Published: 10/01/2001, Volume 112, No. 5787 Page 10

The government's proposed new system for public and patient involvement could cost nearly 10 times as much as the community health councils it will replace, figures seen by HSJ reveal.

The new bodies - patient forums, the national Commission for Patient and Public Involvement, patient advice and liaison services, local authority scrutiny committees and independent advocacy services - could cost as much as£221m in 2003-04, compared with£23m a year for CHCs, figures produced for the Association of CHCs for England and Wales claim.

The replacement of CHCs comes after the government was forced to drop measures to axe CHCs from the Health and Social Care Act. ACHCEW estimates that even without the NHS Reform Bill measures, patient and public involvement costs arising from the Health and Social Care Act will total£108.5m in 2003-04, with PALS set to cost£56.4m, local government scrutiny£17.1m, and new independent advocacy services a further£12m.

The commission and its local bodies, proposed in the new legislation, would cost another£35.6m, ACHCEW says, while patient forums to cover 400 NHS and primary care trusts would cost£32.5m in 2003-04.

Without the opportunity to draw on CHCs in future, local authorities' health scrutiny would face a similar cost ratio as scrutiny of their own services - about£84.6m in 2003-04, assuming three-quarters of the NHS in England was covered. This would give a total of£221m for 2003-04.

But the hike in costs might be largely hidden, coming from local authority or NHS service and financial frameworks, rather than being separately identified, ACHCEW cautioned.

ACHCEW director Peter Walsh said: 'The estimates have to be treated with a degree of caution, but in the absence of any costings from the government, they are the best we have to go on.

'It is clear the new arrangements would be much more expensive, but it would be a tragedy if they also failed to enjoy political consensus and the public confidence that might flow from that.'

Roy Carr-Hill, professor of medical and social statistics at York University's centre for health economics, said: 'We are going to end up spending all the possible savings from Shifting the Balance of Power and It is still unclear how effective this [new system] will be.'

A Department of Health spokesperson said it was 'inappropriate to comment in advance of the comprehensive spending review on what the costs will be'.