Scotland's health councils have always looked enviously across the border to England and Wales, where community health councils are up to 40 per cent better funded for their work.
But with devolution drawing close, the Scottish Association of Health Councils believes it may finally have made the breakthrough.
A new funding formula being developed with the Scottish Office 'will mean more money in the pockets of health councils', says SAHC director Patricia Dawson. And that in turn looks set to give health councils a higher profile.
In the meantime, elections for the Scottish Parliament are due as early as 6 May 1999. 'It is getting very close and there is a lot of thinking to be done, ' says Ms Dawson.
'Under a Scottish Parliament, there will be greater opportunities for the roles and responsibilities of health councils to be strengthened.'
SAHC is working hard on performance and accountability issues in particular. 'We want to make sure there is plenty of evidence about how health councils can make a real difference, ' says Ms Dawson.
'If we can work smarter, be even more locally focused and be vibrant and dynamic, there are real opportunities in the new structure of primary and acute trusts for us to deliver meaningful patient and public involvement.
'Health councils must be seen as a major resource for health boards, trusts, local authorities, voluntary and charitable organisations, facilitating community networks and feedback.'
SAHC has been looking at the role of health councils ever since a review of their work in 1996 by former Ayrshire and Arran health board general manager Jim Eckford.
The Eckford report highlighted three areas which needed to be tackled:
the appointment of health council members;
job descriptions and grading of chief officers;
performance, accountability and funding.
To tackle these, SAHC wants to create a partnership between health boards and health councils to develop appointments. It is also devising a code of conduct for health council members and producing a members' handbook.
The second issue is being tackled by a working group, though work on a core job description and new grading structure has had to be put on hold until the Scottish NHS human resources strategy is published in the next two months.
SAHC will also be developing core standards for health councils and a performance monitoring framework.
Ms Dawson took the helm of SAHC in 1994, after working in nurse management including a secondment to the information directorate of the NHS in Scotland, where she produced a nursing IT strategy review.
Under her direction, SAHC is about to publish its most major piece of work yet, on information for patients and the public about illness and treatment.
The report, to be launched on 20 April, looks at the available literature on what types of information patients want and need, how this information can be delivered and what impact it has on health gain and patient satisfaction.
Ms Dawson hopes the review, carried out with the independent research organisation, Scottish Health Feedback, will help policy makers to define practical steps to improve the quality and accessibility of patient information.
'There is an assumption that the health service in Scotland is awash with information, ' she says. 'We feel there are a lot of good intentions but very little structure to take forward the issues, particularly using the Internet and the patient partnership work developed by the King's Fund.'
The launch of the review will be followed by a seminar to help health councils identify how the government's commitments on patient information, spelled out in the Scottish white paper, Designed to Care , can be taken forward.
So far there has been a 'cautious approach' to these issues by the Scottish Office, although it has funded publication and dissemination of the SAHC review.
'But our view is that, if the NHS doesn't start developing the policies and structures to support good quality information-giving to patients and the public in Scotland, we are going to be left far behind, ' says Ms Dawson.
'The patient partnership strategy in England, and similar work, is making a significant difference to the culture and attitude of health authorities and trusts in terms of their willingness to engage with CHCs in developing innovative ways of finding out what patients want.
'We want health councils to be as well-placed to support and undertake similarly innovative consultation work in Scotland.'
But, although she remains optimistic about what health councils can contribute under a Scottish Parliament, Ms Dawson also recognises 'that we are not everyone's cup of tea'.
And, so far, there has been no indication from Scottish health minister Sam Galbraith of how he sees the future for health councils.
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