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NHS could 'raise bar' for closure objections

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Councils will need to provide “more convincing” evidence when they oppose NHS reconfigurations such as hospital closures, according to the health chief in charge of a review on the subject.

South of England strategic health authority chief executive Sir Ian Carruthers told councillors at an LGA meeting on Wednesday that it was “inadequate” for local authority scrutiny committees to oppose NHS shake-ups in their area on the grounds that they “don’t like it”.

He said he was likely to recommend a new system in which objections to proposed reorganisations had to provide evidence that the plans did not meet “tests” in four areas: safety, patient choice and engagement, clinical evidence and support from clinical commissioning groups.

Councils have the power to refer proposed NHS changes to the secretary of state, and ask for the schemes to be reconsidered. Sir Ian said it was likely that in future these referrals would “need to be made in the form of a statement that meets each of the tests”.

“To simply write and say ‘we don’t like it’ or ‘it’s not what we think should happen’ will be inadequate”, he said.

Sir Ian, who was appointed by NHS chief Sir David Nicholson last autumn to carry out a review of the process by which the NHS reorganises local services, said the quality of councils’ written objections to these schemes was variable.

“I know every scrutiny committee would say, we provide fantastic evidence, but I’m not sure that is actually so”, he said. “If you did an analysis of every letter received, some are extremely full of evidence and others less so. I think we need to be honest about it”.

He added that he wanted to “raise the bar” so that standards of evidence used in these cases would be “higher and more convincing”.

He also warned that plans needed to be in place to deal with possible conflicts within a local authority about NHS changes, for instance if a health and wellbeing board supported the plans but a scrutiny committee did not.

Also at the meeting, Sir Ian was criticised for telling councillors that the presence of a journalist meant he was “limited in what I can say”.

Steve Bedser (Lab), cabinet member for health and wellbeing at Birmingham City Council, told him: “The fact that you feel constrained because this is a public meeting is a small illustration of the bumpiness of the road ahead [as councils take on responsibility for public health]. I think people [in the NHS] will find it culturally very difficult to understand the dynamics of a health and wellbeing board that is democratically accountable and held in public. To manage disagreements in anything other than a transparent and public way would be untoward.”

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