One of the first reactions of a health trust chief executive to the idea of giving evidence to Lewisham council's health scrutiny committee was: 'Is it going to be like an inspection by the Commission for Health Improvement?'
Most health managers, like most local authority managers, baulk at the prospect of yet another group of people trawling over their policy and practice.
Across the country, they are expecting to be given a going-over by local authority members. Old scores will be settled. But in fact the new duty given to local authorities by the Health and Social Care Act has very different aims from those associated with professional inspectorates. Indeed, a pilot in Lewisham has proved that it creates a very different experience for health managers.
The Public Management Foundation suggested to Lewisham health partnership that it should carry out a pilot of the new arrangements. It agreed, and set up a scrutiny committee to look at the needs of special needs children under eight, covering local authority and health services. Over two months, seven meetings were held with relevant service managers and parents.
While health managers came to the committee quite apprehensive, they all left feeling that interaction with elected members had not only been pleasant but helpful. Why was this, and how could other localities learn from it? The most important factor was that Lewisham has a strong track record of carrying out scrutiny of its own services. For more than two years, it has systematically reviewed different services.
Experience of scrutiny means elected members come to see it as a crucial part of their role. They understand that their service to the council is to uncover problems and weaknesses as well as explore strengths.
The pilot suggests that councillors with experience of scrutiny do not expect to defend the council through thick and thin. They expect a similar level of openness from others, including the health service. However, experience also teaches that settling old scores achieves nothing. Becoming aggressive or getting angry simply means your witnesses clam up.
In contrast to professional scrutiny, council members have been given their new duties precisely because they are lay, elected representatives. The Lewisham experience shows they do not pretend to be professional experts. Professionals should therefore be prepared to explain their language to them.
Public service managers should be able to explain to ordinary people what they are doing - and health service managers found that accountability to the local authority is good preparation for wider public and patient accountability.
Many areas now have some form of joint working or forum for discussing, and taking advantage of this to suggest joint training may be one way of defusing potential problems in areas without this experience.
Another revelation to come out of the Lewisham experience concerned the expected culture clash between health and local government. Of course, there are different ways of working within different branches of the public service, but the differences within organisations are sometimes greater than differences between them. For example, the pilot found the ethos of children's primary healthcare services had a lot more in common with local authority early-years work than with accident and emergency. Similarly, local authority staff had more in common with health colleagues than their fellows in refuse disposal. And local authority members know all about the problems of creating corporate working.
Reorganisation after reorganisation of local government has been carried out to try to get people working together, but they still hear horror stories from constituents about separate and confused services tripping over each other.
It is also the case that for the past couple of years, some health-local authority partnerships have brought about real changes through joint working, through joint posts and joint funding. New cultures are emerging.
But, to repeat, it is crucial for local authority members to be careful about which areas to scrutinise first - and not to turn the spotlight on a health matter in isolation from any joint working.
Such an approach would leave one 'side' - the local authority - scrutinising the other - the health service - with all the attendant dangers of one blaming the other.
In Lewisham, members recognised problems of real service co-ordination, but issues were raised about 'their own' services, as well as health.
This new interaction between local authority members and health professionals is bound to have its hesitations and anxieties. But if it is based on experience and done with care, it will have real benefits as well as leading to real accountability for local health services.
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