Published: 27/05/2004, Volume II4, No. 5907 Page 23
Overview and scrutiny committees are helping to bridge the cultural divide between councils and trusts, says Janet McMillan
About 18 months ago, it became clear that the NHS in north east London faced a challenge: to work with the area's eight local authorities to make a success of overview and scrutiny. There were fears that many councillors did not know enough about local health needs and had a tendency to focus on single issues. There was a danger that this process could be used to beat health firmly on the knuckles. Equally, the health service did not understand the world of local authorities and scrutiny well enough.
We began to think about how to develop understanding and partnership working.We organised a forum targeting all NHS nonexecutive directors and local authority councillors involved in scrutiny; about 100 people attended. It helped councillors to understand how local health services are organised and what the particular health needs of the local population are.NHS non-executive directors learnt about local overview and scrutiny arrangements.
A main difference between the groups was the way they thought geographically.When I referred to north east London, local authorities had no idea what I was talking about. They are very focused at borough level, and it seemed unusual for boroughs to work collectively. The health side also held prejudices - there was concern that scrutiny might slow up the pace of change in health services. The predominant contact between the NHS and local councillors had been about single issues - often a long, drawn-out and sometimes confrontational process.
One area all groups could appreciate, however, was health inequality, an obvious reality to both sides in north east London. Councillors were very interested in graphs we showed them, for instance, about children's dental health.You could see very quickly that in particular boroughs it was a real issue.Variation in mortality from coronary heart disease was also of interest to them.
The forums connected councillors involved in scrutiny much more closely with primary care trust agendas, and helped PCTs play a role in shaping scrutiny programmes. Scrutiny work programmes a year ago were about hospitals and about waiting times. Today we see scrutiny plans for asthma, cardiovascular disease, mental health, sexual health, and more. There is now a network that connects scrutiny lead officers and the NHS, which meets regularly. This has helped individual scrutiny committees to develop programmes with a focus on two or three key themes. City and Hackney Teaching primary care trust has just done a piece of work on cardiovascular health and is now undertaking work on sickle cell disease, which is a key health issue for their local population.
We are also starting to develop local approaches for scrutiny committees to work together. If a clinical network, for example, wants to make a major change, it is not going to be possible for eight committees to scrutinise the same thing, so we are discussing joint scrutiny.We are also making sure scrutiny committees share their work programmes with each other.A mental health trust could be involved in a range of different committees and processes, and we need to be sensible about effective use of NHS staff and information.
Janet McMillan is director of partnerships at North East London strategic health authority and chairs the SHA-wide scrutiny network.