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Health activist Maria Goldenberg is damning in her criticism of community health councils. 'They are like a middle class tea party - an incestuous family which does not reach out to the general public,' she says.

'They won't bite the hand that feeds them,' she adds, claiming that Bromley CHC has 'worked hand in glove with the health authority' to push through its plans.

Ms Goldenberg set up the Community Care Protection Group a decade ago to provide information and support to patients and carers in the area.

Since then, the group has taken on a key role campaigning against Bromley HA's plans for an acute site funded by the private finance initiative.

Paul Evans, director of the NHS Support Federation - which shares information between local hospital campaigns - describes Ms Goldenberg as a 'classic example' of a 'new breed' of health activists which are usurping the role of the CHC.

'They are frequently women, they are tough and intelligent - they often have personal experience that has sparked their interest,' he says. And when they believe 'watchdog' bodies do not represent their interests properly, 'it is like stoking a fire'.

Similar 'unofficial' campaigns in Yorkshire and Hertfordshire have also discomforted CHCs as patients and relatives get more militant about local health services.

The NHS Support Federation itself has existed for over a decade, with its 10,000 members divided equally between the medical profession and public.

But Mr Evans says the group has seen a boom in activity among members in the last two years, boosted by growing political awareness of issues like PFI and the use of creative campaigning and new technology.

He believes the 'active citizenry' identified by NHS chief executive Sir Alan Langlands has now become 'a force to be reckoned with'.

Two years ago in Bromley, the HA consulted on proposals for a new site. But it did not intend to put forward modified plans for reconfiguration under PFI for public consultation.

Ms Goldenberg believes that without pressure from CCPG, Bromley CHC would have accepted that. In the end, the CHC accepted a 'focused' consultation on an eight-week timescale.

'They were being led by the nose,' she scorns. 'They were more worried about safeguarding their influence with the HA than keeping the public informed.'

The notion meets a stout rebuttal from CHC chair Petra Willoughby. 'I would totally reject the idea that we are in the health authority's pockets. I have independence written across my heart,' she insists.

Ms Willoughby insists the 'desperate need' for a new hospital left the CHC 'between a rock and a hard place' in tackling its own concerns around the consultation.

'If it hadn't been for the CHC we wouldn't have had any consultation at all. Where I would agree with CCPG is that the HA document wasn't as full as it should have been. The consultation was, I have to say, not entirely satisfactory.'

'My attitude is we have to be pragmatic. We can't expect things to improve overnight,' argues Ms Willoughby, who says the CHC has 'worked with the HA since then to improve the mechanics of the consultation process'.

In Yorkshire, Mick Griffiths, Unison joint branch secretary for Pinderfields and Pontefract Hospitals trust, is a key opponent of proposals to relocate acute services from two sites to one - plans which last month failed to win ministerial approval for PFI.

In May, Mr Griffiths won 12 per cent of the vote in local elections under a 'Stop Pinderfields Privatisation' banner. Other tactics included demands for a parish referendum on PFI screened on Channel 4's Mark Thomas Comedy Product.

The ploy failed when North Yorkshire Parish Community Group learned that its chosen parish was in fact a gap in the district map.

Nonetheless, publicity surrounding the affair led local newspaper The Wakefield Express and Wakefield district council to conduct a readers' poll which showed that 81 per cent opposition to PFI under any circumstances.

But Wakefield CHC did not oppose the proposals.

Mr Griffiths says: 'Our experience of the CHC is that it has been a toothless tiger that ultimately has sided with the HA. I can't remember any vigorous campaigning from Wakefield CHC. It tends to do the rubber stamping for the HA.'

The CHC was not available for comment.

In West Hertfordshire, Dacorum borough council was one of five local authorities which threatened to take its local HA to the High Court over plans to downgrade district hospitals and create one acute centre.

The councils were critical of what they saw as West Hertfordshire HA's 'failure' to provide sufficient information to justify the proposals and felt 'prepared to take a stand' when North West Herts CHC - one of two in the area - did not object.

The CHC was not available for comment. But South West Herts CHC did refer the proposals. Earlier this month, health minister John Denham ordered West Hertfordshire HA 'not to pursue' the greenfield acute site option it had favoured.

Stressing the importance of involving local people in discussions, he said he expected both district hospitals to retain accident and emergency services for the 'foreseeable future'.

For Dacorum borough council the news came as a relief. Legal advice had already revealed that the CHC's statutory role meant it was unlikely the council would be allowed to attempt legal action against the HA.

'There was a view that this created something of a democratic deficit,' says council head of corporate policy Hilary Mitchell.

Dacorum borough council cites popular support for local activists Dacorum Hospital Action Group - led by veteran campaigner Zena Bullmore - as a political motivation behind its active approach.

'There was huge public support for Zena Bullmore and her campaign. We couldn't be seen to let her down,' says Ms Mitchell.

Ms Bullmore welcomes current debate over the role of CHCs, which she believes are 'important' and need more resources.

But she says that is little excuse for North West Herts CHC. 'In this case I think they just did their job badly,' she adds. 'Some CHCs will stick their necks out. Some won't.'

Donna Covey, director of the Association of CHCs for England in Wales, defends the rights of individual CHCs to resist the lure of popular opinion.

'Public interest and public opinion are not the same thing. CHCs have a different information base from the general public and are involved in a longer term dialogue with both the health service and users. It is a very delicate balance. I think they do their job incredibly well under difficult circumstances.'

Health activist Maria Goldenberg is damning in her criticism of community health councils. 'They are like a middle class tea party - an incestuous family which does not reach out to the general public,' she says.

'They won't bite the hand that feeds them,' she adds, claiming that Bromley CHC has 'worked hand in glove with the health authority' to push through its plans.

Ms Goldenberg set up the Community Care Protection Group a decade ago to provide information and support to patients and carers in the area.

Since then, the group has taken on a key role campaigning against Bromley HA's plans for an acute site funded by the private finance initiative.

Paul Evans, director of the NHS Support Federation - which shares information between local hospital campaigns - describes Ms Goldenberg as a 'classic example' of a 'new breed' of health activists which are usurping the role of the CHC.

'They are frequently women, they are tough and intelligent - they often have personal experience that has sparked their interest,' he says. And when they believe 'watchdog' bodies do not represent their interests properly, 'it is like stoking a fire'.

Similar 'unofficial' campaigns in Yorkshire and Hertfordshire have also discomforted CHCs as patients and relatives get more militant about local health services.

The NHS Support Federation itself has existed for over a decade, with its 10,000 members divided equally between the medical profession and public.

But Mr Evans says the group has seen a boom in activity among members in the last two years, boosted by growing political awareness of issues like PFI and the use of creative campaigning and new technology.

He believes the 'active citizenry' identified by NHS chief executive Sir Alan Langlands has now become 'a force to be reckoned with'.

Two years ago in Bromley, the HA consulted on proposals for a new site. But it did not intend to put forward modified plans for reconfiguration under PFI for public consultation.

Ms Goldenberg believes that without pressure from CCPG, Bromley CHC would have accepted that. In the end, the CHC accepted a 'focused' consultation on an eight-week timescale.

'They were being led by the nose,' she scorns. 'They were more worried about safeguarding their influence with the HA than keeping the public informed.'

The notion meets a stout rebuttal from CHC chair Petra Willoughby. 'I would totally reject the idea that we are in the health authority's pockets. I have independence written across my heart,' she insists.

Ms Willoughby insists the 'desperate need' for a new hospital left the CHC 'between a rock and a hard place' in tackling its own concerns around the consultation.

'If it hadn't been for the CHC we wouldn't have had any consultation at all. Where I would agree with CCPG is that the HA document wasn't as full as it should have been. The consultation was, I have to say, not entirely satisfactory.'

'My attitude is we have to be pragmatic. We can't expect things to improve overnight,' argues Ms Willoughby, who says the CHC has 'worked with the HA since then to improve the mechanics of the consultation process'.

In Yorkshire, Mick Griffiths, Unison joint branch secretary for Pinderfields and Pontefract Hospitals trust, is a key opponent of proposals to relocate acute services from two sites to one - plans which last month failed to win ministerial approval for PFI.

In May, Mr Griffiths won 12 per cent of the vote in local elections under a 'Stop Pinderfields Privatisation' banner. Other tactics included demands for a parish referendum on PFI screened on Channel 4's Mark Thomas Comedy Product.

The ploy failed when North Yorkshire Parish Community Group learned that its chosen parish was in fact a gap in the district map.

Nonetheless, publicity surrounding the affair led local newspaper The Wakefield Express and Wakefield district council to conduct a readers' poll which showed that 81 per cent opposition to PFI under any circumstances.

But Wakefield CHC did not oppose the proposals.

Mr Griffiths says: 'Our experience of the CHC is that it has been a toothless tiger that ultimately has sided with the HA. I can't remember any vigorous campaigning from Wakefield CHC. It tends to do the rubber stamping for the HA.'

The CHC was not available for comment.

In West Hertfordshire, Dacorum borough council was one of five local authorities which threatened to take its local HA to the High Court over plans to downgrade district hospitals and create one acute centre.

The councils were critical of what they saw as West Hertfordshire HA's 'failure' to provide sufficient information to justify the proposals and felt 'prepared to take a stand' when North West Herts CHC - one of two in the area - did not object.

The CHC was not available for comment. But South West Herts CHC did refer the proposals. Earlier this month, health minister John Denham ordered West Hertfordshire HA 'not to pursue' the greenfield acute site option it had favoured.

Stressing the importance of involving local people in discussions, he said he expected both district hospitals to retain accident and emergency services for the 'foreseeable future'.

For Dacorum borough council the news came as a relief. Legal advice had already revealed that the CHC's statutory role meant it was unlikely the council would be allowed to attempt legal action against the HA.

'There was a view that this created something of a democratic deficit,' says council head of corporate policy Hilary Mitchell.

Dacorum borough council cites popular support for local activists Dacorum Hospital Action Group - led by veteran campaigner Zena Bullmore - as a political motivation behind its active approach.

'There was huge public support for Zena Bullmore and her campaign. We couldn't be seen to let her down,' says Ms Mitchell.

Ms Bullmore welcomes current debate over the role of CHCs, which she believes are 'important' and need more resources.

But she says that is little excuse for North West Herts CHC. 'In this case I think they just did their job badly,' she adds. 'Some CHCs will stick their necks out. Some won't.'

Donna Covey, director of the Association of CHCs for England in Wales, defends the rights of individual CHCs to resist the lure of popular opinion.

'Public interest and public opinion are not the same thing. CHCs have a different information base from the general public and are involved in a longer term dialogue with both the health service and users. It is a very delicate balance. I think they do their job incredibly well under difficult circumstances.'