The education service has suffered a regime of inspection and scrutiny; now it's the turn of the health service. Tash Shifrin reports

'I'm leaving. I can't face another one.' That was the reaction of one primary school teacher to news of an inspection by much-feared education watchdog Ofsted. But don't worry - it couldn't happen here in the 'supportive NHS', with its emphasis on spreading good practice.

Or could it? With a plethora of new arrangements for scrutiny and inspection to be found in the NHS plan, NHS managers may soon feel they're living in Channel 4's Big Brother house, waiting to find out if they will be flung out.

And the 'naming and shaming' of seven trusts deemed to be 'failing' to tackle outpatient waits, in the first use of the government's traffic-light scheme, had a whiff of Ofsted about it.

The seven were put on 'special measures' - a phrase that carries an echo of tolling bells for teachers.

Perhaps the government was looking for something more likely to grab the headlines than the prospect of health services managers appearing in front of local authority scrutiny committees.

But being answerable to elected local councillors is something of a departure for this generation of NHS managers. And in some quarters, it is warmly welcomed.

John Ransford, head of social affairs at the Local Government Association, says the move is 'very good news'.

'It brings back some democratic accountability for the health service that was lost in 1974.'

He is pleased that the need for legislation on local government's scrutiny of health services offers 'time to look at how to make it work'. He says: 'It's not primarily about interrogation. It's about having a mechanism for expressing the views of local people, hearing from health managers and getting a better rapport.'

Nick Wood, chief executive of East Cheshire trust, agrees. 'In terms of partnership and the main emphasis being where we're looking to change services, it's quite a good idea.We need to have strong connections with local authorities anyway. For a lot of things there's a natural affinity, which is good and helpful.'

Nancy Hallett, acting chief executive of Homerton Hospital trust in Hackney, east London, says scrutiny is 'right and proper'.

But she adds that it 'should not obstruct the running' of hospitals and cautions that with acute services, in particular, 'you can get some emotional responses which defy what we actually know'.

Dorset health authority chief executive Ian Carruthers also supports the concept: 'I think the fact we will be called to account in a public way - although it might be uncomfortable on occasions - will be for the good of the system.'

Scrutiny committees will have the power to refer major health service changes to an independent reconfiguration panel, with a third of its members drawn from the public. This could prove to be the crunch point for health and local government relations.

In Worcestershire, the HA is removing all inpatient acute services from Kidderminster General Hospital in the teeth of opposition from the Health Concern Keeping Kidderminster Hospital Alive Party - which has 19 out of 42 seats on the local Wyre Forrest council.

An HA spokesperson says it is 'not interested' in discussing how the scrutiny system will work out in the area. Campaigners around the country may find that a space worth watching.

One trust chief executive has another reason for caution. Pointing out that her local council 'ought to get its own house in order first' as it is clearly faring worse than the trust, she adds: 'What makes it a bit awkward is our chair is also a local councillor.'

Patients Association assistant director Simon Williams is not impressed with the scrutiny system, either.

'What they have done is removed a statutory body that represented patients - community health councils - and chopped up the role.'

Indeed 'chopped up' rather than 'joined up' is the style of the new regulation system (see box, left).

Along with local government scrutiny, NHS organisations can expect a visit from the Commission for Health Improvement. The government can also send CHI in where it has 'serious and urgent concerns about clinical practice or patient safety'.

But a CHI spokesperson is keen to emphasise that its 'reviews' will 'certainly not be punitive' but 'definitely developmental'.

And the regional office - which, under the plan, will sign off chief executives' performance reports, personal development plans and performance pay - will determine traffic-light status.

This is not quite how it seemed last week when red lights made their first appearance.

David Hunter, professor of health policy and management at Durham University, says the government was 'jumping the gun'. He warns that 'conflating advice and inspection' is 'what we've seen in education'.

'If you look at the stress levels and people leaving the profession, it's not all sweetness and light. If it has had that effect on teachers, doctors are not going to take to it too kindly.'

Managers may also have reason to complain. Southend Hospital trust was one of the trusts named. Chief executive David Brackenbury was 'not thrilled' with the government's approach.

He says: 'This is the first target we've missed in nine years.' The trust is also the 'sixth most cost-efficient' trust in the country.

Leeds Teaching Hospitals trust was also on the list. But chief executive David Johnson points out that his trust had 'already invited' the national patient access team to visit to deal with a problem he 'acknowledges'.

That didn't stop the trust hitting the headlines.

NHS Confederation policy director Nigel Edwards says naming and shaming is not helpful, but is 'pleased that what we actually get is support'.

But the Patients Association's Mr Williams is concerned: 'It's bad management style. Staff morale is going to have a direct effect on the quality of care patients receive.'

A DoH spokesman says it is still 'working on the details of implementation' of the traffic-light system. He adds: 'We didn't shame anybody.We may have named them.'

Scrutiny committees under the microscope Under the new Local Government Act, the executive and scrutiny functions have been separated. Councillors who are 'cabinet members' cannot be on the scrutiny committee.

Scrutiny committees will be made up of all parties represented on the council. They can include lay members - without voting rights - and their meetings are open to the public. They 'can demand all the reasons behind all decisions' by the council's executive, but 'can't force a decision to be overturned'. Powers in relation to NHS bodies have yet to be defined.

The new council structures have been contentious. Jane Roberts, Labour leader of Camden council - which opted not to use the new structure in advance of the law - is worried that 'two classes' of councillor might result as 'you're more likely to get people wanting to take on executive roles'.

Who's looking at you, kid?

The local authority.

CHI and the regional office.

Patients: rewards for trusts will now be linked to patient surveys.

Patient environment action teams:

checking hospital cleanliness.

Appointments commission: looking at board members.

National clinical assessment authority:

examining individual doctors' performance.

UK Council of Health Regulators:

covering the General Medical Council and the other regulatory bodies.