Health Inequalities Scrutiny programme – one year on

Last updated:13 July 2010

It’s hard to believe that on the 1st July the CfPS Health Inequalities scrutiny programme will be one year old. I am really pleased with the way that programme has developed during this time, in particular helping scrutiny to take a more proactive role. This programme will help everyone to get a better understanding of the role that scrutiny can play in tackling health inequalities, by examining the causes and focusing on where the most effective interventions need to take place. 

I have found the response from staff involved in the programme to be both refreshing and reassuring during these difficult financial times. There is a clear commitment by members and officers involved to use the programme as a platform to challenge the effectiveness of current strategies to reduce levels of health inequalities.

The overall aim of the Health Inequalities Scrutiny Programme is to “raise the profile of overview and scrutiny as a tool to promote community well-being and help councils in addressing health inequalities within their local community.”

The programme, funded by the Healthy Communities Programme at Local Government Improvement (formerly the IDeA), was developed in recognition nationally of the important role and contribution of local government scrutiny. This role includes helping to reduce health inequalities, and developing new ways of working that maintain an overall balance in the scrutiny work programme, between service issues and broader health inequalities issues.

One of the main outputs of the programme is the recruitment of Scrutiny Development Areas. Initially it was envisaged that four areas would be recruited, but thanks to an overwhelming response – and good financial management – ten areas have been recruited.  Information on these areas and the focus of their reviews, can be found on the CfPS website.

What continues to be really exciting is the use of non-traditional scrutiny methods to gather evidence and positively engage the intended beneficiaries of the work throughout the programme. I come from a partnership and community development background, and am delighted to see that the majority of the reviews are harnessing good practice from this specialist area. 

As you will see from the information below, some of the reviews of the SDAs are creating ground-breaking innovations:

• In the Sefton SDA, the scrutiny panel are working with local school children and their families to understand the facts beneath the statistics that we rely on as agencies.  What’s the story of how the family live their lives, do they access local services, if not why not? This type of information will provide valuable data to help inform the way that the council and its partners provide services.
• Portsmouth SDA Councillors are working with front line services on the streets of Portsmouth to get a feel for the issues that alcohol causes and getting a real understanding of how services could be improved or developed.
• In contrast the Blackpool SDA is focusing on the issue of minimum pricing of alcohol and using scrutiny as a consultative and informative mechanism for raising the issue of minimum pricing with the community.
• Appreciative inquiry (AI) is a process for valuing and drawing out the strengths and successes of a community. These are then used to develop a realistic and realisable vision for the future and a commitment to take sustainable action.  Chesterfield SDA is using AI to understand in more detail the community that is the focus of the review, and using that to make recommendations to reduce the health inequalities that exist.
• Housing is understood to have a key influence over people’s health – if you suffer poor housing conditions then your health, education and other wellbeing aspects will suffer – such as homelessness, over crowding, and poor liveability conditions.  The London SDA consisting of 7 local councils, is reviewing different aspects of housing and its effect on health.
• Cheshire West and Chester SDA is a scrutiny pilot and also a ‘social determinants of health’ pilot for the IDeA.  They are working together to develop a tool – based on the Foresight Report and the 5 ways to wellbeing – to assess the wellbeing of the community.  This review is also refining a mapping technique for scrutiny committees to help them to understand the inequalities that exist – especially in smaller pockets.

The projects funded by the health inequalities scrutiny programme are expected to provide valuable information about what works and what does not and range of methods available to other authorities to use and also meet national drivers to continue efforts to make a positive difference to the lives of local communities.

The second output from the programme is the publication of a Resource Kit. The resource kit will help local scrutineers undertake similar reviews and use scrutiny to tackle some of the deep seated health issues that we all face.  The kit will build on the experience of these and other scrutiny reviews of health inequalities that have taken place outside of the programme to help to illustrate the unique contribution that scrutiny can make.

Looking ahead it is likely that reducing health inequalities and making best use of the available resources will be a priority for Government when developing its policies and programmes post 2010. The early signs show a widening of the focus from a predominantly NHS-led illness treatment approach and moving the country forward in terms of evidence-based actions, needed to reduce the causes of health inequalities.

The recent independent "Marmot Review", commissioned to advise the previous government on the most effective strategies for reducing the socio-economic drivers of health inequalities in England, was launched in February.  There are strong links between the Marmot Review and this programme – actively seeking to develop exemplar ways of working and models of delivery to support the overall policy objectives in the review.

This national drive to reduce levels of health inequality will continue to present challenges for Local Authorities and partners alike who are expected to look more critically about how effectively resources are being used, particularly those within the gift of Local Authorities.

Scrutiny is a powerful investigative tool that – when used properly – can produce recommendations that deliver innovative solutions to local health issues and raise awareness of the issue and effects. It also helps create capacity from within – really important in the current economic climate.

The value of scrutiny is its independence and the ability to bring in outside expertise where needed to support its work and produce recommendations which are aimed at supporting the required policy changes. The work of individual SDAs and the development of the resource kit will be an important addition to the ongoing work of scrutiny in helping to raise awareness about the issue and in developing a range of methods that make real progress in helping to reduce health inequalities in areas with the worst health and deprivation.

Helping to keep the programme on track and developing effectively is a small national reference group – consisting of local scrutiny practitioners and national health leads. Liam Hughes, a member of the reference group, explains why scrutiny is so important to him.

“Health is everyone’s business, and narrowing the gap in health inequalities requires action by individuals, families and communities, working together with all of the local public services. There is a moral case for doing this, and a business case – keeping people healthy is a good investment. Overview and Scrutiny Committees can support this effort, by identifying things that are going well and things that need more attention. As "critical friends", they can hold up a mirror to health improvement, and encourage the council and local partners to play a more active part. This is important work, which looks beyond health services to local lifestyles and the wider determinants of health”.  

Contact; su.turner@cfps.org.uk

Su Turner, Principal Consultant, CfPS
With contributions from:
Earl Piggot Smith and Liam Hughes – members of the National Reference Group