How can NHS trusts build an open, amiable relationship with local authority health committees? Stuart Shepherd explains

Scrutiny tips

In 2008 the NHS Confederation and the Local Government Association jointly produced the following suggestions for strengthening health overview and scrutiny

Resources

Jointly invest in a shared secretariat to provide effective back-office support

Training

Improve committee members’ understanding of their own roles, function and powers and also how the NHS operates, its statutory role and constituent organisations, the NHS constitution, health policy and legislation

Proactive engagement

Enable scrutiny to have a fuller understanding of the challenges health organisations are working to overcome by getting committees involved in the review and decision making process much earlier - sharing issues such as the need for quality improvement or service reconfiguration sooner rather than later

Non-executive support

Improve links between scrutiny members and health organisation non-professionals in governance roles, through training and other processes

Engagement with Local Involvement Networks

Recognise the commonalities in the role of holding local systems to account and maximising the capacity for involvement

Health overview and scrutiny committees provide one of the most obvious ways for primary care trusts and other NHS organisations - foundation trusts included - to establish legitimacy in decision making and demonstrate accountability at a local level.

The local government committees were established by the Health and Social Care Act in 2001 to monitor local health services and must be consulted on major local service changes.

Ideally health managers will have a productive working relationship with the committee chair and members with timetabled meetings for responses to regulatory reports, strategy monitoring and reviews of service delivery and change programmes.

In addition, open channels of communication will keep councillors briefed on developments, especially where committee recommendations have been implemented and recognise opportunities to enhance the commissioning cycle with surveys or assessments that produce sound and meaningful data (see graph from Norfolk County Council health overview and scrutiny survey of attitudes to death and dying, 2005).

One way to do scrutiny is to be antagonistic, constantly having a go at NHS trusts and berating them for minor breaches

“I couldn’t be sure how many relationships between committees and NHS organisations would actually reflect that in reality,” says Jonathan McShane, head of communications at NHS Southwark and also, as an elected official, chair of the Health in Hackney scrutiny committee.

“Health scrutiny is meant to act as a ‘critical friend’ without political function,” he continues. “It is a difficult balance to strike though and the process still needs some hard questioning and probing. Attitude is often more important than the resources. One way to do scrutiny is to be antagonistic, constantly having a go at NHS trusts and berating them for minor breaches. It tends to be more constructive however where the assumption is that local authority and NHS partners are all working towards the same ends - better care.”

Share the bad news

NHS organisations can begin making an important contribution to the nature of their relationship with health scrutiny by recognising the committee chair as a key stakeholder.

As well as sending them good news, better by far they hear about a poor inspection report or serious complaint from the trust itself rather than through the local press. This serves not only as a professional courtesy but also to allay anxieties that other issues might be held back.

The NHS is also well positioned to raise awareness among scrutiny members.

“Overview and scrutiny committees need to understand the factors that impact on the health and wellbeing of their local communities and the services available to help them meet those challenges,” says Tim Gilling, acting executive director at the Centre for Public Scrutiny. “With a lot of local information at their disposal good engagement with the director of public health, often a joint health and local authority appointment, can be key to this given.”

Lessons arising from the Mid Staffordshire Foundation Trust investigation support the development of the relationship between non-executive councillors from health overview and scrutiny and their counterparts who serve as directors on NHS trust boards and public governors of NHS trusts.

Mid Staffs lessons

“These are complementary roles and responsibilities that enhance the local framework of accountability” says Mr Gilling. “In Mid Staffordshire lots of people had concerns about services but there never seemed to be a mechanism for them to be discussed in the round. If non-executives had been talking regularly to each other they may have got an airing. Scrutiny is an excellent vehicle for these different perspectives.”

Good communication flow also increases opportunities for discussion between trusts and scrutiny on the outcomes of regulatory reports - which can allow for more informed comment and recommendations from committees.

“Anything that an NHS trust can do to strengthen the way overview and scrutiny operates and raise its status will help attract enthusiastic non-cabinet councillors to the committee because they recognise it as valuable and worthwhile work,” says David Stout, director of the Primary Care Trust Network.

“We are not seeking to remove all tension from the process. There is no point having scrutiny if it doesn’t deliver criticism where it is due. But adversarial point scoring isn’t effective and doesn’t help local people get most benefit from the system.”