contacted a patient at home and threatened to sue her because she had made a complaint, and another who sent a letter threatening legal action so intimidating that the complaint was withdrawn.

It also includes the cases of a CHC chief officer who, when asked by a local newspaper to comment on a complaint that an out-of-hours GP service had failed to visit a sick child, responded that, if true, it was a cause for great concern. When the GP co-operative complained to the NHS Executive regional office and signalled its intention to sue the CHC for defamation, the CHC wrote to the newspaper explaining its position and apologising to the doctors.

Still not satisfied, the co-operative demanded a full-page advertisement and apology.

The CHC refused and the matter was taken no further.

'Such threats are extremely worrying as complainants will usually have no recourse to legal support, ' says Ms Covey.