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14 Sep 2017

Clinical Negligence

The Welsh Assembly Government has undertaken a recent review into Health and Social Care in Wales.

In July 2017 a White Paper was published detailing the proposed changes. The report states that the panel was asked to:

assess and make recommendations on how the health and care systems might deliver improved health and well-being outcomes for people across Wales”. In a section entitled “Public Involvement” it shines the light on those services which give a voice to the public about their healthcare concerns such as Community Health Councils (CHCs). CHCs have long been established and provide vital independent support to patients who often find it overwhelming and complex to discuss their healthcare needs. Importantly CHCs communicate these concerns to a Representing body and every autumn to the Welsh Assembly Government. This ensures that patient concerns are clearly heard and if appropriate acted upon.

However, the proposals appear to shift responsibility onto the public as the primary driving force by suggesting the abolition of CHCs altogether and replacing with one national body. Whilst the desire to engage the public more actively is to be applauded, it seems strange that this desire for the “community” to have more involvement into the healthcare system would go hand in hand with the eradication of CHCs which are by their very nature “patient led”. Not only do CHCs provide invaluable advice regarding the Welsh NHS complaints process they also offer independent advocacy services. Standing together with patients through the NHS complaints process ensures thorough investigations are carried out and if appropriate Representing bodies are held accountable.

It should be stated that CHCs are independent and have statutory rights and obligations. CHCs only currently operate in Wales having been abolished in England in 2003 and replaced by Healthwatch England in 2013. However this organisation does not have the same resources and statutory powers as CHCs.

CHCs can enter and inspect premises where NHS funded care is provided, hold meetings with relevant Health Boards and can be consulted by those Health Boards. Most importantly of all the CHCs have an important role to play in communicating effectively those areas of concern to the regulating body. The CHCs bridge the gap between the public and the healthcare system by engaging both in a structured way. These rights have long allowed the CHCs to represent the “people” and voice their concerns. Under the proposed plans these rights would be abolished.

Without effective structure there is a very real risk that important national collective data regarding systematic failures within the NHS are not brought to the forefront of the Welsh Assembly Government and the public. Surely this should be a time to champion and raise the profiles of these “health watchdogs” and not push them into the shadows to be forgotten. If anything existing bodies should be working together with current structures and sharing experiences to create more fluidity and cohesiveness not fracturing the system.

There are currently 7 CHCs across Wales. If replaced with one national body one has to wonder how effective this broader structure will be in proposing and implementing change at a local level. The proposal is that there be a 6 step programme:

1) Planning

2) Assessment

3) Advice from an independent citizen body

4) Clinical advice

5) Decisions made and, only if necessary

6) A call in from Ministers.

The CHCs already have years and years of experience in effecting real change at ground level and it seems that the Government should be looking to establish an alliance with them not diluting and eventually eradicating their functions.

When patients are unhappy, have been adversely affected or worse, harmed by the healthcare system, the fundamental question all patients ask is “what has gone wrong and why?” As a Solicitor acting for Claimants over the last 9 years I have witnessed first hand the benefits of patients having the support of the CHCs in the aftermath of a traumatic event to try and understand what systems have failed. Whilst most would welcome communities to have more of an active involvement in the implementation of change, without clear structure there is every possibility that broader patterns that emerge from individual complaints will never come to light and importantly effect the necessary change.

Written by Sara Uren – Senior Associate, Clinical Negligence


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