Health Review Committee

Health of Our Children and Young People

Report 27 January 2004

Appendix A

The Role of Health Scrutiny

1. Background Information

What is Health Scrutiny

1.1. Hampshire County Council established the Committee in January 2003 in response to the Health and Social Care Act 2002. This gives in London boroughs, county and unitary authorities - i.e., those with social service responsibilities - a statutory power to:

"...review and scrutinise, in accordance with regulations, matters relating to the health service in the authority's area, and to make reports and recommendations on such matters in accordance with the regulations."

1.2. Regulations issued under the Act and subsequent guidance make provisions for local authority health overview and scrutiny committees (OSCs) in relation to:

_ what matters may be scrutinised and reported upon;

_ information which local National Health Service (NHS) bodies must provide to the committee, and that which they should not disclose;

_ which officers of local NHS bodies will be required to appear before the OSC;

_ matters on which local NHS bodies must consult the OSC; and

_ arrangements for joint scrutiny committees between local authorities (including, but not limited to, counties and districts in two-tier areas), for one authority's OSC to operate on behalf of another authority, and for an OSC to co-opt members from other councils.

1.3. In the Act, `the health service' is defined to include health-related functions of local authorities, and `local NHS bodies' means health authorities, primary care trusts (PCTs) and NHS trusts.

1.4. The regulations relating to the functions of health overview and scrutiny define the role of the Committee in relation to the scrutiny of health services and consultation by the NHS on substantial variations or developments in services.

1.5. Supporting guidance produced by the Department of Health emphasises the role of the Committee as a means of improving the health of local people and ensuring that their needs are considered as an integral part of the delivery and planning of health services.

1.6. Proposals that the Committee consider are not in the interests of the health services in the area of the local authority's committee may be referred to the Secretary of State. However conducted health scrutiny needs to have regard to the interests of the population that receives the service under consideration. This interest may be specific to a particular service within a geographic area or be more generic across the area served by the Committee's local authority.

New Arrangements for Patient and Public Involvement in Health

1.7. The NHS Plan proposed the abolition of Community Health Councils (CHCs). Legislation has put in place arrangements to replace CHCs and their national association with a new system for public and patient involvement in healthcare, comprising:

_ Patient and Public Involvement Forums (P&PIFs) in every NHS Trust and PCT, made up of patients and other members of the local community, with power to inspect all aspects of the work of the NHS;

_ a new national patients body, called the Commission for Patient and Public Involvement in Health', to set standards and ensure consistency in the involvement system as a whole

1.8. These new bodies add to other arrangements to support patient advocacy - Patient Advocacy and Liaison Services (PALS) and independent complaints advocacy.

1.9. Local authority health overview and scrutiny functions have taken on some CHC responsibilities, most notably the right to refer contested changes in local NHS services to the Secretary of State. They can also be able to make referrals if they have concerns about how a consultation process has been managed by the NHS locally. As P&PIFs develop, the Committee will develop links to share information, avoid duplication and provide good local intelligence for scrutiny.

Local Progress with Health Scrutiny

1.10. The Committee has sought to build a developmental approach to health scrutiny across its area and with neighbouring authorities. This is a new way of working and emphasis has been placed on ensuring that constructive working relationships are built both internally (with local authority service providers and the Cabinet) and externally with district councils, local NHS bodies, the voluntary sector and most recently the newly established patient and public involvement forums.

1.11. There is recognition that, for the scrutiny process to be credible and influential it must:

_ be challenging but not confrontational

_ be based on evidence and not opinion

_ lead to an improvement in service

1.12. Discussions with partners, including NHS Trusts, PCTs and district councils have emphasised the role of the Committee as a `critical friend' in the scrutiny process and it is hoped that this approach will lead to a culture in which service providers feel able to respond honestly to questioning and provide convincing explanations for why they do not take up scrutiny recommendations.

1.13. Health is a complex area for scrutiny and getting the right balance in the delivery of this new role is difficult. A number of national bodies, notably the Audit Commission, have pointed to the fact that successful health scrutiny requires an investment of time and resources on the part of both local authorities and NHS bodies. This has certainly been the experience of the Committee in our first year of activity. In this sense it is deeply disappointing that this need has not been recognised by central government and resourced. Inevitably this means that local authorities will be limited in the level of scrutiny work they are able to take on board.

1.14. In recognition of the fact that health scrutiny is wide-ranging and can never be fully comprehensive, in the sense of overseeing and scrutinising everything that local NHS bodies do the Committee has adopted a pragmatic approach that focuses on:

_ work that the Committee must do - such as reviewing local service reconfiguration proposals and referring contested proposals to the independent panel/ Secretary of State

_ managing referrals from patient and public involvement forums and other partners

_ issues where the scrutiny approach of open review by lay members representing the local community, can make a distinctive impact.

1.15. Wherever possible existing sources of intelligence are used to inform the Committee's understanding of the problem in hand. This may include access to monitoring activities already established as well as feedback from the communities affected, patient representative groups or the voluntary sector. Similarly the Committee will take account of in-house performance reviews as appropriate.

1.16. In coming to a view about health issues the Committee places emphasis on the engagement of all interested parties as part of the planning and development of health services. If the Committee is not satisfied that this is the case then the matter may be referred back to the agency concerned. Alternatively the Committee may invite feedback from all affected by the proposals under consideration.

2. Guiding Principles

2.1. Genuine partnership working with key stakeholders underpins the work of the Committee. In reaching a view regarding a particular issue account is taken of:

_ The interest of local health services across the Committee's area. This will include issues relating to accessibility and equity in service provision.

_ Clarity about the improvements to be achieved for service users.

_ Change that is based on clear evidence and organisational best practice.

_ The extent to which service users, the public and other key stakeholders had contributed to the planning and delivery of the service in question. Particular regard will be given to the involvement of `hard to reach groups' where this is appropriate.

_ Evidence that the views of the public and key stakeholders were considered and responded to appropriately.

_ Impact of the proposal on the wider community and other services. This may include consideration of issues such as economic impact, transport issues and regeneration.