The Welsh secretary simply 'got his protractors out and started drawing lines on maps', according to one critic of his huge CHC shake- up. Lyn Whitfield reports
If the Welsh Office was expecting to announce a radical shake-up of community health councils a fortnight ago, its press office was hiding it well.
Asked when the outcome of Involving the Public, a consultation document launched in September, would be announced, a spokesman said he had 'no idea'.
In fact, there was 'no press release on the stocks' even though 'to be honest, it would be a good idea to have one' because 'we will need to get moving on this one'.
Less than a week later, Welsh secretary Alun Michael unveiled a 'new, reinvigorated' structure for Welsh CHCs. It is not the first time the Welsh Office has been caught on the hop recently. In the Commons' annual debate on Wales for St David's day, Mr Michael announced a 'stocktake' of the Welsh NHS, focusing on its finances. A Welsh Office official later told HSJ: 'We did not know about this very much in advance.' Did they know before the minister stood up to make his speech? 'A little bit before that.'
An Audit Commission source said all it knew about the stocktake was the report in Hansard - even though it is supposed to be leading the work.
Mr Michael became Welsh secretary after Ron Davies' adventures on Clapham Common. He is likely, but not certain, to become leader of the Welsh assembly, elections for which are in six weeks' time.
One source says: 'Alun Michael is very much his own man. Jon Owen Jones (the Welsh health minister) is not standing for the Welsh assembly, so he is not making any announcements.
'Everything is being done by Alun Michael. He is not taking any notice of his officials. Everything is happening on the hoof.'
The outcome of public consultation used to be easy to predict in Wales. When the Welsh Office decided to shake up the Welsh ambulance service, a single ambulance trust duly emerged at the end of a public consultation that registered considerable opposition to the idea.
The outcome of plans to halve the number of Welsh trusts was never in much doubt either. Now, the inevitable progression from plan to execution is prone to falter.
Involving the Public was hostile to CHCs, suggesting they stretched resources 'unproductively', had been slow to change and needed either a trust or a health authority focus. The Welsh Office made it clear that it would prefer an HA focus, with CHCs providing 'expert advice' and public involvement at a 'strategic level'.
Sue Wilshere, chief officer of the Association of Welsh Community Health Councils, says the new team of politicians 'disowned' the document. 'Alun Michael has got his protractors out and started drawing lines on maps,' she said, before last week's announcement.
The lines have given CHCs a local authority focus. A network of 27 CHCs, based on nine federations 'linked to local authority areas', is envisaged.
Although the plans lack detail - there is no mention of funding, or how long a proposed consultation period will last - comments made suggest that only the federations will have offices.
In a - no doubt hastily compiled - press release, Mr Michael says: 'In Bro Taf, it would mean six CHCs, based on two federations and serviced and supported from two office locations.
'In North Wales, it would mean seven CHCs, based on three federations and supported from three office locations.'
This leads Roger Coakham, chief officer of South Gwent CHC, to question the remit of the new CHCs. 'Mr Michael is talking about slimming down the support services that CHCs use,' he says. 'If you increase the number of CHCs but slim down the support structure, something has to go.'
Mr Coakham also wonders how big the new organisations will be. He points out that CHCs currently have 20 members, plus up to six co-opted members.
Mr Michael envisages five CHCs in Gwent, 'which would mean more than 100 members', says Mr Coakham. 'We would all be falling over each other.'
When local authorities were reorganised in 1996, CHCs were nominally abolished on 31 March and recreated in the same guise on 1 April. Half the members were given new, two-year terms and should have stood down last year. But the Welsh Office asked them to stay put for 12 months while the future of CHCs was decided. Almost 200 members were thus due to stand down on 31 March.
The Welsh Office told HSJ that all existing members would be asked to stay on for a further 18 months. Initial responses to the new CHC structure were favourable, insofar as it moved away from Involving the Public .
But Ms Wilshere says AWCHC was not consulted, despite a promise from Mr Michael that he would talk to the organisation before making a decision.
'In Conwy, he is splitting a CHC into two. There has been intense lobbying over the future of local hospitals there. Presumably, this will help to diffuse the situation. After all, he comes from Conwy, and will be well aware of the issues.'
The 'stocktake' will also help the new assembly. Welsh Office officials say it will be ready for the new body to start work in July.
'Mr Michael is putting two things together.' one says. 'He is saying: 'We cannot just go into the Welsh assembly and say ooh, er, what do we do now?' He is trying to anticipate the need for the assembly to look at the issues.'
The issues include a very large deficit and some potentially explosive decisions about the future of community hospitals that have not been taken under the present regime. Which should keep everyone, including the new CHCs, busy next year.