Although the National Health Service was established in 1948, it was not until 1974 that any major re-organisation of its functions and management structure took place.
Under the 1974 re-organisation, those services previously run by local authorities came under the NHS umbrella. Regional Health Authorities (RHAs) took over from the Regional Hospital Boards and Hospital Management Committees disappeared altogether. Area Health Authorities (AHAs) were introduced and made responsible to the RHAs. Depending upon local circumstances, AHAs could ivied their areas into more than one district. These districts would each have a district management team (DMT) to run their respective hospitals and community services. Services provided by general practitioners, dentists, chemists and opticians were to be administered through the Family Practitioner Committees (FPCs). Re-organisation preserved the tradition that these groups are independent contractors in the NHS.
To prevent the NHS management from becoming remote from the patients it serves, and to give the local communities a say in the health care services available to them, new bodies called Community Health Councils (CHCs) were established under Section 9 of the NHS Re-organisation Act 1973 and subsequently replaced by Section 20 of the National Health Service Act 1977. Every health district must have a Community Health Council, exceptionally there may be two CHCs in one district. Community Health Councils are set up by the relevant Regional Health Authority, called the ‘establishing authority’ in the statutory regulations.
From 01 April 1982, a further ‘restructuring’ within the NHS has brought about the demise of the Area Health Authority and so now we have the Regional Authority dealing directly with the District Health Authority. It is hoped to bring decision making down closer to the point of service.
Structure ____________________________________________________________________________Community Health Councils normally have 18-24 members. In the Oxford region, for instance, all CHCs have 24 members.
One third of the members (8 out of 24) are nominated by voluntary organisations, eg: Red Cross, Society for Mentally Disabled, Age Concern.
One half of the members (12 out of 24) are nominated by the local authorities, eg: district council, borough council, county council.
One sixth of the members (4 out of 24) are nominated by the regional health authority and may include a disabled person and a representative from a trades council.
Members’ term of service is normally for four years. A member may resign at any time by writing to the Secretary of the Council. Six month non-attendance at meetings (or other functions) of the Council must be reported to the appointing body and this would lead, after discussion, to the place being declared vacant.
The members from voluntary bodies represent a number of other organisations within a specific grouping, or can be one of an overall assembly of voluntary bodies. As there are more voluntary bodies than vacancies on the Council, balloting takes place under the auspices of the Regional Health Authority and, invariably, involving the Council for Voluntary Services.
No employees within the National Health Service may become a member of the CHC and a member of the CHC cannot serve on either the District Committee at the same time. No member can serve on more than one CHC. There are various regulations set down for membership and local Community Health Councils can advise on these.
Each CHC has a Chairman and a Vice Chairman who are chosen by the members. It is permitted to have Co-opted Members appointed to the CHCs to help in particular work, or for specialist advice.
There is a paid Secretariat is a p aid Secretary employed by the Regional Health Authority, but chosen by and accountable to the CHC. There is also a paid Assistant and sometimes an additional temporary assistant or assistants.
To run a Community Health Council, a financial budget is agreed by the Regional Health Authority and covers the cost of staff, premises and running expenses. The cost of a CHC is less than the cost of a second-class stamp per person in each district per year.