The power to scrutinise the health service is potentially one of the most important given to councils in many years. But nine months into the health scrutiny process many councils are struggling to find their way.
Despite the Local Government Association's assertion that councils need around £100,000 each to be able to carry out their role effectively, it appears the money may never materialise.
Many now believe the support is likely to take the form of a toolkit, or more specific guidance.
Alyson Morley, policy officer for the Democratic Health Network, part of the Local Government Information Unit, said this would actually be very welcome, because the guidance issued so far is by no means exhaustive. For example, there is no definition of what constitutes a 'significant variation in service'. Obviously the closure of a children's ward would constitute a significant variation, but would the closure of a bus route, or a small reduction in nursing staff? Councils are just going ahead and interpreting this for themselves.
'The biggest issue is one of confidence. Councillors don't feel they have the expertise to be scrutinising health, though generally speaking I think they're doing a pretty good job. The health economy is incredibly complex and members do no need support in order to fulfil this role to its full potential.'
Ms Morley adds that scrutiny is a power, not a duty. Councils do not actually have to do very much - they could just set up a nominal, dormant structure. But to their credit most seem to be taking it very seriously, she says.
'Where problems arise is where councils go in and give failing health services a good kicking. This won't achieve much. Where the system seems to be working really well is where councils are building closer bonds with health services and using this to work better together - improving council-led services as well as NHS ones.'
Eric Pickles MP, shadow secretary of state for local government, said there was a danger conflicts of interest would arise where councillors had to scrutinise services in which their council had a joint responsibility for funding.
'Many of those councillors will be of the same political persuasion as the non-executive directors, and even chairman, of the local trust,' he said.
But Ms Morley said she believed working together was the key to improving services, and that closer relationships between health and social services 'have to be a good thing'.
Johnathan McInerney, social affairs project officer at the LGA, said the association is setting up a network of scrutiny officers around the country to support and advise each other as well as their own committee members. So far about half the UK's councils are covered.
Anna Coote, health policy director at the King's Fund, said: 'I think it's still too early to tell whether scrutiny is working, but there definitely needs to be better support and training for members. Even just taking evidence and then scrutinising that evidence is a skill many councillors don't have.'
Case Study Middlesbrough Council
he area is covered by the County Durham and Tees Valley Strategic Health Authority, which encompasses five primary care trusts: Darlington, Hartlepool, Langbaugh, Middlesbrough and North Tees.
The council employs a dedicated health scrutiny officer who:
??? Maps local health services and patient flows
??? Develops relationships with health services providers and other influential organisations
??? Works with the local community health council to ensure the transfer of expertise and knowledge
??? Develops joint working relationships with other councils
??? Assists scrutiny panels.
Tim Gilling, scrutiny officer at Middlesbrough, is part of a scrutiny suppo rt team of five . Each works with a different scrutiny panel.
Mr Gilling says: 'My first task was to map out health services as they exist locally. At the moment we are just concentrating on the NHS, but eventually we want to broaden this to a wider range of services.
'Our strategic partnership is running a campaign to address funding of the local PCT. We estimate it is under-funded by about 6%, and it looks as though there is some kind of north/south divide going on.
'Another big project is consultation with the strategic health authority, which is planning a major review of all services across Teesside. Obviously we want to make sure this does not lead to any significant service cuts or problems accessing services.'
The council has also created a health scrutiny panel by splitting its former health and social care scrutiny panel into two separate ones. They link to the council's overview and scrutiny board. The health panel has seven members and makes recommendations to whichever body has the ability to carry them out - the NHS or the council's executive.
The councils are nominating representatives to a health scrutiny joint committee. Middlesbrough and Redcar & Cleveland councils are nominating representatives to a Middlesbrough & Eston health scrutiny joint committee, to scrutinise the Middlesbrough PCT, because the boundary is not coterminous.
There are no non-elected members on any of the panels. Health expertise and advice is brought in as necessary depending on the nature of individual reviews.
Scrutiny exercises underway:
The former health and social care panel contributed to a best value review of services for children with disabilities and a review of the physical disabilities strategy.
Upcoming issues 2003-04:
??? Substance misuse - drug/alcohol and effects on mental health
??? Admission/discharge and subsequent care - essentially for older people
??? Inequalities in access to primary and secondary care
??? Access to dental services
??? Transportation issues
??? Sex education and teenage pregnancy - including transmitted diseases and continuing education for child parents
??? Young people's health - physical activity/access to leisure/ obesity/education/safety
??? Suicide prevention.