Since the Local Government Act 2000, Local Authority Elected Members (local councillors) have had a responsibility to examine decisions taken by the executive (scrutiny) and review their policies (overview). It is important to note that Overview and Scrutiny Committees (OSCs) make recommendations rather than decisions (which is the role of the Executive). To view the Local Government Act 2000, please click here.
Committees may co-opt people who are not councillors as committee members or co-opted members who can add to debate (although they do not usually have voting rights in the same way as Elected Members). In addition, committees have the power to summon members of the executive and officers of the authority before it to answer questions, and are able to invite other persons to attend meetings to give their views or submit evidence.
The arrangements for overview and scrutiny differ between authorities. The Isle of Wight Council’s overview and scrutiny function is carried out by a Corporate Scrutiny Committee, a Policy and Scrutiny Committee for Health and Social Care and an Audit Committee. Overview and scrutiny is supported by the Democratic Services Team. The health scrutiny function is carried out by the Policy and Scrutiny Committee for Health and Social Care.
Overview and scrutiny can be carried out through formal or informal one-off meetings of the whole Corporate Scrutiny Committee or Health and Adult Social Care Scrutiny Sub Committee, or through a smaller subsidiary committee, known as a task group.
The Involvment of stakeholders in this context means groups or individuals with an interest or affected by a particular health scrutiny item, this is a key element of health scrutiny.
Background to Health Scrutiny
The Local Government Act 2000 already gave the Council the right to scrutinise services to improve the well being of its inhabitants. This power was strengthened through the Health and Social Care Act 2001 (to view, please click here), which gave specific powers to a Local Authority’s Overview and Scrutiny Committee (OSC) to examine Health Services. This was laid out in the Local Authority (Overview and Scrutiny Committees Health Scrutiny functions) Regulations 2002 - to view, please click here.
The main drive to democratise the health care system in the UK came in 1974, through the establishment of the Community Health Councils (CHCs). After their abolition in December 2003, the role of involving patients and public in health was formally handed over to a number of new bodies as summarised below:
If a formal NHS complaint is made then the Independent Complaints and Advocacy Service may be contacted by the complainant to assist with this process. To view the Independent Complaints and Advocacy Service website, please click here.
The Local Authority’s powers of Health scrutiny allow it to scrutinise health service changes, performance and consult with stakeholders on their local health services. The purpose of health scrutiny is to:
- improve the health and well being of residents;
- provide a critical friend to the NHS;
- facilitate greater involvement of stakeholders in local health issues;
- tackle the ‘democratic deficit’ in health and ultimately improve the health of local people.
Introduction to the NHS
The National Health Service consists of three main layers:
- The Department of Health (lead by the Secretary of State for Health) provides policy and guidance; the Strategic Health Authorities are regional bodies who performance manage both Primary Care Trusts (PCTs) and NHS Trusts (including foundation hospitals).
- PCTs provide primary care (General Practitioners, opticians, pharmacists, health visitors etc) and commission other services (secondary care, operations, referrals etc) from the NHS hospital trusts.
- Social care is provided by Local Authorities.
Healthcare on the Isle of Wight is provided by the Isle of Wight NHS Trust, based at St Mary’s Hospital, Newport. To view the Trust website, please click here.
Aims of health scrutiny
The primary aims of health scrutiny are to identify whether:
- Health services reflect the views and aspirations of the community.
- All sections of the community have equal access to services.
- All sections of the community have an equal chance of a successful outcome from services.
- Proposals for substantial service changes are reasonable.
What the health scrutiny committees do
The committee with responsibility for health scrutiny can review any matter relating to the planning, provision and operation of health services within the area.
The role of the OSC is to look at strategic issues affecting the health of the area, rather than individual complaints. Their remit stretches further than looking at the NHS services and organisations but they should not be involved in performance management as NHS Trusts already have an array of bodies to which they must report. There will be times when a scrutiny process needs to consider health care provided by the private and independent sector on behalf of the NHS. In these circumstances, the committee will need to consider the issue through the commissioning body. Committees do not have the power to require individual GPs, dentists, pharmacists or those providing ophthalmic services to attend a committee to answer questions.
Topics for scrutiny should be chosen on the basis of whether they are:
- In the public interest.
- Not being addressed by another body (eg the Care Quality Commission) or another scrutiny committee.
- Being requested by the NHS directly.
- Proposed substantial developments.
- Offer the potential for outcomes affecting local people.
The OSC has the power to:
- review and scrutinise any matter relating to the planning, provision and operation of health services in the local authority’s area (including the Council’s contribution to the health of local people and the provision of health services, as well as other agencies involved in healthcare);
- make reports and recommendations to the local NHS on any matter reviewed or scrutinised;
- require the attendance of an officer of the local NHS to answer questions and provide explanations about the planning, provision and operation of health services;
- require the local NHS to provide information about the planning, provision and operation of health services;
- establish joint committees with other local authorities to undertake overview and scrutiny of health services;
- delegate functions of overview and scrutiny of health to another local authority committee;
- report to the Secretary of State for Health:
- - where it is concerned that consultation on substantial variation or development of services has been inadequate;
- - where it considers that the proposal is not in the interests of the health service.
Health Inequalities and Health Scrutiny
National targets aim to reduce inequalities in health outcomes by 10% by 2010, measured by infant mortality and life expectancy. The biggest factors in reducing health inequalities have been identified as:
- Improving early years support.
- Improving Social Housing.
- Improving educational attainment.
- Improving access to public services.
- Reducing unemployment.
When looking at health inequalities, the guidance offered eight main themes for OSCs to investigate:
- Causes of health inequalities, eg poor housing.
- Specific populations, eg men between 40 and 55 years old.
- Specific health issues or diseases which increase health inequalities, eg teenage pregnancy.
- Inequality of access to services, eg availability to specialist primary care services, such as district nurses.
- Inequity in the provision and delivery of services, eg smoking cessation support.
- Service redevelopments and their possible impacts on inequalities, eg moving the provision of certain services to other localities.
- Service planning and performance, eg health inequalities Performance Indicators.
The NHS’s responsibilities
There are several duties placed on the NHS in relation to health scrutiny:
- Local NHS bodies must consult the overview and scrutiny committee (including joint committees) on matters of substantial development or variation to services.
- Overview & Scrutiny Committees do not have the power to require individual clinicians to attend a committee to answer questions, as they are not officers of a NHS body. If a committee considers that a view from a particular clinician would be of use, a representative committee or organisation could be contacted.
- Local NHS bodies have a duty to provide OSCs with information on the planning, provision and operation of health services within the Local Authority area that the OSC may (reasonably) need to carry out effective O&S. However, there are some exemptions to this requirement relating to confidentiality and information whose disclosure is prohibited by law. If a request for information is refused, the OSC can refer the matter to the Strategic Health Authority.
- If a local NHS body provides services for more than one Local Authority area, they may form a joint committee. If such a joint committee has been formed then the NHS only has to relay information to this joint committee, rather than the individual OSCs.
- It is recommended that officers from local authorities and NHS organisations work closely together in planning the overview and scrutiny programme so that the NHS body is clear about the information that will be required and time-scales involved for the submission of that information.
- Information that identifies a particular individual or individuals, for example a patient, carer, family member or NHS staff, can be provided to the committee but only if the individual concerned agrees to its disclosure or the data is made anonymous.
- OSCs can request attendance by an NHS officer, who should be identified by the NHS body concerned. The OSC needs to make clear exactly what is expected of the officer and give sufficient notice of its request to attend. The aim of attendance is to enable Elected Members to understand why action has taken place and the options that have been considered. The legislation does not require non-executive members of an NHS Board to attend, but in some instances this may be helpful and invitations can be made.
Joint Health Scrutiny Committees
‘Directions’ were issued to Local Authorities with health overview and scrutiny powers, which require the setting up of a joint committee, with delegated powers, to consider any proposal from the NHS for a substantial variation or development in the delivery of services that are provided across more than one overview and scrutiny committee area. This requirement is additional to the option for Local Authorities to establish joint committees to consider wider scrutiny issues that may be of interest.