The Welsh Government’s White Paper consultation document, ‘Services fit for the future’, claims to focus on the principles of enabling and empowering organisations, staff and citizens. However, it also proposes to replace our regional community health councils, which are independent and therefore able to challenge and scrutinise the NHS on behalf of patients, with what it describes as a new national citizen voice body, thereby threatening yet further top-down, centralised control.

We therefore view with real concern the Welsh Government’s amendment to this motion, which seeks to delete reference to the widespread and evidence-based concerns raised with us. In consequence of these, our motion recognises the important role that community health councils have played in delivering independent public service accountability and providing a strong voice for patients in Wales, and believes that the White Paper proposals will weaken the voice of patients and communities and reduce scrutiny of the Welsh Government and health boards.

The White Paper states that the new arrangements will be based in some respects on the Scottish Health Council and working across health and social care. However, as today’s Plaid Cymru amendment, which we will be supporting, notes:

‘a single national community health council in Scotland was regarded as not sufficiently independent of government by the Scottish Parliament’s Health and Sport Committee.’

In fact, when the director and the chair of the Scottish Health Council attended the Scottish Parliament’s Health and Sport Committee in January, the committee’s convenor stated, ‘I think you are a toothless hamster. I don’t see where you’re adding value’, and that campaigners feel distant from decision making. The committee collectively found that it was clear the Scottish Health Council does not, in its current guise, present itself as a body independent of Government. Some might say that this is what attracts the Welsh Government to this model. After all, they removed the right for an independent review from the NHS complaints procedure in 2011, leaving complaints to be investigated solely by the body complained against, followed by the right to request a review by the Public Services Ombudsman for Wales, who then reported a 50 per cent increase in complaints about the NHS in Wales over the following five years.

In a positive and pioneering step, community health councils, or CHCs, were established in 1974 under a Conservative Government with a statutory duty to represent the local community’s positive interest, which included acting as patient advocates in complaints involving the NHS. They became a whirlwind of activity and achievement. After 26 years acting as the only statutory NHS patient-led watchdogs, Labour abolished all CHCs in England on 1 December 2003. As Andy Burnham, a subsequent Labour health Secretary in England, stated some years later, ‘The abolition of community health councils was not the Government’s finest moment. It seems we failed to come up with something to replace CHCs that did the job well.’ And, as Lord Justice Francis stated in the Francis report on serious failings in care at Mid Staffordshire NHS Foundation Trust before 2009, quote:

‘Community Health Councils…were almost invariably compared favourably in the evidence with the structures which succeeded them’ in England. It is now quite clear that what replaced them—two attempts at reorganisation in 10 years—failed to produce an improved voice for patients and the public, but achieved the opposite.

Labour replaced CHCs in England with public patient forums and then local involvement networks, which were criticised on the basis that they were constrained by a lack of real power, often criticised for not being representative of their local populations, and hampered by cases of internal disputes and a lack of awareness of their work. A Conservative-led Government replaced this with Healthwatch in 2012, comprising independent social enterprises responsible for representing patients across England and dealing with local concerns. The UK Government bit the bullet after the Mid Staffs scandal and commissioned the independent Keogh report, which resulted in 11 English trusts being put into special measures. But it was the north Wales community health council that then wrote to the previous Welsh Government health Minister after it obtained hospital mortality statistics showing that all three main hospitals in north Wales had higher than expected death rates. After that Minister stated the decisions to close the community hospitals at Flint, Llangollen, Blaenau Ffestiniog and Prestatyn were supported by the community health council, the community health council also wrote to him expressing concerns about the robustness of the information provided by Betsi Cadwaladr university health board, which they had used to inform their decision-making process. Community health councils’ acting independently and inconveniently in this way sets the context for the Welsh Government’s failure now to include them in their proposals.

We’re advised that, two years ago, the Welsh Government directly or indirectly appointed the chief executive of the board of community health councils in Wales who made the CHC submission to the preceding Green Paper, ‘Our Health, Our Health Service’. No doubt the Welsh Government will deny that, but that, nonetheless, is what we’ve been advised. We further understand that the White Paper is basically what he said, that the CHCs themselves never saw the paper until it was submitted, and that this chief executive was subsequently suspended and then dismissed—all matters of public record now.

Up until the night before the White Paper was published, the CHCs themselves were told by the Welsh Government that they would not be affected. Successive reports have criticised a single CHC, Abertawe Bro Morgannwg, which was chaired by the former Labour Merthyr Tydfil council deputy leader. But, gradually, those criticisms were extended—wrongly—to all CHCs across Wales.

Despite an ever-increasing shift of resources to the central board of CHCs in Wales, CHCs themselves have sought to get on with their provision of complaints and advocacy services, visiting and monitoring, scrutiny and challenge, and engagement. In 2015-16, Healthcare Inspectorate Wales conducted just one hospital inspection in Betsi Cadwaladr university health board settings, compared to 600 hospital ward visits by north Wales community health council. Whereas every ward is inspected every six months by north Wales community health council, inspections by Healthcare Inspectorate Wales are, on average, only every seven to 10 years. All this is at risk.

Commenting in late July on the Welsh Government’s consultation, the Consultation Institute stated

‘worryingly, there are unanswered questions about the proposed process for public involvement on service change’, that there are

‘important questions that need to be properly considered’ and that they were therefore organising their own ‘special Roundtable’ in Cardiff.

However, on 1 September, they stated that they had encountered a problem they ‘had never seen before’, with the Welsh Government uniquely stating

‘that to attend such a third-party event would compromise the integrity of the consultation’ and suggesting

‘that it would be wrong for NHS Managers and other public bodies to attend anything that was chargeable.’

In reality, the respected Consultation Institute is an independent, best practice, not-for-profit body.

Facebook posts then revealed that the organisation hired by this Welsh Government to lead on public engagement had only begun their search for venues three weeks before the consultation ends. One post includes the phrase ‘tight turnaround’. In another, the employee seems to suggest the scrapping of CHCs is inevitable, despite the consultation phase still being ongoing. Only yesterday, the organiser issued an e-mail requesting support from its members where events were still low on participant numbers—just nine days before the consultation ends. Further, CHC members and staff are explicitly excluded from attending.

Another e-mail yesterday stated that older people in north Wales obtain help when they need it from the Bangor and Wrexham offices of the CHC, but very often they approach one of the 72 individual CHC members who reside in north Wales. These unpaid, but skilled volunteers, who are the eyes and ears of the public, have also been instrumental in alerting the health board management and Assembly Members to major issues such as the mental health and infection control failings we have experienced. There are 700,000 patients residing in the area served by Betsi Cadwaladr, which translates into just one CHC representative for every 10,000 people.

The White Paper references the Organisation for Economic Co-operation and Development report published last year. The White Paper suggests that CHCs should be closed, but the OECD did not say at any point that CHCs should be closed down. The OECD advised that they should evolve. Professor Marcus Longley, also referenced, did not say in his report that CHCs should close down, but evolve, and based his advice on the presumption that they would continue.

CHCs across Wales agree that a new body is needed with a remit over health and social care, but have expressed serious concerns about these Welsh Government proposals. They have therefore confirmed that they support the calls on the Welsh Government in our motion to extend the consultation period on the White Paper, following its failure to properly engage with community health councils, patients, and the Welsh public, and to work more constructively with community health councils on future proposals for a new people’s voice body. For goodness’ sake, listen to them.