Stockton-on-Tees Borough Council

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Cabinet Decision: 11th July 2013
Title of Item/Report
New Health Scrutiny Regulations
Record of the Decision
Consideration was given to a report on the new health scrutiny regulations following the introduction of the Health and Social Care Act 2012 and subsequent amendments to the regulations.

The report highlighted the previous position, amendments to legislation and the revised regulations.

The key points of the new regulations were as follows:-

a) The scope of health scrutiny powers now extends to both NHS and ‘all relevant health service providers' - this means public, private or voluntary organisations that deliver services when commissioned by a CCG, NHS England, or local authorities themselves in relation to public health;

b) The power to undertake health scrutiny is now conferred on a Council as a whole. This can be discharged through establishment of a HOSC or through other arrangements.

c) The power to make referrals to the Secretary of State is conferred on a Council as a whole. The power of referrals may be delegated to a HOSC or joint committee by Council but not to any other health scrutiny arrangement that may be set up.

d) Consultations on substantial variations must be led by NHS commissioners (eg. a CCG), whether the proposals come from commissioners or providers originally.

e) When proposals for substantial variations cover more than one LA area, a joint committee must be formed by those LAs that are consulted. It is only the joint committee that has the right to be consulted and to require NHS attendance at meetings on the matter. However the joint committee itself does not have the power to refer a matter to the Secretary of State unless each Council involved has delegated its power to do so to it.

f) According to draft guidance, those LAs choosing not to be involved in such a joint committee (ie. by not considering it a substantial matter) forfeit their right to be consulted on the matter and the ability to make a referral to the Secretary of State.

g) The NHS must publish timescales that set out by when it will decide on which of the options for service change it will implement. The local authority must publish timescales that set out by when it will make a decision as to whether to refer a matter to the Secretary of State, and subsequently by when it intends to make that referral.

h) Reasonable steps must be taken by the NHS and local authorities to achieve a local resolution to disputes over service changes

i) Any referrals to the Secretary of State must be evidenced and include an explanation as to how the local authority has considered the effect of the proposal on the sustainability or otherwise of the local health service (eg. regarding quality, safety and financial issues), and an explanation of any steps taken to reach agreement with the consulting body

j) Normal health scrutiny functions will not apply when either a Trust Special Administrator or a Health Administrator is appointed to a provider of NHS services, when such a provider has become unsustainable.

There was an expectation that NHS England (through the relevant Area Team primarily) would be involved either by health scrutiny or the local CCG in order to assist with the local resolution of any disputes and potential referrals (unless NHS England was itself the commissioner proposing a particular change).

A summary of the revised legal powers and duties relating to health scrutiny were as follows:-

Powers of local authorities

Local authorities may:-

a) review any matter relating to the planning, provision and operation of health services in their area;
b) request information from NHS bodies and relevant health service providers;
c) require attendance of NHS staff and members of relevant health service providers at scrutiny meetings;
d) make reports and recommendations to NHS bodies, relevant health service providers and the local authority, and expect a response where one is requested within 28 days;
e) respond to consultations by NHS bodies and relevant health service providers on matters of substantial variations or developments to health services;
f) refer contested service changes to the Secretary of State on specific grounds. They must provide robust evidence in support of this and publish clear timescales within which the referral will be made;
g) co-opt representatives onto their health scrutiny arrangements;
h) delegate health scrutiny powers to another local authority, or to a joint committee of a number of local authorities;
i) delegate health scrutiny powers to a Health Overview and Scrutiny Committee (HOSC), where one is retained;
j) delegate some health scrutiny functions where a HOSC has not been retained in favour of an alternative mechanism;
k) form joint scrutiny arrangements with other local authorities. This is mandatory in relation to proposals for substantial service change.

Duties of NHS bodies and relevant health service providers

NHS bodies and relevant health service providers must:

a) provide information requested by local authorities, subject to certain exemptions;
b) attend before local authority scrutiny meetings to answer questions, subject to exemptions;
c) on request, respond to reports and recommendations made by local authorities within 28 days of the request being made;
d) consult the local authority (including joint committees) on proposals for substantial variations or developments to health services;
e) publish timescales for consulting on and implementing substantial variations or developments to services.

In terms of structures there was no requirement to amend Stockton's arrangements following these changes. As the draft guidance makes clear, health scrutiny functions were non-executive functions of the local authority (where an authority operates Executive arrangements).

The draft statutory guidance highlighted the role of health scrutiny in the new health ‘system' and post-Francis Inquiry era. The function should provide an ongoing overview of local health services including an emphasis on monitoring quality, in-depth outcome focused reviews of key issues, and a mechanism for testing new proposals to ensure that they remain ‘grounded' and address local concerns.

The report outlined the revised duties and powers. A separate report had been produced in relation to an improved approach to monitoring the quality of local health and care provision in more practical terms.

RESOLVED that the revised health scrutiny regulations, the production of draft guidance, and the implications for Stockton be noted.
Reasons for the Decision
To provide Cabinet with an overview of the revised health scrutiny regulations.
Alternative Options Considered and Rejected
Declared (Cabinet Member) Conflicts of Interest
Details of any Dispensations
Date and Time by which Call In must be executed
Midnight on Friday, 19th July 2013

Date of Publication: 15 July 2013

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