TOWARDS the end of the summer a government proposal with potentially far-reaching implications for the way our health services are run slipped into the public domain.

As part of a series of changes to way patients interests are represented on the bodies that run our hospitals and other health service providers, the government suggested that the network of community health councils be abolished on the grounds that CHC would only duplicate the proposed new arrangements.

Among the proposed new arrangements are a Patient Advocacy and Liaison Service (with the cringingly daft acronym PALS); a requirement for NHS trusts and primary care groups to ask patients what they think; a patient forum to provide direct input from patients into how trusts are run and direct representation on every trust board via these new forums.

It is also suggested that local councils should take a greater role in scrutinising local health policies and that in addition local advisory forums should be established to provide additional feedback.

All these new forums and services will take the place of the existing CHCs. It doesn't take much thought to realise that the replacement structure is cumbersome and potentially bureaucratic. For example, to what extent will the new patients' forum liaise with the local advisory forum and the local authority to form a common view on an issue?

More important perhaps is the issue of independence and power backed up by statute to make real difference in influence health policy and acting as patients advocates.

Community health councils may not be the perfect mechanism for representing the interests of patients but they are, crucially, independent of the health bodies they are set up to scrutinise. This has meant that when they have felt poor or inappropriate services have been provided by a trust, they have had the freedom to say so publicaly and demand answers.

Historically, there have been instances locally where CHCs in both Darlington and Northallerton have taken local health managers to task, the most recent example being the role played by the Northallerton CHC in suggesting that the counselling helpline for the victims of the Friarage's former consultant Richard Neale be funded by the Northallerton NHS trust and the health authority.

That freedom to call local health managers to account is laid down in statutory regulations. There is no mention in the government's proposals for any of the new bodies to be given those powers.

Too much of the proposed new structure is to be run by the health service itself. For example the PALS services are to be based in hospitals and the people who run the service are to be employees of the local NHS trust. To what extent can PALS be truly independent and also to what extent will patients trust it. If a patient has a bad experience in a hospital, how will that patient feel about the complaints procedure being handled within the same building rather than that CHC office.

The inescapable conclusion, and certainly the one drawn by the CHCs' national association is that the government is intent on replacing a watchdog with teeth with a lapdog. Community health councils are not perfect and arguably need reform and strengthening, but abolishing them in favour of a series of toothless focus groups is not the best way to improve patient rights and representation.