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Published: 25/07/2002, Volume II2, No. 5816 Page 15

They may be bruised and bloodied, but delegates to the final conference of the Association of Community Health Councils for England and Wales seemed unbowed. Tash Shifrin watched them rage against the dying of the light

It has been grim for staff and members of England's community health councils since the one-line announcement of their abolition in the NHS plan. But their two-year battle has succeeded in forcing enough concessions from the government to make the future shape of patient and public involvement in the NHS quite different to that outlined in the plan's notorious chapter 10.

So it was in a spirit of some pride that the delegates gathered in Bournemouth last week, at a conference given special dispensation by council unions, who shut the rest of the conference centre as part of their national strike action.

Unison branch secretary Dave Higgins said he had spoken to some delegates who would be popping along to the strikers' lunchtime rally. So peace and harmony all round, then.

Well, not quite - new junior health minister David Lammy blotted his copybook by not turning up for his scheduled speech.A Department of Health spokesperson says 'regrettably' Mr Lammy could not attend as he had 'ministerial business to attend to'.

CHCs may make their view of this known to the minister later: it emerged at the conference that arrangements for transition to the new system are so up in the air that CHCs could be with us for a while to come (see box).

But it was poignant when Association of Community Health Councils for England and Wales director Peter Walsh got up to deliver 'my first and probably my last address to ACHCEW conference', and more so when he pointed to the contrasting experience of CHCs in Wales, which are not being abolished, merely reformed 'following public consultation - yes, a consultation'.

Mr Walsh expressed 'cautious optimism' that the new patient and public involvement system could draw on CHCs' best work and prove itself fit for purpose.

'I was going to leave it to David Lammy to explain the new system, 'Mr Walsh continued, to gallows chuckles from delegates. But Mr Walsh's outline showed just how much had changed since the original proposals.

'There was to be no national body, ' he began. But 'now the Commission for Patient and Public Involvement in Healthcare is being trumpeted as a key element'.

And so it went on: patient forums, as outlined in chapter 10, would have been 'almost completely lacking in independence', patient advice and liaison teams - PALS - were now clearly delineated as part of a trust's structures, and where chapter 10 had offered nothing to replace CHCs' integrated overview role, primary care trust patient forums now 'have the potential' to do so.

The confusing 'local networks' of CPPIH, the staff-only bodies once known as VOICES, had vanished, and independent advocacy would now be commissioned by primary care trust patients' forums. And the forums' independence and powers to refer and to act had all been strengthened.

'None of these changes came lightly. They all had to be fought for and argued for, ' Mr Walsh stressed. He thanked the Liberal Democrats, Conservatives and Labour rebels - particularly Commons health committee chair David Hinchliffe, for their efforts.

Liberal Democrat health spokesperson Evan Harris and the Tories' Earl Howe were there to soak up the gratitude in person, with Mr Harris - speaking without notes - being particularly entertaining. He pleased veteran casualty watchers by laying into the trolley waits and the redesignation of trolleys as beds. 'It can still look like a trolley, but it can be called a bed, ' he explained.

Mr Evans is not keen on corridors, either. He described an area at Kent and Canterbury Hospital as 'the Alan Milburn memorial ward, which is a corridor...' This won the biggest laughter and applause all day. Though the delegates maintained a dignified refusal to rehash all the angst of the past two years, mention of actual government ministers or phrases too reminiscent of them got a reaction every time.

The conference heard Imperial College professor of health policy Nick Bosanquet urge the 'cadres' of the CHCs onwards to press for 'can-do' primary care. 'Politicians tend to go weak at the knees, starry-eyed, when you mention hospitals, ' he said. 'We need you to fight for the local patient interest in developing more flexible primary and ambulatory care hubs.'

The good attendance at workshops and seminar sessions, despite the seafront location and glorious weather, showed CHC staff and members will be keeping the eye on the ball, right up until the new patient and public involvement structures are put in place - whenever that is.

But the karaoke efforts of ACHCEW vice-chair Donald Roy expressed the regrets of the delegates, too. In what one observer described as 'the style of a retired brigadier', Mr Roy sang the Beatles' Yesterday. l Transition advice: draft stage Christine Hogg is project manager of the transitional advisory board set up to look at how to move to the new system.Without a hint of irony, she told a seminar session: 'We have got to the point of making draft interim recommendations.'

Among other outstanding points, new names are needed for PCT patients' forums and 'ICAS'- the independent complaints and advocacy service.

Some sort of regional structure for patient forums, possibly elected, and a national 'reference group'of around 100 people, are also ideas being floated.But the main gap is the lack of timescale or process for shifting from CHCs to patient forums.TAB had not decided between a 'big-bang' shift or 'staggered approach'.