[Nigel Spalding]

Yes, on pages 25-26 of the 27 page document on Patient and Public Accountability. Reads as if they had run out of eneryg and interest by this point but realised they had to say something about health scrutiny. It doesn't really add anything new, as far as I can see.

[Graham Spencer]

Nigel Spalding Wrote:Yes, on pages 25-26 of the 27 page document on Patient and Public Accountability. Reads as if they had run out of eneryg and interest by this point but realised they had to say something about health scrutiny. It doesn't really add anything new, as far as I can see.

I think the whole report makes the role of health scrutiny seem like a bureacratic add-on. WIth the notion of 'beefing up' Health & WellBeing Boards and championing the 'scrutiny' role of HealthWatch i'm not entirely sure what role (and power) health scrutiny will really have in the long-term.

Obviously there is the whole Public Health and Local Authority relationship to continue to look at in terms of addressing health inequalities. But, in terms of looking specifically at health and its integration into social care, i'm not sure the future is particualrly rosey at present.

Still, it's up to us and Members of health scrutiny to prove we are of use rather than bemoan the situation...onwards and upwards (and not outwards all being well).

[Gareth Wall]

I'm struggling to look positively at this. The Bill strengthened the role of scrutiny in relation to consortia and other health service providers, and this doesn't weaken that in any way. The role of healthwatch arguably did need more clarity and this goes some way to suggesting how that can be done.

But the suggestion that Healthwatch should provide a 'scrutiny and challenge function in relation to health and wellbeing commissioners and providers' definitely blunders into the remit of scrutiny (as proposed in the Bill). It ignores the positive track record of health scrutiny to date and doesn't recognise the difference between strategic challenge to commissioning (scrutiny) and challenge as consumer champion (healthwatch). A more clear statement, and set of suggestions, about the relationship that is needed between these two would have been helpful.

I suppose that's one to lobby for at Committee Stage 2.0, along with: clarity over "designated services", and removing referall to SoS from full Council in favour of health scrutiny (more tricky now as this doesn't insist on a health scrutiny function/committee)

Also noted:

• Interesting expectation that HWBs and O&S will hold the local authority to account for funding of healthwatch, particularly when it says that funding shouldn't be ringfenced.
• No reference to health scrutiny arrangements in two tier areas (not sure if that came up in listening sessions)
  

[Graham Spencer]

Interesting to note this from the Goverment's response published today (p6):

"HWBs will be subject to oversight and scrutiny by the existing statutory structures for the overview and scrutiny of local authority executive functions. The existing statutory powers of local authority overview and scrutiny functions will continue to apply. In line with the principles of the Localism Bill, local authorities will have greater discretion over how to exercise these powers.

Local authorities will still be able to challenge any proposals for the substantial reconfiguration of services, and we will retain the Government's four tests for assessing service reconfigurations."

Pleasing to hear but still has the caveat of allowing local authroities to discharge the health scrutiny function in a way they see fit. Hope they also reconsider the requirement for a local authority to have to go through full council with regards a referral to the SoS.

With regards to local HealthWatch the response simply states:

"We will add an explicit requirement that local HealthWatch membership is representative of different users, including carers."

Certainly not as detailed as the Future Forum papers yesterday!

Still not sure if things are looking up or down for health scrutiny but today's response is certainly more hopeful than yesterday's report. What will tomorrow bring...

[Leanne Martin]

gspencer Wrote:Interesting to note this from the Goverment's response published today (p6):

"HWBs will be subject to oversight and scrutiny by the existing statutory structures for the overview and scrutiny of local authority executive functions. The existing statutory powers of local authority overview and scrutiny functions will continue to apply. In line with the principles of the Localism Bill, local authorities will have greater discretion over how to exercise these powers.

Local authorities will still be able to challenge any proposals for the substantial reconfiguration of services, and we will retain the Government's four tests for assessing service reconfigurations."

Pleasing to hear but still has the caveat of allowing local authroities to discharge the health scrutiny function in a way they see fit. Hope they also reconsider the requirement for a local authority to have to go through full council with regards a referral to the SoS.

With regards to local HealthWatch the response simply states:

"We will add an explicit requirement that local HealthWatch membership is representative of different users, including carers."

Certainly not as detailed as the Future Forum papers yesterday!

Still not sure if things are looking up or down for health scrutiny but today's response is certainly more hopeful than yesterday's report. What will tomorrow bring...

These are my thoughts too, I have worries about duplication of HealthWatch having a scrutiny role as mentioned in the Future Forum report, and am saddened that the Government do not appear to have take on board the concerns around referral to full council, or the changes to what substantial variations/referral to SoS for all servoces,not just those in receipt of the additional payment.

[tim gilling]

The Future Forum report was quite strong on scrutiny but then wandered off towards the end of the paragraph.

There is confusion about language - using 'scrutiny' confuses roles with OSCs - or review and scrutiny as in the Bill. There is also to be a 'Citizens Panel' to provide 'challenge' to poor commissioning. How all this will work remains to be seen.

We will continue to make the case in committee stage and in the Lords and we hope to be able to begin to test out some of the new relationships later in the year.

[tim gilling]

Sir David Nicholson has provided a recent briefing for the NHS on the reform transition process following the Future Forum report and government response. A link to the briefing is here:

http://www.dh.gov.uk/prod_consum_dh/grou...127736.pdf

The briefing includes a reference to scrutiny committees (as part of new governance arrrangements) as one of five priorities for shadow health and wellbeing boards to consider.

[Claire Lee]

gspencer Wrote:Interesting to note this from the Goverment's response published today (p6):

"HWBs will be subject to oversight and scrutiny by the existing statutory structures for the overview and scrutiny of local authority executive functions. The existing statutory powers of local authority overview and scrutiny functions will continue to apply. In line with the principles of the Localism Bill, local authorities will have greater discretion over how to exercise these powers.

Local authorities will still be able to challenge any proposals for the substantial reconfiguration of services, and we will retain the Government's four tests for assessing service reconfigurations."

Pleasing to hear but still has the caveat of allowing local authroities to discharge the health scrutiny function in a way they see fit. Hope they also reconsider the requirement for a local authority to have to go through full council with regards a referral to the SoS.

With regards to local HealthWatch the response simply states:

"We will add an explicit requirement that local HealthWatch membership is representative of different users, including carers."

Certainly not as detailed as the Future Forum papers yesterday!

Still not sure if things are looking up or down for health scrutiny but today's response is certainly more hopeful than yesterday's report. What will tomorrow bring...

Like others I was very disappointed with the Future Forum comments (or lack of) around health scrutiny. I particularly enjoyed (not) the idea that Healthwatch will want to scrutinise scrutiny! However, as Graham said, the Government response was a bit more positive which may reflect CfPS work with DH to improve their understanding of scrutiny! I agree that, having been told they need to keep health scrutiny, they now don't know what to do with it and are focusing on Healthwatch. I do wish they would stop using the word 'scrutiny' in relation to Healthwatch which is very confusing and encourages duplication.

I read the comment "Local authorities will still be able to challenge any proposals for the substantial reconfiguration of services, and we will retain the Government's four tests for assessing service reconfigurations" as possibly removing the proposed restriction on referrals to 'designated' services (the reference to 'any' proposals)... or maybe I am being over-optimistic!?

[tim gilling]

Relevant parts of the Government response to the Future Forum report:

4.14. Members of health and wellbeing boards will be subject to oversight and scrutiny by the existing statutory structures for the overview and scrutiny of local authority or health functions. The existing statutory powers of local authority overview and scrutiny functions will continue to apply. In line with the principles of the Localism Bill, local authorities will have greater discretion over how to exercise their health scrutiny powers.
4.15. We are already taking action to extend local authority health scrutiny powers to facilitate effective scrutiny of any provider of any NHS-funded service, as well as any NHS commissioner. Local authorities will also still be able to challenge any proposals for the substantial reconfiguration of services, and we will retain the Government's four tests for assessing service reconfigurations. Proposals for reconfiguration will need to continue to demonstrate:
i) support from clinical commissioning groups;
ii) strengthened public and patient
engagement;
iii) clarity on the clinical evidence base; and
iv) consistency with current and prospective patient choice.

5.45. We have always made clear that regulation is needed to protect patients' interests. The listening exercise has demonstrated support for this principle, particularly, the importance of Monitor being able to intervene in 'distress' to support recovery and prevent failure before it happens. We have heard concerns about the practicality of our proposals for designating which services should be subject to additional regulation, and an overarching concern to ensure democratic legitimacy by maintaining local authority scrutiny rights.
5.46. We are responding to these concerns, whilst remaining true to the principles that the Health Select Committee and others have endorsed, and we will be amending the Bill accordingly. We will take an evolutionary approach, building on current legislation. This will mean withdrawing our proposal for commissioners to apply to Monitor to designate in advance which services would be subject to additional regulation. We will also maintain democratic oversight by reinstating local authority scrutiny rights.
So, it looks like 'designated services' are being dropped and the existing referral powers around 'substantial variation' will remain. The language is slightly confusing, referring to health and wellbeing boards being subject to 'existing statutory structures' for overview and scrutiny - this would suggest existing overview and scrutiny committee arrangements but also referring to greater discretion over how health scrutiny powers are exercised.

[Graham Spencer]

The full response does seem more positive now but there is still a long way to go I feel.

We'll hopefully be trialling some ways of working with the Health and WellBeing Board here over the next few months so it's helpful that the Government has publicly 'backed' the existing role of scrutiny.