The case for good governance in our health and care system doesn’t need to be made.
We know what happens when scrutiny is ineffective and the cost of poor accountability in health is measured in lives lost, not pounds and pence.
The Centre for Public Scrutiny (CfPS) has been funded by the Department of Health, NHS England and Public Health England to bring together people who plan and deliver services with councillors in a new health scrutiny programme.
Pressures on budgets, an ageing population and increases in demand mean we are facing significant challenges to our health and social care services but we must make sure that patient care, wellbeing and safety are kept at the centre of future changes and reconfigurations.
Of course, the bodies responsible for caring for the sick and elderly must have established governance structures and clear channels of accountability. Of course, we need them to be responsive to local need, use data more effectively and deliver better outcomes in smarter, safer ways. The health scrutiny programme is not about adding layers of bureaucracy, making complex organisations harder to manage; it will be squarely focused on how good scrutiny can help leaders make better decisions.
Council scrutiny can add value to tackling inequalities and the move of public health to local government means the link can be strengthened. Better understanding of how to use information can help focus council scrutiny on the important local risks to health and can help prioritise actions to prevent poor health.
We will facilitate better sharing of information and improved understanding of local areas by getting council scrutiny talking directly with general practices, clinical commissioning groups and NHS England area teams. This improved dialogue is going to bring a number of benefits.
First, it will make the process of service reconfiguration more efficient, responsive to local need and credible to those who might be impacted by changes. Our ambition is for a more consensual approach, understanding and addressing local concerns with fewer reconfiguration referrals to the health secretary.
Second, council scrutiny can help shape local action that is focused on people and pathways rather than organisations and institutions. Dialogue with elected representatives will enable commissioners to be more ambitious about healthy communities in the long term, rather than focusing on managing demand relative to the available resources.
Finally, the health scrutiny programme will help create a culture of accountability, one which doesn’t see good governance as a necessary component of risk management but rather relishes challenge; a culture which opens itself to intelligence from those that have their ears to the ground and uses scrutiny to anticipate not just problems but innovations to deliver better health for all.
Lord Bob Kerslake, chair, Centre for Public Scrutiny