User representation in the NHS and the future of community health councils

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This paper explores the issue of user representation in health care in the light of the important changes to the organisation and funding of health and social services outlined in the government's reform programme for the NHS and community care. Its first section summarises the health and community care reforms themselves in an attempt to map the changing environment in which user representation will take place. The second sketches the history of consumerism and user representation in the NHS in order to indicate the ideological and organisational context within which changes to user representation in health and social care must be considered. The third examines the strengths and weaknesses of CHCs in representing users' views on the organisation and delivery of health and community care. The final section takes a broad look at the new health and social care commissioning structures and indicates the points at which user involvement is needed. It then explores the future for user representation and suggests a possible avenue for the development of CHCs. The paper ends with a series of questions designed to structure debate within CHCs and other interested bodies on the way in which user involvement should be organised within the new system.

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