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Paper  4 -   22 March 2002 Meeting


22 March 2002


Report by the Chief Executives’ Group in consultation with Directors of Social Services



(1) That the Association comments on the Department of Health consultation document ‘Local Authority Health Overview and Scrutiny’ reflecting the points in paragraph16 of this report; and

(2) That Members consider at this preliminary stage how the four social service authorities and eleven district councils might work with each other and with the Health Service on options for managing the overview and scrutiny functions.


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 this 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. The consultation document proposes that the appropriate 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. Changes in NHS structures are resulting in a strategic health authority for Hampshire and the Isle of Wight responsible for monitoring performance of the ten Primary Care Trusts (PCTs) and seven NHS Trusts, four 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. Hampshire County Council’s area is co-terminus with seven PCTs (see map in the Annex). In many cases the PCTs provide services on behalf of each other. In addition to the six 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. Full text of ‘Local Authority Health Overview and Scrutiny: A Consultation Document’ is available on the Internet and has been sent to all local authorities.

5. 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. They were discussed at the Association’s meeting last November.

6. The proposal set out in the consultation document for local authority overview and scrutiny of 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.

7. 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. Scrutiny review committees can require information from NHS bodies and attendance of chief executive or appropriate officer to give evidence and answer questions.

8. The consultation document indicates that the Government intends scrutiny to focus on broad considerations of the health needs of an area. It is not about NHS services alone but how health is promoted generally. Some reviews may focus on a particular NHS Trust or PCT or on a proposal to reorganise a service or close a facility. But by and large, reviews are likely to be wider in scope, cross-cutting local authority and Trust/PCT boundaries and responsibilities and looking at the way those organisations work together. It is likely additionally to include consideration of unitary, county and district councils’ roles in social care, education, housing, transport/accessibility, environment etc and how that relates to objectives/activities/provision by other agencies including health, voluntary and independent sectors.


9. The consultation document indicates that the Government intends a non-prescriptive approach. Authorities with social service responsibility are required to decide an approach to health scrutiny, set up appropriate arrangements for working in partnership with district councils, 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 county and district 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.

10. The consultation paper (paragraph 11.2) states that local authorities should "make the most suitable arrangements to meet local circumstances whilst ensuring NHS bodies are not burdened by multiple scrutiny". We will need to consider:-

(a) working with neighbouring authorities outside of Hampshire/Isle of Wight where a review includes regional specialist services

(b) arrangements for the four authorities with social services responsibilities within the strategic health authority’s area to work together to review issues of shared concern, to meet the requirement to make best use of an NHS Chief Executive’s meeting with local authorities’ scrutiny committees

(c) how Hampshire County Council will work with the Hampshire District Councils many of which already undertake health scrutiny-related work .

11. The Local Government Act 2000 gives district councils powers to consider health improvement and some district councils have used that power to work with health authorities to examine issues of shared concern. The consultation document anticipates County Councils making arrangements to involve district councils in health scrutiny. It suggests the following options:-
(a) co-option of district non-executive members as voting members onto the County Council’s scrutiny/review committee

(b) a joint committee (with County Council remaining in the lead)

(c) delegation of function (but not responsibility) for particular reviews.

12. The consultation document proposes that consideration should also 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.

13. The first job of the scrutiny/review committees 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.


14. Arrangements are needed to open up dialogue between the four authorities with social service, (and so health scrutiny responsibilities) and the district councils, NHS partners and CHCS. A seminar is being organised for the Strategic Health Authority and the four Social Services authorities to take this forward. The Director of Corporate Affairs for the new Strategic Health Authority will attend this Association meeting to help initiate the discussion.

15. 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.


16. Representations have to be made by 16 April. Members may wish to consider a response additional to responses made by individual authorities. It is proposed that the Association’s joint response:-

- welcomes the proposals of the consultation paper for local authorities to scrutinise health and NHS services as recognition of local government’s authority and legitimacy in representing community views

- requests that this important new role for local government is adequately funded and resourced and that additional cost to local authorities should be reflected in SSAS

- proposes that the aims of the scrutiny process (paragraph 3.1 of the consultation document) should include improvement of public health

- questions the absolute exclusion of any local authority Executive Member (including co-opted District Council representatives) when members of NHS Trust and PCT executives are not similarly disqualified (paragraph 9.9) and proposes that the same protocol about disqualification/declaration of interests should apply to both

- District Councils should be added to the list of organisations to receive copies of Scrutiny and NHS response reports (paragraphs 5.3 and 6.6).


Date: 12 March 2002
Annex: 1   
Contact: Nick Goulder - 023 8068 8431, E-mail hiow@eastleigh.gov.uk

Last update: 12/03/2002
Author: Nick Goulder, Policy Manager

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