Primary care groups and other players in the new NHS should be watched carefully, the community health councils' annual conference heard. Pat Healy reports

Community health councils have been worried that the government does not take their role as seriously as they would like.

So they were delighted when health minister Baroness Hayman congratulated them on reaching their 25th anniversary and told them: 'You have, in a sense, been ahead of the game.'

But she told delegates to the Association of CHCs for England and Wales' annual conference in Eastbourne last week that the challenge now was to stay ahead of the game.

'You are going to have to prioritise, just as the government has to prioritise, ' she said. 'There is an enormous raft of things you could be involved in, in addition to the things CHCs have traditionally done.'

Baroness Hayman acknowledged that CHCs were adapting. She pointed to the way some worked with health action zones and primary care groups, and to the commission that ACHCEW set up to examine public representation in the NHS.

'No organisation can stand still, ' she said. 'I sense from the CHC movement a willingness to engage in the developmental agenda to see where they fit in.'

But she did not offer any clues as to where that might be.

And when Sally Young of North Tyneside asked about the government's plans to use CHCs as a vehicle for accountability, Baroness Hayman said that they could not be the 'sole' channel through which patients' views were sought.

That was fair enough for Donna Covey who, in her maiden speech as ACHCEW 's d irec tor, cha l lenged the government to give CHCs the tools to deliver on their changed role in the new NHS.

'We are unique, ' she told HSJ . 'But we don't have a monopoly on wisdom.'

That was a common view among delegates. Audrey Jacobs of Salisbury CHC said: 'We can't monitor it all. I have no problem with Mind or other patient representative groups doing it too.'

Ms Jacobs was also encouraged by Baroness Hayman's speech. 'It confirms that we have a future, and the fact that she is going to take note of the commission is important, ' she said.

The commission's interim findings - which call for an overhaul of the NHS to make it more accountable - are being posted on ACHCEW's website to give people a chance of influencing the final report, due in the autumn.

Ms Covey commented: 'We are relaxed about opening up to that wider public scrutiny because we think we can stand up to it.'

But she thinks CHCs must be given similar statutory powers over primary care as those that they already have in relation to hospitals.

'The new structure in the NHS must not be allowed to develop without strong scrutiny, ' Ms Covey said. 'CHCs representing the public interest in the health service must be able to shine the light of truth in all the dark corners of the reformed health service.'

There was a danger that the diversity of decision-making involved in NHS changes would create 'plenty of dark corners for people to hide in', and arrangements for PCGs were at the heart of that.

'The public cannot be expected to trust PCGs unless there is strong, independent scrutiny at local level and a strong public interest presence with speaking rights around the table when decisions are made.'

This had already happened in Eastbourne, where a CHC member was an 'associate member' of the PCG board.

Ms Covey said if there was resistance to that being a statutory right, ministers should ask PCG chairs what they had to hide. 'Primary care is typical of an area where CHCs are seeking to embrace new challenges, only to run up against the old vested interest groups, ' she said.

But the conference made it clear that CHCs want to retain their independence, calling for government guidance to make clear that CHC members appointed as lay members of PCG boards should resign from their CHCs.

Margaret Taylor of Manchester South said: 'We want observer status and speaking rights. We have to watch them - not join them.'

The conference found itself dealing with a topical issue when it narrowly threw out a call for a dead person's organs to be available for transplant unless they had opted out.

The motion emanated from Bristol, home to the UK Transplant Support Service Authority, but it was inspired by the experience of the city's large renal unit.

But in the light of health secretary Frank Dobson's inquiry into Northern General Hospital's decision to accept an organ with a racist condition attached, delegates backed an emergency motion noting the incident 'with horror' and calling for an urgent review of the law 'to ensure that organ donation is made without imposition of discriminatory conditions'.

What conference did next It opposed compulsory treatment orders as inconsistent 'with the principles of user involvement and respect for individual dignity now underpinning general NHS care'.

It called on the government to abandon the private finance initiative as a principal means of capital investment because the NHS cannot afford it.

It called for a government statement before the summer recess about what it plans to do with the recommendations of the Royal Commission on Long-term Care.

www.nhsconfed.net/achcew/index.htm