Paul Corrigan seems to think that the local authority health scrutiny function is in competition with CHCs' patient-advocacy role. The Democratic Health Network and the Local Government Information Unit believe that the two roles are essentially complementary.
We welcome the proposal that local authorities should have a role in evaluating, commenting on and influencing policymaking and service delivery within their local health communities. But the strategic role of scrutinising decisionmaking and service configurations is very different from that of patient advocacy.
We believe that the advocacy role should be entirely independent both of health bodies and of local authorities, both of which provide healthrelated services.
As Paul Corrigan points out, many local authorities have already begun to operate a system of internal and external scrutiny which could and should bring greater democracy, accountability and openness to the health sector. However, unless councillors are aware of patients' experiences with health services and unless they have a sound understanding of how the health system works, they will be unable to take an informed view of the quality and direction of service development.
In a recent DHN survey of councillor lay members of primary care groups and trusts, a significant number of councillors said that an important source of training, information and development on health matters had come from CHCs.
If CHCs were to be abolished, we foresee a potential loss of just the sort of expert support that councillors need to carry out their health scrutiny role.
Reformed and more independent versions of CHCs, under a national umbrella organisation to ensure consistency, could provide statistical and case-study information about the actual performance of the local NHS; and they could provide advice, expertise and even training and development for councillors on health matters.
Both the scrutiny and patient advocacy functions would be enhanced by such a relationship.
Indeed, it is hard to see how they could operate effectively without it.
Fiona Campbell Democratic Health Network Local Government Information Unit London WC1