News Focus

A 'critical friend', or a chance to 'score cheap points'?

Your local council's overview and scrutiny committee may train its sights on you.

Mark Gould reports You might be forgiven for thinking the NHS was under quite enough scrutiny already, thanks very much. But no. Just wait until the OSC gets hold of you.

do not panic - It is not the assassination bureau of the French secret service. The OSC is your friendly local authority's overview and scrutiny committee. From next year, the committee will be asked to investigate health issues in its area as part of the government's stated goal of improving patient and public involvement in the NHS.

Most importantly, they will be able to call 'local NHS representatives' to answer questions 'of public concern', in public. The committee will be expected to deliver recommendations for changes which deliver measurable improvements in health.

At this point, managers might conjure up images of being spitroasted in public at the hands of popularity-crazed local politicians.

But it does not have to be like that.

A Healthy Outlook, a new management paper published this week by the Audit Commission, sets out how health services can gain from this scrutiny.

Author Helen Oxtoby admits that, without careful preparation, the whole exercise could end up as a political point-scoring match: 'A process that seeks only to allocate blame, rather than focusing on opportunities for improvement, is likely to have a detrimental effect on the day-to-day working relationship, ' Ms Oxtoby says.

Rather, she wants to see the local health community work in partnership with the committee by identifying broad areas for investigation across service boundaries (for instance children's services), providing advice and information and working together to produce 'do-able' reports.

'OSCs could provide a powerful mechanism to look across service boundaries from the perspective of users, and bring together local stakeholders to address health inequalities.'

One of the main provisos is that investigations are 'useful and collaborative', while also 'challenging and sometimes uncomfortable'.

OSCs should aim to be a 'critical friend', while health bodies 'need to respond with honesty to questioning, and provide convincing explanations if they do not take up scrutiny recommendations'.

NHS managers might blanch at the prospect of being grilled by enthusiastic amateurs when some local authorities are perceived to be having difficulty keeping their own houses in order.

'Scrutiny will not add value if it is seen as an opportunity to score cheap points, ' Ms Oxtoby says. In a bid to ensure even-handedness, the government has already decreed that OSCs will not operate along party-political lines. But there are also worries in the health community that some boroughs, such as Hackney in London, which have teetered from crisis to crisis, may not be up to the job.

John Moore, a member of City and Hackney community health council, says: 'Local authorities are having difficulty sorting out their own internal scrutiny functions without having to take on health as well.'

For this reason, Ms Oxtoby says committees will require training, resources and support from the government - which has not yet made any promise of extra cash.

However, the Department of Health is expected to publish draft guidelines later this year. These will cover funding, the place of scrutiny committees in the accountability framework and performance measures.

'There is going to be a bit of bidding for money from the same pot between those groups that will replace CHCs, ' Ms Oxtoby explains.

Guidance should also explain which members of the NHS family will be called to account. But it is expected that this may vary according to the area of the health economy under investigation.

NHS Confederation policy manager Alastair Henderson welcomes the idea of committees which, in the majority of cases, will fit primary care trust boundaries.

'Local authorities are the right place for them to fit. They also give us the potential to look at issues from a user's perspective across a range of services.'

He also believes a collaborative approach might avoid stand-offs like the Kidderminster Hospital reconfiguration row, which has seen the public fighting a dogged rearguard action to prevent the hospital's accident and emergency unit being downgraded to a minor injury unit.

'Problems have cropped up in the past where there have been public concerns about reconfiguration because the public has been presented with a fait accompli .

'If people are thinking through issues with you, then there is less of the feeling that health experts 'who know best' are telling us what to do.' l Sheffield city council: scrutiny committee rules of engagement l Scrutiny should develop a positive relationship between the council and the health community;

the scrutiny committee should ensure that the community's aspirations for health improvement are pursued;

relationships must be constructive and deal with disagreements in the same way;

the scrutiny process will be inclusive and will relate to other processes of patient and public involvement.

A Healthy Outlook: local authority overview and scrutiny of health www. audit-commission. gov. uk