Nick Edwards reports on a survey of OSC chairs about their attitudes towards NHS managers

The overview and scrutiny committees run by local councils have already made an impact on how local changes in NHS services are argued for and implemented. The delayed local government white paper is likely to further increase their scope at a time when local NHS managers will be making 'tough decisions' on reconfiguration, prefigured by statements from acting chief executive Sir Ian Carruthers.

But the NHS and OSCs often do not see eye to eye on fundamental issues surrounding provision of local healthcare services. Sometimes this can lead to robust and useful debate. At other times it can lead to cultural cold wars that disrupt decision making.

As part of our Managers Make the Difference campaign, HSJ surveyed OSC chairs from around the country about their attitudes to NHS managers, their experiences and what they thought could improve the relationships. And right, the Centre for Public Scrutiny gives its own view.

The results from the snapshot of 54 responses are often surprising, sometimes worrying and occasionally encouraging.

On the whole, OSC chairs enjoyed a reasonably close relationship with their local NHS - 43 per cent met or spoke to managers at least once a month and 89 per cent had visited an NHS facility this year. Of course this means more than half of councillors whose main role is policing the NHS fail to even speak to a manager once a month.

However, most believe their relationship with the NHS is strong - 68 per cent rated it good or very good while only 6 per cent said it was poor or very poor. Moreover 84 per cent said the relationship had got better or much better in the last 12 months. This suggests that, at least in the minds of chairs, the OSC in itself is helping strengthen ties with the NHS - indeed 96 per cent agreed with that statement. As one OSC chair said of a local situation where 'we had been at loggerheads - everyone knows what has gone on and is making a determined effort to ensure history will not repeat itself'.

Some examples of where the OSC had played a positive role were in bringing the NHS and council together on issues that neither were, in the view of the OSC, giving proper attention.

One said: 'The issue of transport for the elderly and infirm is crucial but the NHS does not want to get involved. The council has other priorities. It needs scrutiny to get stuck in and press both organisations on behalf of patients.'

Another reported that OSC pressure on cleanliness in one local hospital 'helped the operations manager to keep the item high up the board's agenda'. Successful joint work in mental health services was also commonly cited.

Despite this, when the OSC chairs were quizzed on their attitudes towards NHS managers, some divisions began to open up. On the plus side, more than half said managers were both articulate and informed and only 29 per cent found them evasive.

However, almost two-thirds said managers were focused on money while only a quarter said they were focused on patients. Similarly, almost half described managers as politically naive, compared to only 15 per cent who found them politically astute.

Hence a picture emerges of NHS managers who, while not actively obstructive of OSC work, are seen not to be keyed into the same priorities. This was borne out when they were asked about the quality of local consultations - almost three-quarters agreed that the NHS 'was not good at consulting with local people'. It was the issue of the quality of consultation that drew most flak in terms of comments.

As one OSC chair said: 'Consultations have been disappointing, in that the factual base for actions is not laid out in a way that the ordinary person can understand. It took six months to improve our hospital consultation, and the same with the mental health trust.' Another says: 'For three years we were given the runaround and lied to until our patience snapped and we made an official complaint on a failure to consult.'

Another added: 'The acute trust wanted to move services but forgot to consult us or the public and everyone found out from the press. Not the way to do it...'

An interesting point for NHS managers was the OSC chairs' favourable view of doctors - 64 per cent agreed with the statement that 'medical staff make better advocates than NHS managers'.

This may explain a sometimes negative view of NHS managers. Despite all the good things they had to say about their own local NHS, more than half of OSC chairs thought there were too many of them. Their views of ability was mixed - only 13 per cent thought they were strong, but only the same proportion thought they were weak.

There was also a split between views of the quality of local services and the NHS nationally - itself reflecting a division borne out by repeated MORI surveys of public attitudes. When asked about local services, 77 per cent said they had got better in the last three years. But 69 per cent agreed with the statement that the 'NHS is in crisis nationally'.

One OSC chair said: 'The reconfiguration of PCTs has caused concern to the public and underneath all the confusion is the feeling of health service managers trying to justify their well-paid jobs rather than providing the services required.'

There was also concern about last-minute cuts in social care funding, put through without any warning.

What does this snapshot survey tell us about the relationship between OSCs and the NHS? First, that there is real enthusiasm about working with NHS managers but also frustration about a perceived lack of engagement and information- sharing on the part of the health service.

Second, OSC chairs are broadly positive about the quality of local services but believe the NHS as a whole is in trouble.

Third, many are damning about the quality of local consultations, both in practice and principle - in other words too many NHS organisations do it badly and do not value it enough.