Contact: Graham Linecar, ext 7390
Carole Bennett, ext 7153

1. Summary

1.1 The following decisions are sought:

1) The County Council's response to the Department of Health consultation paper `Local Authority Health Overview and Scrutiny' to be agreed by the officers in consultation with the Leader, following any comments by the Leaders of the other political groups and submitted to the Department of Health by him on behalf of the County Council. It should welcome the Government's recognition of local government's legitimacy in representing community views on health and express reservations on resourcing.


2) Welcome and accept the strategic health authority's chief executive's offer to fund preliminary seminar and make arrangements for it to be held in late spring, preferably after publication of draft Guidance and Regulations. Representation to be invited from Community Health Councils, NHS Trusts, PCTs and District Councils.

3) Work up proposals for the County Council's Policy and Resources Policy and Review Committee to take on the County Council's health scrutiny function based on principles in this report and emerging from discussion at the seminar with the intention of undertaking formal consultation with partners late summer/early autumn on proposed arrangements, issues for scrutiny and a draft programme of reviews.

2. Reason

The Health and Social Care Act 2001 provides for local authorities with social service functions to scrutinise health services as part of a wider role in health improvement and reducing health inequalities. The Department of Health has published a consultation document on how local authorities should organise and perform their role of health overview and scrutiny. Responses have to be made by 16 April.

3. Other Options considered and rejected:

None

4. Conflicts of interest declared by the decision maker or a member or officer consulted - not applicable.

5. Dispensation granted by the Standards Committee - not applicable

6. Reason(s) for the matter being dealt with if urgent - not applicable.

Approved by: Date:

Councillor T K Thornber CBE

Contact: Graham Linecar, ext 7390
Carole Bennett, ext 7153

1. Purpose of report

1.1. To agree arrangements for considering how the County Council will exercise its power of overview and scrutiny of health and NHS services.

1.2. To consider a response to the Department of Health consultation paper `Local Authority Health Overview and Scrutiny.'

2. Background

2.1. The Health and Social Care Act 2001 provides for local authorities with social service functions to scrutinise health services as part of a wider role in health improvement and reducing health inequalities. The Department of Health has published a consultation document on how local authorities should organise and perform their role of health overview and scrutiny. Responses have to be made by 16 April. It is intended to consult on draft Regulations and Guidance over the summer and for Guidance to be published late in the year and Regulations to come into force early in 2003.

2.2. The consultation document proposes that local authorities' overview and scrutiny committees should extend their role to health and NHS services. The consultation makes explicit that it is intended to be a function of review/scrutiny committees, not authorities' Executives.

3. The new NHS structure in Hampshire

3.1. Changes in NHS structures in Hampshire are resulting in a strategic health authority for Hampshire and the Isle of Wight responsible for monitoring performance of the 10 Primary Care Trusts (PCTs) and 7 NHS Trusts, 4 of which are hospital trusts, one is for the Hampshire ambulance service and one for mental health. There is a NHS Trust for hospital, mental health and ambulance services for the Isle of Wight. The County Council's area is co-terminus with 7 PCTs (see map at Appendix 1). In many cases the PCTs provide services on behalf of each other. In addition to the 6 NHS Trusts referred to above which provide services to Hampshire residents, others located outside Hampshire - for example Bournemouth and Frimley - provide hospital-based services for Hampshire residents and patients are referred for specialist treatment to other hospitals outside the area.

4. The Department of Health consultation document

4.1. Full text of `Local Authority Health Overview and Scrutiny: A Consultation Document' is available on the web (www.doh.gov.uk/healthscrutinyconsultation)

4.2. The Government intends NHS services to be more responsive to patients and to the health needs of the wider community. Changes in NHS structures are directed at strengthening the voice of service users. There will be a Patients' Forum in each PCT (taking on some functions of Community Health Councils) and Patient Advisory and Liaison services (PALS) are to be set up. These, and other changes, are intended to achieve responsiveness to patients/service users. The proposal set out in the consultation document for local authorities' overview and scrutiny committees to extend their role and purpose to health improvement and NHS services is the Government's way of strengthening community accountability and responsiveness. It is an encouraging recognition by Government of local government's legitimacy and authority in representing community views.

4.3. The Health and Social Care Act requires the Trusts to provide information and co-operate with the County Council and unitary authorities in health scrutiny. The scrutiny review committee can require information from NHS bodies and attendance of chief executive or appropriate officer to give evidence and answer questions.

4.4. The consultation document indicates that the Government intends scrutiny to focus on broad considerations of the health needs of an area. Some reviews may focus on a particular NHS Trust or PCT or on proposals to reorganise a service or affecting an individual facility. But by and large, reviews are likely to be broader in scope and not about NHS services alone but how health is promoted generally. It therefore `fits' with our own move towards more thematic cross-cutting Best Value reviews. It is likely to include consideration of the County Council's role in social care, education, transport/accessibility, environment etc and how that relates to objectives/activities/provision by other agencies including health, district councils, voluntary and independent sectors.

5. Process

5.1. The consultation document indicates that the Government intends a non-prescriptive approach. The County Council is required to decide an approach to health scrutiny, set up appropriate arrangements for working in partnership with NHS bodies and others (Patients' Forums, local office of the Commission for Patient and Public Involvement in Health) and set priorities for early reviews. `Output' is intended to be a report with recommendations addressed to relevant authorities/organisations. These may not be just NHS bodies, recommendations could be made about the County Council's own services. NHS bodies will be required to respond in writing within 12 weeks. Reports will be published, circulated widely and placed on deposit in libraries and on websites.

5.2. Joint working/delegation between local authorities is intended. We will need to consider:-

4.2.1 working with neighbouring authorities where a review includes regional specialist services
4.2.2 arrangements to work with/in co-ordination with unitary authorities
within the strategic health authority's area to review issues of shared
concern and to meet the requirement to make best use of an NHS Chief
Executive's meeting with local authorities' scrutiny committees
4.2.3 involving district councils.

5.3. The Local Government Act 2000 gives district councils powers to consider health improvement but powers under the Health and Social Care Act 2001 are reserved to authorities with social services duties. The consultation document anticipates County Councils making arrangements to involve district councils in health scrutiny. It suggests the following options:-

4.3.1 co-option of district non-executive members as voting members onto the County Council's scrutiny/review committee
4.3.2 a joint committee (with County Council remaining in the lead)
4.3.3 delegation of function (but not responsibility) for particular reviews.

5.4. The consultation document proposes that consideration should be given to including representation on scrutiny/review committees from Patients' Forums, the CHCs (while they still exist) and from voluntary organisations. Arrangements for membership should be flexible to ensure for any given review the most appropriate mix and range of members and style and approach whilst allowing democratically determined balance in voting powers.

5.5. The first job of the scrutiny/review committee will be to establish links with NHS bodies and other partners and to discuss and determine a programme of reviews. They will maintain a forward programme of reviews in consultation with district councils, NHS partners and other key stake holders and determine the style and approach for each review. The committee will be expected to respond to new issues not included in the programme, if necessary amending the planned programme if that is concluded to be in the interests of the local community. Reviews may be initiated at short notice if there are grounds for concern.

6. Issues for the County Council

6.1. The County Council has not charged one particular PRC with what might be termed `external' or `community' review. Our policy review committees were set up constitutionally and within standing orders so they could operate in the free-ranging way of a parliamentary select committee - which is the approach advocated in the consultation document. We are still developing the expertise to enable PRCs to take that more enquiring and listening approach. Policy and Resources PRC is the most appropriate PRC to take on health overview and scrutiny, which spans across the broad range of the County Council's functions.

6.2. Early arrangements are needed to open up dialogue with districts, NHS partners and CHCs. That discussion would enable proposals to be drafted for formal consultation with partners and adoption by the County Council as its means for discharging its health scrutiny function. Consideration would need to be given to co-option of district council and CHCs/PALs representatives onto Policy and Resources PRC for the health scrutiny part of its business. There would be the opportunity to co-opt additional representation on an ad hoc basis for individual scrutiny reviews. Arrangements will be needed to inform and possibly include Local Strategic Partnerships in health scrutiny reviews.

6.3. The newly appointed Chief Executive of the strategic health authority has offered to fund a seminar to inform and shape proposals for how the County Council would undertake its health scrutiny role.

6.4. Some first thoughts on procedures/organisation would be:

_ for health scrutiny to be made an explicit function of P & R PRC

_ and dealt with as separate part of agenda, with co-opted members joining the PRC only for that part of agenda

_ co-option of district council-appointed representatives, with voting rights : consider co-option of CHC/PALs/Patients Forums representative(s) and Members from the County Council's other PRCs

_ additional members to be appointed to the PRC for specific reviews, including from PALs and Patients Forums : consider forming `working groups' so not all P&R PRC members involved in undertaking every review, working groups to bring draft report to full PRC

_ when functioning as health scrutiny committee, P & R PRC to operate flexibly to receive submissions (written and spoken), make visits and pursue enquiries/research in the mode of a parliamentary select committee or commission of inquiry

_ programme of health scrutiny reviews to relate to Best Value programme and Health Improvement and Modernisation programme- avoid overlap, encourage compatible/complementary reviews

_ develop arrangements to involve Local Strategic Partnerships in developing programme of review and in some individual scrutiny reviews.

6.5 A preliminary list of the sort of issues which might be the focus for individual reviews is attached as appendix 2. Its purpose is not to define possible reviews but to give an appreciation of the type of issues the consultation paper suggests should be the focus of reviews - and to show how additional co-opted members may be appropriate for specific reviews, possibly from the County Council's other PRCs. Few reviews are likely to focus on only one PCT or NHS Trust or one district council's area.

6.6 Consideration will need to be given to resourcing. The consultation paper does not indicate additional Government funding for the management, staffing and support costs of undertaking scrutiny/review.

7. Recommendations

7.1. The County Council's response to the Department of Health consultation paper `Local Authority Health Overview and Scrutiny' to be agreed by the Leader in consultation with Leaders of the other political groups and submitted to the Department of Health by him on behalf of the County Council. It should welcome the Government's recognition of local government's legitimacy in representing community views on health and express reservations on resourcing.

7.2. Welcome and accept the strategic health authority's chief executive's offer to fund preliminary seminar and make arrangements for it to be held in late spring, preferably after publication of draft Guidance and Regulations. Representation to be invited from Community Health Councils, NHS Trusts, PCTs and District Councils.

7.3. Work up proposals for the County Council's Policy and Resources Policy and Review Committee to take on the County Council's health scrutiny function based on principles in this report and emerging from discussion at the seminar with the intention of undertaking formal consultation with partners late summer/early autumn on proposed arrangements, issues for scrutiny and a draft programme of reviews.

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act.

File Location

None

Appendix 2

Suggestions for topics for scrutiny/review

Access to elective surgery for people over 65 (cataract, hip replacement) - DoH anti-ageism strategy

Access to preventative services for people over 65 - DoH anti-ageism strategy and health improvement

Access to and equity of healthcare for people living in rural areas - would include County Council support for public transport

Access to and provision of speech and language therapy for children and young persons - relates to Special Education Needs assessment and provision.

Access to healthcare for children looked after by the County Council (also Quality Protects target)

Public and patient involvement in the NHS - link to County Council's own customer surveys

NHS service/facilities changes - possibilities include post-implementation review of orthodontic service changes in North Hampshire, closure of The Mount Hospital, Bishopstoke, reconfiguration of accident and emergency services in Mid Hampshire - all raise issues of accessibility/transport

Planning and providing primary healthcare provision/facilities in areas of new housing development

Review of ambulance service - Health Minister announced 15 January that new strategic health authority would, with PCTs, review the ambulance service and make recommendations about how the service should be organised in the future.