CHCs' successor bodies 'set to cost five times as much to run'

Patients' forums, patient advocacy and liaison services, local authority scrutiny, independent local advisory forums and specialist advocacy services could cost as much as£114m by 2004-05, compared with a current annual cost of£23m for CHCs, figures produced by the Association of CHCs for England and Wales claim.

In 2002-03, PALS will absorb CHC funding, with an additional£10m to come from the Department of Health, while patients' forums are estimated to cost£45m - with 0.05 per cent of each trust's budget set aside to fund them.

ACHCEW estimates that adding health to local authorities' scrutiny role would cost£70,000 per authority -£14m in total - while health authorities would foot a£4.2m bill for independent local advisory forums and another£4.2m for specialist advocacy services.

But the total£100.4m cost for 2002-03 would rise to£114m in 2004-05, ACHCEW says, because although costs of independent local advisory forums would fall as the number of HAs decreases, patients' forum costs will rise to£60m as more primary care groups become primary care trusts, with their patients covered by the new system.

ACHCEW director Donna Covey said: 'If you are going to spend this much on patient involvement, then you ought to make sure you get it right.

'But the worry across the health community is that the government is replacing an effective independent watchdog with a cumbersome and ineffective system, lacking in statutory powers and independence.'

Nik Barstow, chief officer at Central Manchester CHC and chair of Unison's national CHC forum, feared that 'levying the costs out of trust and HA budgets' would mean patient and public involvement being 'just tagged on to the jobs of existing staff '.

Roy Carr-Hill, professor of medical and social statistics at York University's centre for health economics, said the new system was 'daft'.

'CHCs are cost-effective and very cheap. If the government spends nearly five times as much on this, I can see the average tabloid starting to scream - possibly with some justification.'

He queried whether the government would go ahead with patients' forums in both purchaser and provider bodies, and warned that 'the only earmarked funding' for the new arrangements was the extra£10m for PALS and the CHCs'£23m.

King's Fund health systems programme director John Appleby said looking at the costs was 'no good at all without a value for the benefits' of the two systems.

He hoped the figures would 'help push the DoH' to say 'what are they going to get for the extra money?', adding: 'As an evidencebased policy decision, where's the evidence?'

Patient Concern director Roger Goss said: 'The issue is not the amount, It is whether it will be value for money. At this stage, we are not convinced that this is the case - there is no evidence that the new service would be independent.'

A DoH spokesperson said the£114m figure 'seems a bit excessive' but could not supply 'any bottom line figures' as they 'haven't gone to ministers yet for a costing'.