Contact : Graham Linecar Ext: 7390

1. Summary

1.1 The following decisions are sought:

1) recommend the County Council at its meeting on 28 November to agree changes to the Constitution to add health overview and scrutiny to the terms of reference of one of the Council's overview and scrutiny committees, and to consider setting up a new overview and scrutiny committee for the expressed purpose of health scrutiny

2) recommend the County Council to consider including co-option of three district councillors representative of the Hampshire district councils collectively to whichever overview and scrutiny committee has responsibility for health scrutiny, and inviting HIOWLA to agree with district councils arrangements for nomination of those three district council representatives

3) request the Policy & Resources Policy Review Committee in January 2003 (or Health Review Committee if set up by the County Council and it is possible for it to be convened, possibly in `shadow' form) to consider:

- representations received on consultation paper
- Government guidance and Regulations
- any advice on meeting the costs of health scrutiny

and agree arrangements for the County Council's exercise of its power of health scrutiny

4) to consider what provision should be included for health scrutiny in the County Council's Budget 2003/04 in the light of the Policy and Review Policy Review Committee's or Health Review Committee's decisions and recommendations.

2. Reason

2.1 Policy and Resources Policy Review Committee (PRC) 11 October 2002 agreed a consultation paper setting out proposals for how the County Council should exercise its power of health overview and scrutiny for discussion, in particular, with partner organisations in Health, unitary and district councils

2.2 Policy and Resource PRC recommended the Cabinet:

- to consider setting up a Health Review Committee
- to consider health scrutiny when preparing the Council's budget for 2003/04.

3. Other options considered and rejected:
Not applicable.

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

5. Dispensation granted by the Standard's 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

1. Previous consideration

1.1. Cabinet 25 February 2002 resolved that Policy and Resources Policy Review Committee work up proposals for how the County Council should exercise its power of health overview and scrutiny.

1.2. An informal Member meeting on 16 September 2002, to which all Members were invited, considered issues involved and discussed draft proposals. The meeting was attended by three Executive Members.

1.3. Policy and Resources Policy Review Committee 11 October 2002

_ agreed a consultation paper (attached) for discussion with, in particular, partner organisations in Health, unitary and district councils

_ recommended the Cabinet to consider setting up a separate Committee

_ recommended that the Cabinet take account of health scrutiny when preparing the County Council's budget 2003/04.

2. Separate Committee

2.1. When the Cabinet asked the Policy and Resources Policy Review Committee to develop proposals, it had been implicit that health scrutiny would be added as an additional function to the terms of reference of an existing Policy Review Committee - and Policy and Resources Policy Review Committee was the most appropriate because it spanned all services and was not focused on one aspect, like the Social Care PRC.

2.2. Health review and scrutiny will involve extensive committee consideration and Member time. It is a matter of significance and importance to the County Council and will be of considerable public interest and concern in its own right, and it may not, therefore, be appropriate for it to be added to the agenda of a PRC with other important terms of reference. A separate, new committee gives the County Council the opportunity to bring in a wider range of expertise from Members with interest and knowledge in all relevant related issues from social care and education to environment and transport/accessibility.

2.3. Policy and Resources PRC accordingly recommends the Cabinet to recommend to the County Council at its meeting on 28 November the setting up of a Health Review Committee with terms of reference to develop arrangements for exercising the County Council's power of health overview and scrutiny and for establishing relationships and liaison with the County Council's NHS partner organisations.

2.4. This would require change to the County Council's constitution, setting of terms of reference, appointment and co-option of Members and determination of frequency of meetings.

2.5. Consideration should be given to inviting the Hampshire and Isle of Wight Association of Local Authorities (HIOWLA) to appoint 3 district councillors, representative of all Hampshire district councils, to be co-opted to whichever PRC has responsibility for health review and scrutiny. Representatives from other partner organisations, such as Patients Forums and user organisations, will be involved in individual reviews in ways proposed in the consultation paper but it is not considered that they need, at this stage, to be co-opted to membership of the committee.

3. Budget provision

3.1. Health scrutiny is a power not a duty. The County Council may decide whether to exercise that power or not and, if it decides to do so, the extent to which it uses the power.

3.2. Policy and Resources PRC and the informal Member meeting were of the view that health scrutiny was an area of considerable public interest. The Government's proposals that local authorities should provide the mechanism to achieve community accountability of NHS services was a significant recognition of local councils' authority and legitimacy to represent the interests and views of the communities that elect them. Members considered it would be imprudent to fail to take steps to exercise the power of health scrutiny.

3.3. It is to be hoped that the Government will indicate how it intends that health scrutiny is to be funded when guidance is issued. It is the Government's intention that community health councils should be abolished from the end of March 2003. Part of the functions of CHCs has transferred to Patients Forums and the Patient Advisory and Liaison Service. Part is transferring to local authorities with social services responsibilities. It would be equitable for funding also to transfer to these authorities to fund the role of health overview and scrutiny.

3.4. Policy and Resources PRC recommends the Cabinet to consider health scrutiny when preparing the Council's budget for 2003-04. The Committee records in its resolution its view that it would be imprudent for the County Council not to make arrangements to exercise the power of health scrutiny and that detailed arrangements, including a programme of reviews, should be determined when the Government's decision on funding is known.

3.5. If that is accepted by the Cabinet, there must therefore be some provision for health scrutiny in the Budget, even if it is made contingent on a Government announcement about off-setting funding.

3.6. The question then becomes what level of provision should be considered for inclusion in the Budget? If a new Review Committee is set up there would be consequences for committee administration. Professional advisers would be needed to manage and guide individual reviews. The proposed style of working - hearings, visits, commissioned research - would also need appropriate funding.

4. Making decisions on health scrutiny

4.1. The consultation paper published by the Policy and Resources PRC indicates that the County Council will make decisions on the extent to which it exercises its power of health scrutiny - the arrangements it sets up to undertake reviews and the extent of its programme of reviews -when Regulations have been made and Government's intentions on funding are known.

4.2. It is proposed that either Policy and Resources PRC or the new Health Review Committee meet in January to consider representations received on the consultation paper and, in the light of those representations, Government guidance, Regulations, any statement about the Government's intention on funding health scrutiny and the Government's financial settlement, consider an appropriate approach to health review and scrutiny and whether to commence a first review. The Cabinet would need to consider those proposals, and make appropriate provision in the budget it proposes to the County Council.

Recommendation

It is recommended that the Cabinet:

1. recommend the County Council at its meeting on 28 November to agree changes to the Constitution to add health overview and scrutiny to the terms of reference of one of the Council's overview and scrutiny committees, and to consider setting up a new overview and scrutiny committee for the expressed purpose of health scrutiny

2. recommend the County Council to consider including co-option of three district councillors representative of the Hampshire district councils collectively to whichever overview and scrutiny committee has responsibility for health scrutiny, and inviting HIOWLA to agree with district councils arrangements for nomination of those three district council representatives

3. request the Policy & Resources Policy Review Committee in January 2003 (or Health Review Committee if set up by the County Council and it is possible for it to be convened, possibly in `shadow' form) to consider:

_ representations received on consultation paper

_ Government guidance and Regulations

_ any advice on meeting the costs of health scrutiny


and agree arrangements for the County Council's exercise of its power of health scrutiny

4. to consider what provision should be included for health scrutiny in the County Council's Budget 2003/04 in the light of the Policy & Review Policy Review Committee's or Health Review Committee's decisions and recommendations.

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 N/A

Health Review in Hampshire

A Consultation Paper

October 2002

Good health is important for us all, individually and as a community. As individuals, we make choices and take decisions that affect our own health. As communities, the decisions and actions of many different bodies affect our health.

Hampshire County Council has long worked successfully in partnership with NHS organisations to improve the health of the community and to support individuals.

As part of the Government's modernisation agenda for the NHS, it is giving councils with social services responsibilities a new power. The Government has recognised that local councils have the authority and legitimacy to speak on behalf of the communities that elect them and which they serve. The Government wants councils like Hampshire County Council to work with the NHS organisations in their areas to help develop and plan health services reflecting needs and aspirations of individuals and communities.

Councils with social services responsibilities have a new power to review, or `scrutinise', the operation of the health service and the way it relates to other services. But scrutiny will not just be of NHS services. Accessibility to health services and the health of communities are directly affected by actions and decisions of councils themselves, other public bodies and the independent and voluntary sectors. Reviews will therefore look across organisational boundaries at the whole picture of health provision and the health of communities.

`Health scrutiny' is about recognising links and making recommendations for working in partnership to improve the health of people in Hampshire as individuals and as communities. NHS bodies will be required to respond to reviews and recommendations made to them and to set out proposed action, or reasons for not acting as recommended.

This paper seeks views on ideas for how Hampshire County Council would work with its partner organisations, especially in the NHS, to use its new power of health review and scrutiny. These proposals are based on what was set out in a Department of Health consultation document * and from conclusions on principles and actions drawn from a seminar which the Hampshire and Isle of Wight Health Authority held for partner organisations in June 2002.

The Government says it intends making Regulations(and issuing supporting guidance) for power of health scrutiny to be effective from 1 January 2003 and has just issued a further consultation paper on proposed contents. The County Council intends to reach decisions in January 2003 about how it will undertake health reviews, taking account of representations on this paper, the Regulations and Government decisions on funding.

Who are our partners?

1. NHS bodies

· Hampshire and Isle of Wight Health Authority (HIOWHA)


· primary care trusts (PCTs) : there are 7 PCTs in the County Council's area


· NHS Trusts running the hospitals that serve Hampshire, the ambulance and patient transport service and specialist mental health and learning disability services : some are based outside the County Council's area.


These are listed in an appendix.

2. The new bodies intended to help NHS bodies be responsive to service users and patients - Patients Forums and the Patient Advice and Liaison Service (PALS) and, while they continue, the Community Health Councils.

3. Voluntary and independent sector providers of health and social care services and support.

4. Organisations representative of social care service users and carers.

* Local Authority Health Overview and Scrutiny, a consultation document, Department of Health, January 2002.

5. Other local authorities

· neighbouring councils with health scrutiny powers where NHS bodies providing services to Hampshire residents are based


· Hampshire district councils.

What can we review?

There are two separate but related functions. First, the County Council can develop a programme of reviews of health services commissioned or delivered in its area. These may focus on a particular service or facility - and so may be `thematic', looking at a particular issue or related activities over a wide area - or focused on an individual facility or service within a confined area. The County Council will choose and determine the focus for these reviews.

Second, NHS bodies will have to consult the County Council at an early stage on proposals for significant change in the services they provide. These will not be chosen by the County Council : they will result from the management planning decisions of the PCTs and NHS Trusts.

Acting on behalf of the community

The Government's intention is that health services should become more responsive to the communities they serve. It is giving this power of health scrutiny to councils because they democratically represent their communities. But it is expecting councils to undertake reviews in partnership with NHS bodies and with community participation.

There is the expectation that reviews will involve the active collection of views from those providing services and those using them. That may be achieved by commissioning research, by making visits and by holding public sessions when individuals and organisations can present their views. NHS bodies will be obliged to provide information and chief executives or their representatives can be required to attend to answer questions.

It is important that the arrangements Hampshire County Council makes for health review and scrutiny make possible involvement of partners and seek out information about health provision and how it impacts on the health of the community.

The arrangements we are considering making and on which we invite your views

1. A new Health Review Committee?

Health review and scrutiny must be undertaken not by the Council's Executive (Cabinet) but by one of its overview and scrutiny committees. The County Council has 5 Policy Review Committees and has gained experience and developed expertise in `scrutiny' through its programme of Best Value Reviews.

Health review is an important new role, and the County Council will consider setting up a new Policy Review Committee for that express purpose.

2. Membership of the Health Review Committee

The County Council would appoint the members of a new committee and the chairman. No Executive Member can be appointed. Members who are also members of a NHS Board can be appointed but will not consider issues relating to that NHS body. The new Health Review Committee would be constituted in the same way as other Council committees, with membership proportional to the representation of political groups on the Council.

The County Council will consider asking the Hampshire and Isle of Wight Association of Local Authorities (HIOWLA) to appoint 3 district councillors, representative of all Hampshire district councils, to be co-opted to the Health Review Committee. Representatives from other partner organisations, such as Patients Forums and user organisations, will be involved in individual reviews as proposed below.

3. How the Health Review Committee could operate

It would meet formally six times a year. But individual members of the Committee would take the lead in the work it commissions and so their commitment is much greater than attendance at those meetings.

The Committee would, in consultation with NHS partner organisations and district councils, develop a programme of reviews. The Committee would have to prioritise the issues and services it might wish to review and decide annually on a programme of reviews to be carried out each year. Capacity to undertake reviews will be determined by resources. The Government has not yet said how the new power is to be funded.

The Committee would also respond to individual NHS bodies when they come forward with preliminary proposals for substantial development or change in health services. Consideration of those proposals and deciding a response will take time and capacity.

Arrangements made for undertaking individual reviews would be flexible and developed taking account of the particular issue under review to bring in the right expertise. The Committee could commission others to undertake work on particular reviews - for example, district councils and user and carer organisations - and would set up a working group for each review drawing in people with specific local knowledge or topic expertise. So the working group undertaking a review focused on services or facilities of a particular PCT or NHS Trust could include the local County Councillor, district councillors and representation from the Local Strategic Partnership. It could include representation from patient and user organisations, such as Patient Forums. In that way it should represent and reflect local circumstance and opinion and bring in topic expertise. The review working group would consider whether to:

undertake research, possibly commissioning studies and surveys
meet those providing and using the service to gather evidence

hold public hearings

ask for evidence and information from individual NHS Trusts, including meeting with the chief executive or appropriate officers.

The review working group would prepare a report of its findings for presentation to the Health Review Committee. NHS bodies and other organisations responsible for the services under review (including County Council services) would be consulted informally on the draft report before it is considered by the Health Review Committee. The report and recommendations would then be published. The Government requires NHS bodies to respond. The County Council would expect other organisations to respond in the same way. The Health Review Committee would consider the responses made by those bodies and organisations and their proposals for action.

Although not proposed in the Government's consultation document, the County Council thinks the Health Review Committee should subsequently look again, when proposals have been acted on, to check that intended outcomes were achieved.


Working with neighbouring Councils

Residents in the County Council's area use health facilities in the area of neighbouring councils. NHS Trusts based outside the county provide services to Hampshire residents. The County Council's Health Review Committee may want to review and scrutinise those services, and there may be issues of shared concern with adjoining councils.


The County Council will want to agree with those neighbouring councils protocols and arrangements for joint reviews.


The Health Review Committee will need to establish protocols with Portsmouth City Council and Southampton City Council about reviews considering services to Hampshire residents provided by the Portsmouth Hospitals NHS Trust and the Southampton University Hospitals NHS Trust.

A conclusion from the seminar arranged by HIOWHA was that each of the four councils with health scrutiny powers in the strategic health authority's area would want to have its own health review arrangements and did not want a single joint committee. Nevertheless, the four health scrutiny committees would need to co-ordinate programmes of reviews and the approaches made to the PCTs and NHS Trusts for information.

The County Council is therefore proposing regular consultation between the respective health scrutiny/review committees, and that there should be joint meetings of chairmen as required.

Similar arrangements will be considered with Surrey County Council (about services provided by Frimley Park Hospital, Royal Surrey County Hospital and Surrey Hampshire Borders NHS Trusts), and may be considered with Bournemouth Borough Council (about services provided by Royal Bournemouth and Christchurch Hospitals) and Wiltshire County Council (about services provided by Salisbury Health Care NHS Trust).

There may be the need to work with other councils, on an ad hoc basis, if particular services located outside Hampshire are reviewed.

Timetable

2002

November/

December Hampshire County Council consults with partner organisations on this consultation paper

28 Nov County Council meeting : consider a recommendation that a new Health Review Committee be set up

December The Government says it will publish guidance and get Parliamentary approval of the Regulations necessary for...

2003

January ...health scrutiny powers to be effective from 1 January 2003

January Committee meeting to consider representations received on this consultation paper, Regulations and Government guidance plus any announcement about funding. The meeting may also consider starting a review : initial thoughts are that an appropriate topic would be `The Health of our Children and young persons,' covering a range of issues over a period of time, of which the first could be
health care for looked-after children
followed by
health of school age children, focusing particularly on health inequalities

and then
mental health services for children and the mental health problems of 14-19 year olds
access to therapy in schools.

Your views are invited on:

· choice of topic


· those who should be included in the review working group


· how the working group might approach its task (eg public hearings, collection of data and views/opinions of service users and providers)

Discussing our proposals, making comments and expressing your views

We hope to meet and discuss issues and our draft proposals with our principal partners, especially the Executives of the PCTs. We will try to meet other partners organisations if requested.

To allow time for proper consideration of what you tell us, we would like to have completed meetings and received written responses by 31 December.

Representations should be addressed to:-

The Chief Executive

Hampshire County Council

The Castle

Winchester

SO23 8UJ

You may also send comments by e-mail to: [email protected]

APPENDIX

Health Services in Hampshire and the Isle of Wight

Primary Care Services

Primary Care Services in Hampshire and the Isle of Wight include:

· Over 1000 general medical practitioners (family doctors)


· Over 300 pharmacies


· Over 650 opticians and ophthalmic medical practitioners


· Over 650 general dental practitioners

There are ten Primary Care Trusts serving Hampshire and the Isle of Wight, broadly aligned with district and unitary authorities:

· Blackwater Valley and Hart (covering Hart and Rushmoor)


· East Hampshire (covering Havant and the southern part of East Hampshire)


· Eastleigh and Test Valley South (covering Eastleigh and the southern part of Test Valley)


· Fareham and Gosport (covering Fareham and Gosport)


· Isle of Wight (covering the Isle of Wight)


· Mid Hampshire (covering Winchester and the northern part of Test Valley)


· New Forest (covering the New Forest)


· North Hampshire (covering Basingstoke and Deane and the northern part of East Hampshire)


· Portsmouth City (covering Portsmouth City)


· Southampton City (covering Southampton City)

NHS Trusts

There are seven NHS Trusts with their HQs in Hampshire and the Isle of Wight and accountable to the Hampshire and Isle of Wight Health Authority. Their role includes providing acute hospital services, specialist mental health and learning disability services, ambulance services and patient transport.

· Hampshire Ambulance Service


· Isle of Wight Healthcare


· North Hampshire Hospitals


· Portsmouth Hospitals


· Southampton University Hospitals


· West Hampshire (mental health and learning disabilities for Hampshire, excluding Basingstoke, Hart, Rushmoor and northern part of East Hampshire)


· Winchester and Eastleigh Healthcare