[tim gilling]

You can watch Andrew Lansley giving evidence to the Health Select Committee on the Parliament website

[tim gilling]

main headline from the response in relation to health scrutiny:

"recognise that our original proposal to merge local authorities' scrutiny
functions into the health and wellbeing board was flawed. Instead we will
extend councils' formal scrutiny powers to cover all NHS-funded services,
and will give local authorities greater freedom in how these are exercised"

Full briefing etc will come later this afternoon

[Steve Sienkiewicz]

This is good news Tim. Many thanks for the prompt update.

[Matthew Garrard]

"We therefore propose to give local authorities a new freedom and flexibility to discharge their health scrutiny powers in the way they deem to be most suitable - whether through continuing to have a specific health OSC, or through a suitable alternative arrangement. To enable this flexibility, the Bill will confer the health overview and scrutiny functions directly on the local authority itself."

http://www.dh.gov.uk/prod_consum_dh/grou...122664.pdf

page 101 and 104

Enhanced power of scrutiny

Our intention in developing this revised set of provisions has been to design an integrated and balanced package of measures which seeks to:

• distinguish more clearly between local authority executive and scrutiny functions and does not therefore place scrutiny functions within the health and wellbeing board;
• achieve consistency with the principles of provider autonomy and economic regulation and ensure local democratic input about what services are subject to additional regulation;
• maintain referral rights for local authorities, extended to any provider, in relation to services subject to additional regulation;
• uniquely amongst the Secretary of State's newly limited NHS functions, provide in relation to local authority referrals an ability to direct a specific NHS commissioner;
• extend the principles and powers relating to scrutiny to any provider of any NHS-funded service;
• provide for clear local scrutiny of GP consortia commissioning plans.
  

[Graham Spencer]

Good news indeed and well done Tim and the CfPS for their role in speaking up for scrutiny.

On to the report and i'm a bit confused by some of the statements coming out of it. For example para 5.43 on p110:

"To ensure that the health scrutiny model is consistent with other forms of scrutiny in local authorities, and as democratic as possible, we propose that any decision to refer a substantial service change proposal should be triggered by a meeting of the full council. This is in line with the views expressed by the Association of Directors of Adult Social Services and many councils that "flexibility" and "local determination" are crucial, combined with a recognition that the strengthened role of local authorities in relation to health should be reflected in a new approach to scrutiny and referral."

Should it not be that full council approves the referral?

Interesting that they have also suggested that the health scrutiny function can be delivered in any way and not solely through HOSCs...not sure if that is encouraging or worrying....

[tim gilling]

Our summary of relevant parts of the consultation response is now available:

http://www.cfps.org.uk/news/cfps-news/?id=376

Graham - I think they mean 'approved' rather than 'triggered'. This is taking away some autonomy from OSCs that currently don't need to refer to Cabinet or Council. We'll lobby around this in the Bill.

What the Bill says about how health scrutiny is carried out has to reflect the fact that councils will get a choice (through the Localism Bill) to operate different arrangements. We'll be pushing for all the current principles, freedoms and flexibilties to be retained in whatever mechanism councils choose. What is important is principles and outcomes, not structure and process.

The retention of separate health scrutiny powers and the extension of the powers over all commissioners and providers is a significant concession (even though I say so myself).

Thanks to everyone who put in comments on this aspect of the consultation

[Graham Spencer]

Thanks for clarifying Tim.

I accept that there has to be some concessions - I just hope that the 'independent' and 'non-political' nature of scrutiny is kept in tact in whatever form it is delivered in the future.....

[Matthew Garrard]

In addition the National Overview and Scrutiny Forum are looking to meet with the Department of Health to discuss and comment on the detail of these proposals... views to feed into that discussion most welcome.....

On referral, use of the Power obviously has to be consistent (some might even say joined up) with the options for governance provided in the Localism Bill but for those Authorities operating executive arrangements the evidence is presented and considered by an OSC and then an extra process is added by having to table a report to full council - a political environment - when often timing will be a key issue for the NHS proposal

[Steve Sienkiewicz]

mgarrard Wrote:In addition the National Overview and Scrutiny Forum are looking to meet with the Department of Health to discuss and comment on the detail of these proposals... views to feed into that discussion most welcome.....

On referral, use of the Power obviously has to be consistent (some might even say joined up) with the options for governance provided in the Localism Bill but for those Authorities operating executive arrangements the evidence is presented and considered by an OSC and then an extra process is added by having to table a report to full council - a political environment - when often timing will be a key issue for the NHS proposal

Timing would certainly be an issue. Full Council meetings occur here every 2 months and if there was to be a referral, the very fact that it would be taken as a last resort and inevitably be connected with a serious issue, would mean that there would be a degree of urgency about it. The involvement of full Council in the process would introduce an unecessary delay and I can't see it adding any value, apart from perhaps carrying a bit more weight upon approval. Conversely, what would happen if full Council didn't approve it?

There is also the issue of Executive Member involvement at full Council which doesn't sit comfortably with the O&S process.

The referral process has been used very sparingly over the years but has been a very useful persuader in OSCs gaining the cooperation of NHS bodies. It would be a mistake to tinker with it in this way, particularly in relation to Council's who will continue to operate an OSC / cabinet system. Government are now keen to stress that Council's should be able to devise their own arrangements for Health scrutiny, but at the same time appear to be introducing an unecessary layer of prescription.

[tim gilling]

I imagine that the thinking is that service reconfiguration issues will have been driven through Health and Well-being Strategies and Consortia Commissioning Plans - joined up through Health and Well-being Boards.

In our white paper response we suggested that OSCs have a role in sorting out locally disputes between health and well-being board members (with some support from CfPS possibly). This seemed to find favour at the time.

The reconfiguration process is an area of the Bill we have identified for further lobbying. There have already been some discussions with DH about reconfiguration in the new environment.

At our Health Forum meeting yesterday we received an update from DH and it has been agreed that CfPS will bring together a group of councils (scrutiny and executive members/officers) to help begin to inform the regulations (where most of the detail about this will end up being spelt out). More about that process in the New Year - it might be a long term commitment, facilitated through our advisers - and of course we are keen to include GP consortia and Healthwatch partners too so that we can learn about the 'whole system'. I'm pleased people are already interested in having those discussions.