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Asking questions about inequalities in local health

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One of the tools we have to support the government’s public health agenda is scrutiny. Scrutiny at a local government level has had a mixed press at times: confrontational and accusatory at worst but probing and unique at best. How can we, the NHS, take lessons from councils to avoid talking shop and blaming?

The Centre for Public Scrutiny is having a good shot at this, using insight and learning from ten projects (including a total of 47 local authority areas) to build a practical resource kit to help other areas use their scrutiny role to understand and tackle health inequalities. One of the key attributes these reviews identified is proactive searching for evidence.

As GPs, we refer for an opinion and assimilate that opinion into a holistic view of the patient, adding the nuance of ourselves, the patient and the family’s wishes. We are scrutinising a condition, a symptom or a holistic health picture.

So scrutiny is a variant of what we do already. We will need to be brave enough to commit resources to it: officer support is crucial in gathering evidence, coordinating those involved and helping to write up the project. Their time and experience can be invaluable.

Scrutiny takes many forms, a number of which are reflected in the Centre’s Scrutiny Development Areas. The project, chaired by myself in Warwickshire, was an assessment of teenage parent access to antenatal and postnatal care.

Children of teenage parents tend to have multiple poorer outcomes: the incidence of infant mortality amongst young parents is 60% higher than rates for children born to mothers aged 20-39; children born to teenage mothers are more likely to be born pre-term with a 25% higher risk of low birth weight - the list goes on. The logic is such that if a healthcare system provides access for this group and their families, different groups might also be able to access health more easily.

A large part of the project was a select committee-style event bringing together a wide range of staff from across Warwickshire employed by the NHS, local authorities and voluntary organisations.

Many of the tasks identified for follow up are the responsibility of the NHS. Who should then pursue the task of continuing the improvement when the roles are scattered across different councils, different acute providers, different community services and different charities?

I don’t know the answers to these questions, but I’d like to stimulate that debate. I don’t think scrutiny will be as effective if it remains something that just councillors do. Perhaps the Health and Wellbeing boards will facilitate a focus along with the new HealthWatch?

So if someone mentions scrutiny, please don’t run too fast in the opposite direction - think of how best the NHS could develop its own brand of resource effective scrutiny and how it fits into the bigger picture.  

Angela Warner (Con) GP and Warwickshire CC

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