One eye on health

Attempts to improve collaboration between health and social care
agencies are far from new. However, partnerships are now seen as
“core business” rather than the optional, marginal activities they
have been in the past. This change is greatly enhanced by the
introduction of both statutory duties and financial resources that
support partnership developments between health bodies and local
authorities.

Since January, powers have been in place for local authorities, led
by social services, to scrutinise services provided by NHS bodies.
Elected councillors influencethe provision of services in local
authorities and this principle is now extendedto health service
provision through overview and scrutiny committees.

This development has the potential to enhance or derail the
progress of partnership working. The new health scrutiny guidance
issued by the Department of Health states that “where inter-agency
relationships are poor, steps should be taken to build an
understanding between partners to ensure effective
scrutiny”.¹

The health scrutiny system has been introduced against a background
of changing policy and organisations in local authorities and the
NHS. First, there was the Local Government Act 2000, which created
the split between executive and inspection functions in the
governance of local authorities and gave them the power to promote
the economic, social and environmental well-being of communities.
Second, the Health and Social Care Act 2001 conferred on local
authorities with social service responsibilities the role of
reviewing and scrutinising health service matters. Third, the NHS
Reform and Health Care Professions Act 2002, which abolishes
community health councils in England from this December, creates
patients’ forums for each primary care trust and NHS trust and the
Commission for Patient and Public Involvement in Health.

Health scrutiny links into a range of policies, from inequalities,
development of local strategic partnerships and strategic plans to
patient and public involvement. It brings to the health service the
possibility of enhanced democratic accountability through elected
councillors. It will be important that health scrutiny adds value
to an already complicated area of inspection that includes Best
Value reviews and Commission for Health Improvement
inspections.²

For any inspection to be successful the potential benefits must
outweigh the potential costs. Potential benefits include improved
accountability, early identification of problems and suggestions
for improvement, plus the possibility that inspection will act as a
catalyst for improvement. Potential costs include costs of
compliance, lost opportunities and loss of innovation.³

Issues such as political management, overview and scrutiny
arrangements, involvement of district councils in two-tier
authorities, different geographical boundaries between the local
authorities and their associated NHS trusts and primary care
trusts, and the development of strategic partnerships locally will
greatly influence how this policy is implemented.

In addition, there are the added complications of who scrutinises
the working of strategic health authorities and regional health
provision, such as ambulance and specialist services.

In late 2002 the National Primary Care Research and Development
Centre at the University of Manchester carried out a postal survey
with all the social services authorities in England to ascertain
what preparations were being made for the introduction of health
scrutiny. The response rate was 86 per cent with most willing to
participate in further in-depth work, including qualitative case
studies on implementation, local governance and partnership working
in terms of health scrutiny.

The survey suggested that most respondents were making preparations
and taking a positive attitude to the introduction of health
scrutiny. More than four-fifths of local authorities had had some
form of discussion with their associated primary care trusts on
health scrutiny and a further 7 per cent had spoken to at least
some of their local primary care trusts. Nine in 10 local
authorities included health as a specific brief of an overview and
scrutiny committee – usually that responsible for social
services.

Almost half of the local authorities had already undertaken some
form of scrutiny of either local health services or health
organisation, while four-fifths had plans to continue or start this
process within 12 months.

From details of scrutiny already undertaken and planned, it appears
that authorities will be looking at health and not just illness.
They will be scrutinising a range of social and economic factors
that contribute to health, including NHS services. Many issues were
cited that would involve looking at services provided by both the
NHS and local authorities, including mental health services, older
people’s services and children’s services.

The Centre for Public Scrutiny suggests that good scrutiny depends
on three themes: appropriate training and support, access to
information, and independence.4 Yet our survey found a worrying
lack of support, a lack of funding, a lack of officer support and
time and little clear guidance. More than two-fifths of respondents
rated overall support for health scrutiny within their authority as
“inadequate” or “very inadequate”.

Adequate resources will also be important to the success of health
scrutiny and issues of officer support, training, consultations,
meetings, research and dissemination will all have resource
implications for local authorities with little spare funding.
Despite the publication of the guidance in May, there is still no
word from the Department of Health about possible extra funding to
support health scrutiny.

Just over half the respondents said officers and councillors had
received some form of training. But nearly half stated that no
training had been conducted for officers – the very people who will
support the process and the elected members. Training so far
appeared to be general and basic, such as introductory seminars and
workshops and would be of concern to the respondents in the
future.

Before the implementation of the health scrutiny legislation in
January this year many social services local authorities were
making plans for the next 12 months. The survey highlights the
potential of a policy that promises so much if it is resourced
adequately and conducted in a positive manner in partnership with
the local health economy.

But if done badly or with inadequate resources, health scrutiny has
the potential to adversely affect partnership working between
councils and the NHS.

Anna Coleman is a research fellow at the National
Primary Care Research and Development Centre, University of
Manchester.

References

¹ Department of Health,
Overview and Scrutiny of Health – Guidance, DoH,
2003

² D Bradshaw and K Walshe
“Powers of observation”, Health Service Journal, 18 April
2002 p28-29.

³ H Davis, J Downe and S
Martin, External Inspection of Local Government. Driving
Improvement or Drowning in Detail?, Joseph Rowntree
Foundation, 2002 4 P Wheeler “Making a success of scrutiny”
from
www.idea.gov.uk/news/?id=mj_scrutiny
, 2002