Community health councils have largely failed in their role as local NHS watchdogs and are in need of a radical overhaul, according to a report backed by the NHS Executive.

The shake-up proposed by the report, In the Public Interest, to be launched at the NHS 50th anniversary conference in London today, would spell the end of CHCs in their current form. The findings, which come amid rumours of ministers' intense dissatisfaction with CHCs' performance and internal turmoil at the Association of CHCs for England and Wales, are bound to ignite controversy.

It is the first time that the NHS Executive has explicitly acknowledged that CHCs are not fulfilling their role of representing the public interest in health services at a local level.

The report, jointly commissioned by the NHS Executive, the NHS Confederation and the Institute of Health Services Management, goes so far as to propose alternative means of scrutinising the NHS.

It endorses criticisms that CHCs lack democratic legitimacy and are often seen to be unrepresentative of their local communities.

And the report acknowledges that the quality of their work is variable, with a lack of clarity about their role.

It calls for a 'revitalisation' of CHCs, which could be linked to proposed reform of local government. It says: 'Given the quasi-representative nature of CHCs, any review of their role needs to look beyond the health field to government plans for revitalising local government and local democracy.'

And it adds: 'CHCs could reform their membership in order to become more professional scrutineers.' As scrutineers, revitalised CHCs could focus on reviewing the contribution of health and local authority services to the public health of local people, auditing policies to asses their impact on health and inspecting health facilities.

Their remit should also be extended to primary care, the report recommends.

Alongside this, scrutiny of the NHS by elected representatives could be achieved by other means, such as the locally elected panels already set up by some local authorities to advise on and examine services.

IHSM deputy director Suzanne Tyler said: 'The area panels, which have democratic legitimacy, would represent the community voice, while CHCs would be more involved in quality and performance monitoring.'

Although their role would change, CHCs would have a part to play in holding the NHS to account locally, added Ms Tyler, one of the report's authors,.

In The Public Interest: developing a strategy for public participation in the NHS. Available from the Department of Health, PO Box 410, Wetherby, LS23 7LN. Fax: 0990 210266. Free.