Archived decisions

Contact: Graham Linecar ext: 7390

1. Summary

1.1 This report sets out for this first meeting of the Health Review Committee information regarding the new power, under section 7 of the Health and Social Care Act, 2001, for County Councils to establish overview and scrutiny committees to scrutinise health services in the authority's area. It also updates the Committee on consultation undertaken by the County Council on proposals for implementing this power and responses made to consultation. A final section makes recommendations for moving forward the work of this Committee.

2. Introduction : the new power of health scrutiny

2.1 As part of the Government's modernisation agenda for the NHS, it has given 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 local authorities to work with the NHS organisations in their areas to help develop and plan health services reflecting needs and aspirations of individuals and communities. The Government's intention is that health services should become more responsive to the communities they serve. It is giving the 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.

2.2 Parallel changes within the National Health Service are intended to make services more responsive to the needs and aspirations of patients and service users. A Patients Forum is being established for each Trust to put forward the views of patients. A Patient Advice and Liaison Service (PALS) has been established to take up concerns of patients and service users and to investigate concerns and complaints.

2.3 The new arrangements for local authority overview and scrutiny and for Patient Forums and the PALS take over roles presently undertaken, effectively and successfully in Hampshire, by the Community Health Councils (CHCs). The Department of Health has not yet decided when CHCs will cease to exist - they will continue to operate beyond the end of March which the Department previously intended should be the date for abolition. It will be important for the new Health Review Committee to work in tandem with the CHCs and pick-up those parts of their work where they represented the community in decisions taken by NHS bodies.

2.4 The powers for the County Council to undertake health scrutiny are contained in section 7 of the Health and Social Care Act 2001. Regulations setting out the detailed arrangements for the interpretation of this section are set out in a Statutory Instrument published by the Government on 19 December last which came into force on 1 January 2003. The Department of Health will publish guidance shortly. There has been no statement from Government about how the new power is to be funded : because local authorities are taking on part of the role of CHC's it would be reasonable for part of the Government's funding of CHC's to be re-allocated to local government to support that function.

2.5 There are 2 main functions :

2.5.1 The first is that the Committee can initiate its own programme of reviews focusing on issues of local concern and where it is considered that objective review by elected representatives will help NHS bodies and other organisations involved in the provision of appropriate services to plan and run those services. The Regulations prescribe that such reviews shall result in publication of reports which include

· explanation of the matter reviewed

· summary of the evidence considered

· list of participants in the scrutiny exercise

· recommendations to NHS bodies and other organisations on the matter reviewed.

NHS bodies are required to respond in writing, if requested, within 28 days of the written request. The response is intended to set out the action to be taken, or the reason for not taking the action recommended in the report.

2.5.2 The second is that NHS bodies are required to consult health scrutiny committees when considering making proposals for a `substantial development of the health service' or `substantial variation in the provision of such service' within the authority's area. The Regulations do not define or prescribe a definition of what constitutes `substantial' development or change and arrangements will be needed to agree with NHS bodies when proposed change is `substantial', and that formal public consultation should be undertaken. The CHCs at present undertake a similar role in providing community response to proposals for development and change. The CHCs have provided, as an indication of what will be involved in fulfilling this role, a list of current consultations (see appendix B).

2.6 An appendix (A) provided by the Hampshire and Isle of Wight Health Authority (HIoWHA), the strategic health authority for the area, sets out the NHS bodies which provide services in Hampshire and the Isle of Wight and gives briefing on their role, function and budgets.

2 The County Council's consultation paper

2.1 The Cabinet requested that the Policy and Resources Policy Review Committee (P&R PRC) developed initial thinking on how the County Council might respond to the new challenge and exercise its powers under section 7 of the Health and Social Care Act 2001.

2.2 P&R PRC established dialogue with main partner organisations in Health and in other local authorities. A seminar was held at Sparsholt in June 2002 which helped develop an understanding and appreciation of issues involved in developing arrangements. An informal meeting in September 2002, to which all Members of the County Council were invited, considered how the County Council might propose to exercise the new power.

2.3 P&R PRC 11 October 2002 agreed a consultation paper for discussion with, in particular, partner organisations in Health, unitary and district councils. The consultation paper was distributed at the end of October to all Health bodies, district councils, neighbouring authorities with Social Services responsibilities, CHCs and organisations with an interest in the health of the community. It was available to the public on the internet or on request. Publication was reported by local media.

2.4 The consultation paper (attached, appendix C) sets out the two parallel functions of this committee:

· carrying out of reviews which the Committee itself selects and defines


· responding to NHS bodies on their proposals for substantial development and change in services.

It explains the power of the Committee to publish reports of reviews, with recommendations, to which NHS bodies are required to respond, and sets out the expectation that other bodies should similarly respond. It sets out that, in undertaking reviews and publishing recommendations, the Committee should act on behalf of the community - the purpose of Government's proposals is to strengthen community accountability of NHS bodies. The Committee will itself be solely responsible for deciding what to include in reports of reviews.

2.5 The consultation paper sets out proposals for how the Committee would approach its task:

2.5.1 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.

2.5.2 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.

2.5.3 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 bodies, including meeting the chief executive or appropriate officers.

2.5.4 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.

2.5.5 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.

2.5.6 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.

2.6 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 consultation paper therefore proposes agreement of protocols with neighbouring councils with health scrutiny powers under the Health and Social Care Act 2001 for the carrying out of joint reviews. It also proposes regular consultation between the health scrutiny committees of the four authorities with health scrutiny powers in the Hampshire and Isle of Wight Health Authority's (HIoWHA) area.

2.7 The consultation paper sought views on issues for consideration for review.

3 Responses to the consultation paper

3.1 18 written responses have been received and are listed and summarised in appendix D. The County Council's Partnership Managers have presented the consultation paper and discussed its proposals with PCTs (Executive or Board). There has been discussion at meetings of the Association of Hampshire and Isle of Wight Local Authorities attended by the Leader. The Chief Executive has met with, and is to meet again, Chief Executives from the other (unitary) authorities in the HIoWHA's area.

3.2 There has been support for the overall approach and proposed role of the Health Review Committee. NHS bodies emphasise the need to ensure that individual reviews do not duplicate and over-lap with other scrutiny and reporting exercises and utilise information already compiled for other purposes. They provide an encouraging indication of wishing to work with and support the Committee in seeking services responsive to the community. Several responses from NHS bodies offer briefing and the opportunity for `familiarisation visits' and training to assist Members in their task.

3.3 Responses from NHS bodies, including those in adjoining areas, refer to what might be characterised as `the complexity of the Health landscape'. PCTs may have responsibility for health provision within a defined geographic area, but responsibility for service provision is more complex with one PCT having responsibility for provision of specialist services in the areas of other PCT's. All except 2 of the NHS (hospital) Trusts providing secondary care services to Hampshire residents are based in the area of other local authorities. Individual hospital Trusts have responsibility for provision of specialist (tertiary) services over even wider geographical areas - Salisbury Health Care NHS Trust's response, for example, refers to the Trust's responsibility for provision of tertiary services of plastic surgery, burns, genetics and spinal injuries for the whole of Hampshire.

3.4 The Hampshire and Isle of Wight Federation of Community Health Councils made a particularly useful response. An extract is attached (appendix B) which includes the offer to work in collaboration with the Committee to transfer knowledge, experience and expertise.

3.5 Surrey, West Sussex and Wiltshire County Councils support proposals to consider agreements about joint review. Discussions are commencing to identify proposals.

3.6 The Hampshire district councils have concerns about the capacity of the 4 district council nominees to be co-opted to the Committee properly to articulate the interests and concerns of individual district councils. The Regulations include the power for the County Council to delegate to a district council responsibility for undertaking particular reviews. Some district councils point to their responsibility to prepare a Health Improvement and Modernisation Plan with local PCTs and advocate a broad delegation to individual district councils of responsibility for `monitoring the services provided by the local PCT'.

4 Making arrangements for health scrutiny - issues for consideration

4.1 The new Health Review Committee is invited to affirm the overall approach set out in the consultation paper prepared by the P&R PRC, and which responses to consultation shows is generally supported by partner organisations. No representations have raised issues challenging the overall approach or fundamental principles set out in the consultation paper. The Committee may therefore resolve to continue to prepare arrangements whereby it

· consults with partner organisations in Health and with district councils to prepare a programme of reviews

· consults with authorities with health scrutiny powers in adjoining areas to identify issues of shared concern to work up arrangements for joint review or to delegate responsibility

· sets terms of reference and commissions work to undertake reviews, setting up, when appropriate, a working group to undertake that review and delegating to that working group responsibility for undertaking the review within the terms of reference set by the Committee

· receives from such working groups a report of matters and evidence considered, the steps taken to secure views of users and providers of the service and draft recommendations

· will consult with NHS and other bodies responsible for the service under review on the conclusions and draft recommendations of the working group

· will consider and agree a final report and recommendations for publication, on which NHS and other bodies will be requested to respond.

4.2 The Committee should consider its own style of working. The approach advocated by Government is of a more investigative and participatory approach than a conventional local authority committee. The Committee may wish that to be reflected in its procedures. Members who have been members of CHCs will know of the active involvement of CHC members in consultation exercises. The Committee may wish to resolve that each review working group is led, or facilitated, by a member of the Committee who will take an active part, if not the lead, in securing information (especially when meeting service users and providers and securing information from NHS officers) and will act as rapporteur in bringing the working group conclusions before the Committee.

4.3 Only a small number of representations commented on the proposed first review - the health of our children and young persons. Representations made were supportive. The Committee may wish to consider preparing for its next meeting (8 April) a draft programme of reviews, which will test the proposition that issues for reviews are likely to span across organisational and geographical boundaries. Consideration should be given to whether work in undertaking individual reviews could and should be delegated to a particular district council and to the representation on working groups for each review. The Committee might then wish to consider holding a seminar with partner organisations (as at Sparsholt last June) to debate that programme.

4.4 The Committee must also consider immediate arrangements for responding to Health bodies on whether proposed changes to services are `substantial', and should therefore be the subject of public consultation. It is recommended that the Committee asks the CHCs to continue as initial point of contact whilst they continue to exist, and that the CHC consults with the Chief Executive who will, in consultation with the Chairman, advise the CHC, and so the appropriate NHS body, of the Committee's view.

4.5 The Committee should consider arrangements for ensuring transfer of knowledge and expertise from the CHCs. It is recommended that an officer representative of the Hampshire and Isle of Wight Federation of CHCs be asked to attend meetings of the Committee.

4.6 The strategic health authority, HIoWHA, has also offered to provide an officer to attend and advise the Committee. This would be of considerable assistance in timely identification of likely proposals for `substantial change'.

4.7 The Committee should be aware that the Cabinet is giving consideration to provision to be made in the County Council's budget 2003-04 to fund the activities of this Committee.

Recommendations

It is recommended that the Committee

1. Endorses and affirms the broad principles set out in the County Council's consultation paper `Health Review in Hampshire' which will guide and support the arrangements the Committee develops for health scrutiny.

2. Thanks those who have commented on the consultation paper and welcomes the general support indicated by those representations and discussions.

3. Expresses particular thanks to those NHS bodies who have responded and welcomes the opportunity for, initially, the Chairman and Vice-Chairman of the committee to meet with representatives of the Board and/or Executive of each NHS Trust in Hampshire.

4. Welcomes the Federation of Community Health Councils' proposal to work with the Committee to facilitate transfer of knowledge and expertise from the CHCs to the Committee and invites an officer representative of the Federation to attend meetings and advise the Committee.

5. Welcomes and accepts the offer of the Hampshire and Isle of Wight Health Authority to provide an officer to attend meetings and advise the Committee and to provide regular reports on issues being faced by NHS bodies in Hampshire.

It is further recommended

6. that the Committee confirms that `The Health of our Children and Young Persons' should be an issue for review and that a programme of reviews be prepared for the next meeting of the Committee (8 April) setting out other proposed reviews, draft terms of reference and suggestions as to how the review work be commissioned and membership of review working groups

7. that, after consideration at the 8 April meeting, the draft programme be discussed with partner organisations, especially in Health and other local authorities, and that a seminar by arranged for that purpose in May or June


8. that a second report to the 8 April meeting proposes arrangements for responding to NHS bodies' consultations on proposals for substantial development or variation in health services and that, while Community Health Councils continue to exist, NHS bodies be requested initially to contact the appropriate CHC who will consult with the County Council and that the Chief Executive be authorised, in consultation with the Chairman of the Committee, to respond on behalf of the Health Review Committee to initial requests for advice on whether proposed changes are substantial and should therefore be the subject of full public consultation by the NHS body.


9. that opportunities for briefing, training and `familiarisation visits' be examined with the NHS bodies.