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FRONT LINE FIRST - SOCIAL SERVICES

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The Department of Health has published a document on the new health scrutiny function for councils, setting out pro...
The Department of Health has published a document on the new health scrutiny function for councils, setting out proposals for regulations on how health scrutiny is carried out (LGC, 25 January).

Both health bodies and councils have been waiting anxiously for these regulations. Many NHS bodies are concerned they will be answerable to what they perceive as another level of bureaucracy. Others of a more democratic cast accept the health scrutiny function introduces a route of accountability that is currently missing.

There are significant differences between health scrutiny as set up by the Health and Social Care Act 2001 and the general scrutiny function created by the Local Government Act 2000. Council scrutiny committees - not councils or their executives - will be the official consultants on major health service changes and reconfigurations. It is these scrutiny committees, not the councils of which they are a part, that will have the power to refer contested NHS decisions to the secretary of state for health.

Health scrutiny committees will be required to report their findings and recommendations to the relevant health bodies and not to the council. These provisions give the council scrutiny committees a separate identity and legal standing that has not been conferred by the scrutiny role envisaged under the Local Government Act 2000.

Councils have welcomed the health scrutiny power as a greater democratisation of local health services and as a recognition of councils' community leadership role. Scrutiny committees will certainly embrace health as an important aspect of their work. But what would happen if a health scrutiny committee reached conclusions that differed from those of the council's executive, for example about the council's own impact on health or regarding a proposed hospital closure? We could see each side invoking its statutory powers to claim legitimacy for its views.

The worst thing any council executive could do would be to try to silence its health scrutiny committee. The most sensible way to avoid potential clashes is for council executives to incorporate findings and recommendations into the council's own policy and decision-making structures.

This would mean scrutiny committees' programmes are known in advance and are supported by the whole council, and that any matter about which there is agreement becomes policy.

This may still leave areas of disagreement, but it should at least mean, where there is agreement, health scrutiny committees have a chance to influence the health impact of councils' policies. Where there is consensus about improvements the support of the council, its executive and its health scrutiny committee should provide a powerful voice for change.

Dr Fiona Campbell

Co-ordinator, Democratic Health Network

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