In 1997 the NHS Confederation published a consultation paper called Towards the 21st Century: a way forward for the NHS. It was considered in some detail by the 28 community health councils in North Thames. The representatives supported the general thrust of the document and most of its proposals. They did, however, take exception to the two paragraphs which, without any supportive evidence, were strongly critical and condemnatory of CHCs.

On their behalf, in submitting a response to confederation corporate affairs director Derek Day on 25 September 1997, I invited him or a representative of the NHS Confederation to attend a meeting of the regional association to discuss this.

Since by 13 November 1997 I had not received even an acknowledgement I repeated the invitation, only for my letter to suffer a similar fate. On 10 April 1998, I wrote to Stephen Thornton, by then the Confederation's new chief executive, and repeated the invitation. The record of discourtesy continued. The confederation, while apparently keen to publish critical material, seemed arrogantly unwilling to discuss evidence with CHCs.

In the light of the confederation's involvement in the report In the Public Interest (News, page 7, 2 July), why was it not willing to discuss a section of its 1997 report with CHCs in North Thames?

Why was the text of this document (commissioned by the NHS Executive, the confederation and the Institute of Health Services Management, but involving other people) changed so drastically, presenting such a negative portrait of CHCs, after it was last seen by the group from whose discussions it emanated?

Is there another conclusion to draw here? Is it perhaps that the joint commissioning bodies sometimes find CHCs' effective interventions, honestly fulfilling their responsibility to represent the public interest, rather a nuisance, and would prefer less or less effective scrutiny?

Reg Pyne

Former chair of East Hertfordshire CHC,

chair of the regional association of CHCs in North Thames

and vice-chair of the Association of Community Health Councils for England and Wales

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