'A new statutory duty for quality' was promised in A First Class Service, but the Health Bill going through Parliament seems to sidestep this issue feebly, concentrating on process without enforcing the purpose. Section 13(1) of the draft bill says: 'It is the duty of each primary care trust, and each NHS trust to put and keep in place arrangements for the purpose of monitoring and improving the quality of healthcare which it provides to individuals.'

This is a duty to set up a committee, and trusts already have enough of those, including audit, quality and complaints committees. The requirement is not even that the committee should be effective or public, nor that it should involve community health councils, patients or outside bodies. A duty to talk is not the same as a duty to act.

For a legal duty to be worthy of the name it must confer real rights on those it is intended to benefit - in this case, patients. The parents of the babies who died in Bristol will take no comfort from the right this legislation would give them, to force their trust to set up a committee - one that neither they nor their representatives could gain access to.

The Commission for Health Improvement, with its powers of intervention, is very welcome. But it cannot be everywhere, and local accountability structures need to be strengthened as well. Other provisions in the bill relating to trust powers seriously weaken their local accountability by removing the obligation to consult with a CHC or anyone else when additional powers are to be granted to a trust. Many trusts are merging and acquiring more of a monopoly on providing local services, while health authorities' power to call them to account is being fragmented by primary care groups.

CHCs are ideally placed to fill this gap. This bill misses the opportunity to use them as a vital tool in performance management - strengthening the patients' voice. The drive for quality will depend on equal bargaining power for those who depend on NHS services and those who provide them. As drafted, this clause fails to do this.

Elizabeth Manero


Barnet CHC