The government has been forced to make substantial concessions over patient involvement and representation in the first significant departure from the NHS plan.

The shift comes in the wake of pressure from Labour backbenchers over the Health and Social Care Bill as it reached its report stage on Wednesday.

The proposed abolition of community health councils and their replacement by a plethora of new patient involvement structures had been the most contentious part of the bill in the Commons and throughout the committee stages.

But the government was expected to support two compromise amendments tabled by Labour Commons health committee chair David Hinchliffe yesterday following eleventh-hour negotiations.

The amendments would not prevent the abolition of CHCs, but address widespread concerns about the disjointed nature of the government's proposed patients' forums - which would be established separately in every trust - as well as the independence of CHCs' successor bodies.

Mr Hinchliffe told HSJ: 'These are two new clauses that I believe take account of the concerns of most people.'

Under his proposals, patients' councils will be created as umbrella bodies grouping together patients' forums. The councils would have 'a comprehensive overview' of a local health economy, including primary care and would include an independent advocacy service, Mr Hinchliffe said.

The amendment states that the patients' council would facilitate co-ordination of the forums' work, make reports to health authorities, local authorities and the health secretary, and provide independent advocacy services for patients.

Members of the council would be appointed by two or more local patients' forums.

The second amendment ensures statutory provision for independent advocacy services to support patient complaints.

Provision of the service should 'so far as practicable be independent of any person who is the subject' of a complaint or 'involved in investigating or adjudicating' it.

Mr Hinchliffe said the clauses 'could be fine-tuned in the Lords'.

Association of CHCs for England and Wales director Donna Covey reacted cautiously to the compromise amendment which coincided with a lobby of Parliament against CHC abolition.

Describing the amendments as 'a step forward', she said they still left 'abolition of CHCs on the face of the bill'. 'The answer is reform not abolition, ' she added.

London Health Link chair Elizabeth Manero said: 'The introduction of an independent advocacy duty on the health secretary is excellent.'

But there was still a long way to go before the bill met all the needs of patients, particularly in relation to services provided jointly by the NHS and local government, she said.

Ms Manero welcomed the patients' councils as 'a sensible idea'. But she warned that the skills to make the proposal work would be lost, 'because they're getting rid of CHCs' staff and members'.

The amendments created a good jumping off point for the Lords to make further changes, she said.

Other measures in the Health and Social Care Bill were expected to clear the Commons without significant opposition from the Labour benches.

The full report stage debate on the Health and Social Care Bill will appear on