letters

I am delighted to see HSJ taking such an interest in the health service in Wales, and in particular your report on the radical shake-up of community health councils which I announced a few weeks ago (news, page 8, 18 March; news focus, 21 March). Your report picks up much of the flavour of discussion, but seems unclear as to my intentions.

I have long supported the work of CHCs in Wales.

Those with a long memory will recall that I fought for their survival when the NHS and Community Care Bill (as it then was) was going through the House of Commons. At that time I was the shadow minister of health in Wales.

When I came to the Welsh Office in October, I was determined to give priority to preparing the ground for the new national assembly for Wales to be really effective in creating the best possible health service in the principality.

For that reason, I reviewed the reconfiguration of trusts which was just coming to fruition and made changes to meet the different needs of different parts of Wales and to ensure that an underlying principle would emerge. That principle is the creation of a single integrated health service - with acute community and mental health services working in partnership - for every part of Wales.

But co-operation must go further, linking with the care services of local authorities.

You rightly report that I rejected the two options presented for discussion by the Welsh Office. Each of the health authorities in Wales covers far too large an area to be considered a 'community' and it made no sense to allow CHCs to become coterminus with them. Similarly, trusts cover too large an area for coherence.

The crucial principle is that CHCs should be able to address health service organisations but do so on behalf of individual communities. That is why I came to the conclusion that a 'federal' approach should be adopted. The simplest area is Gwent, where there are three CHCs, a single HA and now a single trust. By creating five smaller CHCs, each can represent the discreet community of a local authority area. The nervousness of North Gwent about the creation of a single trust can be helped by giving each local authority area that clear voice, but the five together can communicate collectively with the trust and HA. The fact that this has been welcomed by local authorities and communities in Gwent reflects the fact that it seeks to bring together community and NHS reality.

I also had to accept the professional and clinical advice that Llandudno General Hospital should be grouped with North West Wales. But I was acutely aware of local concerns. Providing a CHC which reflects the Llandudno General Hospital catchment area gives the chance of the community having a voice and ensures that the promises I made last December are delivered.

Another issue to resolve was the situation in Rhondda Cynon Taf, and Merthyr, where the boundaries of the local authority bear little relationship to hospital boundaries. By creating a federation of four CHCs based on Merthyr, Cynon, Rhondda and Taff Ely, the first two are able to co-operate in order to address NHS issues with one trust while the latter two can do the same. On the other hand, Merthyr CHC can relate easily to its local authority area while the other three are able to enter dialogue with the county of Rhondda Cynon Taf.

I have also set in train a 'stock-take' with the help of the Audit Commission so the new Assembly has a clear agenda to address. My request to the commission to help arises from a meeting with its chair and director and a request I made to Andrew Foster and his deputy, to which they responded with alacrity.

I certainly think the NHS in Wales will receive fresh impetus, a fresh focus and fresh coherence from the arrival of the national assembly for Wales. I shall certainly do all I can to make that happen.

Alun Michael

Secretary of state for Wales

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