Letters

As recently as 1996, the NHS Executive appointed Insight, the Department of Health's human resources management consultancy, to conduct a review of community health council resourcing and performance management, at a cost of around£80,000. As far as we know, the resulting report is gathering dust in the DoH's archives.

It is surprising, therefore, that it should have been found necessary so soon to spend yet more public money on yet another report which seems to cover much of the same ground (News, page 7, 2 July).

It is disappointing that the dialogue CHCs hoped for regarding their future role, following the changes implicit in the white paper, appears to have been hijacked by a pre-emptive and destructive broadside.

The so-called 'turmoil' at the Association of Community Health Councils for England and Wales has nothing to do with the performance of individual CHCs.

It is mischievous to link the two.

If CHCs have 'largely failed in their role as local NHS watchdogs', that is an indictment of the NHS Executive regional offices, which are the establishing authority for CHCs and have a duty to make sure they fulfil their statutory obligations.

'Democratic legitimacy' is an endlessly debatable concept. CHC members are, variously, elected by voluntary organisations, nominated by local authorities and selected by regional officers. They are unpaid, so their independence is uncompromised. Their democratic credentials compare favourably with the public input into health authorities and trusts, whose non-executive members are appointed by the secretary of state and receive honoraria from public funds.

That is not to say that CHCs would resist being associated with the proposed reform and 'revitalisation' of local government. Nor would they resist having their remit extended to primary care. Indeed, they have asked for this repeatedly. Plans in many areas for the organisation of primary care groups already include the local CHC.

As for professionalism, CHCs are served by chief officers with qualifications at least as good as NHS managers'. Under their guidance, quality and performance monitoring already takes place, through visits, contract monitoring meetings and questioning of exception reports. One way of achieving more rigorous scrutiny would be not through turning all CHC members into professional scrutineers, but facilitating collaboration between CHCs and, say, the Audit Commission, the new National Institute for Clinical Excellence and the Commission for Health Improvement.

It is to be hoped that the actual report, In the Public Interest , is rather less churlish and condescending than you reported. Otherwise, hitherto enthusiastic and conscientious CHC members may wonder why they should put up with such an onslaught and begin to drift away. It would not be 'in the public interest' for that to happen.

Joyce Struthers Member North Bedfordshire CHC

Your latest story attacking community health councils deserves some comment. It focuses on the role of CHCs as if it were the only issue addressed in In the Public Interest . In fact, the section on CHCs is just over three pages in a 36-page document. Much wider issues raised in the report - how to involve citizens in the health service through citizens' juries, opinion polls and direct participation of patients - do not even get a mention in your article.

The last thing CHCs want is to be stuck in a time warp. It is common knowledge, as In the Public Interest mentions, that we are setting up a working group to look at how best the public can be involved in the health service.

As for improving accountability and introducing national performance standards for CHCs, the Association of CHCs has already asked the King's Fund Organisational Audit whether its methods could be used by our members.

In the meantime we wholeheartedly endorse the report's suggestion that the remit of CHCs should be 'much wider in terms of the services and policies which would come under their scrutiny'.

Toby Harris Director