'We should be encouraged by evidence that shows a collaborative, improvement-driven approach'
Our Health, Our Care, Our Say is steering healthcare further towards preventive and patient-led services, but what role will overview and scrutiny committees play in holding the NHS to account for delivering this vision?
Research findings from Manchester University show health scrutiny has been more constructive and consensual than expected: characterised by cross-cutting reviews and joined-up solutions for local government and health.
Any new relationship takes time to develop, so it is unsurprising that some awkwardness is cited in HSJ's survey. However, we should be encouraged by evidence that shows a collaborative, improvement-driven approach, as advocated by the Centre for Public Scrutiny's four key principles:
- Good public scrutiny provides a 'critical friend' to executive policy-makers. 'Critical friendship' may sound difficult to sustain, but the Manchester research team found relationships between NHS bodies and local government have tended to improve since health scrutiny was introduced.
- Good public scrutiny enables the voice and concerns of the public. Some chairs were uneasy about the quality of health managers' public consultation, which OSCs can help facilitate. OSCs can support managers in tough decisions by acting as a conduit for views from diverse communities.
- Good public scrutiny is carried out by 'independent-minded governors' who lead and own the role. OSCs offer a reality check on healthcare delivery and how it affects their communities. Their independence from decision makers allows them to take a cross-cutting approach, suggesting actions to improve health and access to care.
- Good public scrutiny drives improvement. Their independence allows OSCs to gather a range of evidence and make creative and coherent judgements. HSJ's survey shows these are being realised.
Having a 'critical friend', then, may not always be comfortable, but presents managers with opportunities rather than threats as the public voice and joined-up approaches become increasingly important.
Tim Gilling is health scrutiny programme manager at the Centre for Public Scrutiny.www.cfps.org.uk/health