Published: 22/08/2002, Volume II2, No. 5819 Page 6 7

Hospitals that meet national rather than local demand could be inspected by the local authority of every referred patient, unless special regulations are drawn up.

The problem has come to light as negotiations continue on the arrangements for the overview and scrutiny of health at local levels.

Last year's Health and Social Care Act legislated for overview and scrutiny arrangements which will allow local councils scrutiny powers over health services from next year.

A senior source at the Department of Health said: 'We are currently working on how to resolve what's known as the Great Ormond Street problem - or what to do about national referral centres. They receive patients from all over the country but do not really fall into one local authority area.We do not want to end up with some trusts subject to multiple scrutiny.'

A spokesperson for Great Ormond Street Hospital said: 'We have not heard anything about this though we understand [the DoH] is looking at the issue.

'We are hosted in Camden primary care trust and are in the North Central strategic health authority. So if Camden Council sets up a scrutiny committee, then that one committee could do the job for other local authorities wishing to inspect. However, fewer than three per cent of our patients are referred from the Camden area.

'We would hope for a bit of common sense when these arrangements are finalised.'

Another allied issue causing concern within the DoH is that of coterminosity with local authority boundaries. Local authority and trust boundaries vary so much that in a given area a local authority may share trusts covering primary care, ambulance services and a local hospital with other councils.

This is the case in Peterborough, where the local general hospital is in the city, the ambulance service is based in Norwich, the primary care trust commissions services outside the area and Addenbrooke's Hospital is a tertiary referral centre.

Pat Jones, overview and scrutiny manager for Peterborough City Council, said: 'If it is a national provision, we can't have everyone dipping in and saying they will be visiting as and when they wish.

We are liaising with colleagues in the special health authority in Cambridge, Norfolk and Suffolk.

'Two main principles have led the discussions: first, single scrutiny, so that if one body is inspecting something then the others will not need to duplicate.

And secondly, that the home authority is the lead authority.We are working with guidance that says that the home authorities will be the lead authorities but can co-opt anyone as necessary.'

She said the Peterborough overview and scrutiny committee would set up a work programme in conjunction with the health authority. 'The SHA will officially be in place in October, so we are working on it now.We hope for a common sense and pragmatic approach. It is all in the process of being agreed but I can't envisage a situation where we do not work together, ' she added.