Contact Denise Holden ex 7338

e-mail: [email protected]

Purpose and Summary

1) Section 7 of the Health and Social Care Act 2001 places a statutory responsibility on the NHS to consult Local Authority Health Overview and Scrutiny Committees (OSCs) on any proposals to substantially vary or develop NHS provision to people living in the area of the OSC(s). This requirement is additional to the duty placed on NHS bodies to consult and involve patient and the public in the planning and operation of health services as set out in Section 11 of the Health and Social Care Act.

2) This document provides a context to the dialogue that needs to be taking place between the OSC(s) and NHS organisations to establish if a proposal is substantial in nature. It is not, nor is it intended to be, a `blueprint' for engagement between the OSC(s) and the NHS as the timing of consultation and methods of engagement may vary from proposal to proposal.

3) The framework draws on the following documentation:

a) Overview and Scrutiny of Health - Guidance (July 2003)

b) Overview and Scrutiny of Health-Supplementary Guidance (July 2003)

c) Strengthening Accountability -Policy and Practice Guidance (Feb 2003)

d) Keeping the NHS Local- A new direction of Travel (Feb 2003)

e) Independent Reconfiguration Panel- Guidance & Template (Feb 2004)

4) The regulations supporting the health scrutiny function do not define `substantial'. This needs to be determined locally and will be dependent on the impact that the changes will have on people using, or who have the potential to use, the service in question.

5) The role of the OSC(s) working with local NHS bodies and the duties for engagement and involvement placed on the NHS require that new working relationships develop. These are evolving across Hampshire and the Isle of Wight and the intention is that this document makes a positive contribution to supporting the effective delivery of these arrangements. It will therefore be reviewed by the participating OSC(s) and NHS organisations in 12 months. During this time all participants will work to explore the scope for developing a local mechanism for resolving any contested change.

6) The recommendations included in this report support Aim 5 of the Corporate Strategy (Improving Services).

Introduction and Rationale

7) New arrangements for the scrutiny of health services introduced in January 2003 made local authorities with social service departments responsible for the overview and scrutiny of health services in their area. Where the NHS plans to substantially change or vary health services for which it is responsible, the OSC(s) whose populations are affected are statutory consultees.

8) The term `substantial' is not defined in the legislative framework supporting the role of the OSC(s). The guidance supporting arrangements for Patient and Public Involvement in the NHS, and that relating to health scrutiny is clear that there is an expectation that the NHS body responsible for the proposal should initiate early dialogue with the OSC(s) affected by the proposal to determine:

a) If the change constitutes a substantial variation or development

b) The timing and content of the consultation process.

9) Where it is agreed that the proposal does constitute a substantial change the response of the OSC(s) to the subsequent consultation process will be shaped by the following considerations:

a) Has the consultation process been appropriate in terms of timing and content, including the delivery of Section 11 requirements

b) Is the change proposed in the interests of the health service in the area

10) The framework attached at Appendix One identifies a range of issues that may inform both the discussion about the nature of the change and the response of the OSC to the consultation process. The intention is that this provides a simple prompt for assessing proposals, explaining the reasons for the change and understanding the impact this will have on those using, or likely to use, the service in question.

11) The framework is not a `blueprint' that all proposals for changing services from the NHS are expected to comply with. The diversity of the health economy across Hampshire and the Isle of Wight and the complexity of service provision need to be recognised, and each proposal will therefore need to be considered in the context of the change it will deliver. The framework can therefore only act as a guide. It is no substitute for an on-going dialogue between the parties concerned. It is designed for use independently by the NHS in the early stages of developing a proposal, or provide a basis for discussion with OSCs regarding the scope and timing of any formal consultation required.

12) The development of the framework has taken into account the introduction of new arrangements for patient and public involvement in the NHS and other regulatory developments including:

a) The right of the Patent and Public Involvement Forums to refer issues of concern to the OSC in their area;

b) The statutory duty on the NHS to involve and engage with local people in planning and operating services (often referred to as section 11);

c) The impact of the proposal on vulnerable populations using public services. (e.g. Race (Amendment) Act requirements, issues identified in public health equity audits)

13) The guidance supporting OSCs provides for some flexibility in the length of time the consultation will last and the methods to be used, taking into account local needs. Whilst it is good practice to follow Cabinet Office Guidelines, and this will be normal practice, there is scope to vary the consultation process. Early discussions with OCS are essential if this flexibility is to be used to benefit local people.

14) Any request to reduce the length of formal consultation with the OSC(s) will be underpinned by robust evidence that the NHS body responsible for the proposal has engaged, or intends to engage local people in accordance with section 11 requirements. These require the involvement of service uses and other key stakeholders in developing and shaping any proposals for changing services. `Strengthening Accountability- policy and practice guidance' summarises the duty to involve patients and the public:

a) Not just when a major change is proposed, but in the on-going planning of services

b) Not just when considering a proposal, but in the development of that proposal, and

c) In decisions that may affect the operation of services

15) All proposals shared with OSCs by the NHS should therefore be able to demonstrate an appropriate consideration of Section 11 responsibilities.

Local Context

16) Within Hampshire and the Isle of Wight an ambitious programme for service reconfiguration in the form of `HealthFit' and `Beyond HealthFit' has been developed. Initial drivers for change included the need to conform to the European Working Time Directive and modernisation agenda. Financial pressures in terms of a significant underlying deficit and the affordability of the current configuration of services are also significant factors. It is essential that local people are able to contribute to any change to health service provision that results from the implementation of this programme. This framework is therefore designed to complement the changes that will result from these initiatives, providing a clear template against which the NHS can share proposals with the OSC(s) to:

a) Explain the rationale behind proposals for change and the options considered

b) Demonstrate how services users, their families and other key stakeholders have contributed, or will contribute, to the development of the proposal.

17) Different ways of working are beginning to emerge to support this process in Hampshire and the Isle of Wight. New relationships are being established between the NHS, the OSC(s) in their area and increasingly Patient & Public Involvement Forums. This framework capitalises on these emerging networks to draw together the different strands of involvement and engagement needed to support service change and identifies the issues to be taken into account by the NHS and OSCs when considering such proposals.

18) The guiding principles set out below will also inform these discussions.

Guiding Principles

19) The four OSCs in Hampshire & the Isle of Wight have worked closely together over the last year to build effective working relationships and share good practice. This has extended to the way in which the OSC(s) interact with the local NHS. Arrangements for joint working, which is required under statute where a proposal from the NHS spans more than one OSC area, have been established.

20) All OSCs in Hampshire and the Isle of Wight recognise that, for the scrutiny process to be credible and influential it must

a) Be challenging but not confrontational

b) Be based on evidence and not opinion

c) Contribute to improvements in services

d) Be consistent and proportionate to the issue to be addressed

e) Take account of the total population affected

21) Early discussions with OSCs regarding potential for significant service change will assist with timetabling and avoid delays in considering a proposal. Specific information about the steps (whether already taken or planned) in response to Section 11 will support discussions about additional information or action required.

22) Difficult decisions will need to be made by NHS Boards on occasion. Although each issue will need to be considered on its merits the following information will help shape the views of the OSC(s) regarding the proposal:

a) The case of need and evidence base underpinning the change. This may include the health needs of local people (including public health equity audits as appropriate), clinical best practice and progress towards the delivery of local/nationals targets

b) The extent to which service users, the public and other key stakeholders have contributed to developing the proposal. Particular regard will be given to the involvement of `hard to reach groups' where this is appropriate, including the need for any impact assessment for vulnerable groups.

c) The improvements to be achieved for service users. This will include issues relating to service quality, accessibility and equity.

d) The 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 as well as other service providers affected.

23) This information will enable the OSC(s) to come to a view about whether the proposal is substantial, and if so, whether the proposal is in the interest of the service users affected.

24) The absence of this information may result in the proposal being referred back to the responsible NHS Board for further action.

Recommendations

1. The Health Review Committee supports the approach to assessing proposals from the NHS set out in this document

2. That this approach is shared with other health overview and scrutiny committees in Hampshire and the Isle of Wight with a view to agreeing a common framework for assessment

3. That NHS organisations and other partners are invited to comment on the framework.

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 that disclose exempt or confidential information as defined in the Act.

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