It's a dog's life as CHCs refuse to lie down and die

I remember wondering at the time if that meant 'bye-bye, CHCs'. But when I re-checked my yellowing newspaper clippings from 28 July I could only find one oblique reference to this prospect, in The Daily Telegraph. The Consumers' Association had welcomed the advocacy and liaison service, but warned that the plan 'would work only if patient representatives were independent of the health authorities'.

Well, what goes round comes round, and the simmering row over the fate of CHCs finally reached prime minister's question time the other day. Stephen O'Brien - the same Conservative MP who quizzed Tony Blair - had a crack at Alan Milburn as well, waving the three-page letter Mr Blair had sent him in the interval.

Was the PM aware that the proposed scrapping of 'independent watchdogs' was bitterly opposed by patients and staff, the MP for Eddisbury asked Mr Blair. Yes, he was, but 'if he goes round the country the Hon Gentleman will find that people in certain areas do not believe that CHCs have been as effective as they might be. It is precisely because we want to consult that we have issued the health plan, ' the PM replied.

Such exchanges are the staple dross of parliamentary accountability. But what happened next was different. Mr O'Brien got a long letter from Mr Blair, in effect rowing back from his reassuring talk of consultation. 'He rabbits on at great length about the plans to abolish CHCs, and in the very last page says there is no consultation at all. The decision has been made, ' the MP told me.

Stephen O'Brien is, as you'd expect, a defender of CHCs and - crucially - their independence from trusts and the Department of Health. On the basis of his experience since becoming an MP in the 1997 by-election, he finds CHC types a strong, enthusiastic army of - admittedly - self-selective volunteers, unsung heroes and heroines of the system who are admired by clinicians and managers alike even though they can be 'a thorn in their side'.

He does not think their replacement by what the NHS plan calls 'all-party scrutiny committees of elected local authorities' will be an improvement. I suspect he's right.

The second real surprise of this affair, when Opposition MPs ganged up on Mr Milburn a few days later, was that no Labour MP backed the government line. We are talking some tough customers here. Wakefield's David Hinchliffe, militant chair of the select committee, recalled how the committee had proposed that patient advocates should be located in CHCs, not within trusts 'where they will not be seen to be completely independent'.

Barry Jones, a veteran Welsh loyalist as loyal as they come, said: 'As the system is working, perhaps we should not fix it too soon.' Burnley's Peter Pike dropped a similar hint. As for Pudsey's Paul Truswell, he praised the 'excellent record' of Leeds CHC and managed to venture that no-one was particularly concerned about the loss of CHCs. He then spoiled it. What they were concerned about was fragmentation of the patient voice, 'the creation of a Tower of Babel rather than a tower of strength'.

Of course, 'Billy Elliott' Milburn wasn't having any of it. The new system would create 'more independence, more patient power and more patient influence', he insisted.

Dr Liam Fox, who last week pledged himself to restore CHCs, taunted Mr Milburn with accusations of phoney consultation with the Association of CHCs and others. Unfazed, the minister brushed it aside.

But pressure is mounting. An all-party Commons motion has been gathering signatures. Stephen O'Brien staged a small debate on Tuesday. Milburn speaks of a 'democratic deficit' which needs mending. Critics argue that few CHCs really failed. As folk say in deeply conservative New Hampshire: 'If it ain't broke, don't fix it'.