APPENDIX 1
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ADULT
AND COMMUNITY SERVICES SELECT COMMITTEE – 27 JANUARY 2005 HAMPSHIRE COUNTY COUNCIL AND SOUTHAMPTON CITY COUNCIL
LOCAL AUTHORITY HEALTH OVERVIEW AND SCRUTINY COMMITTEES: FRAMEWORK FOR
ASSESSING SUBSTANTIAL CHANGE IN NHS PROVISION REPORT OF THE HEALTH REVIEW MANAGER – HAMPSHIRE COUNTY
COUNCIL |
1)
Section
7 of the Health and Social Care Act 2001 places a statutory responsibility on
the NHS to consult Local Authority Health Overview and Scrutiny Committees
(OSCs) on any proposals to substantially vary or develop NHS provision to
people living in the area of the OSCs. This requirement is additional to the
duty placed on NHS bodies to consult and involve patient and the public in the
planning and operation of health services as set out in Section 11 of the
Health and Social Care Act.
2)
This
document provides a context to the dialogue that needs to be taking place
between the OSCs and NHS organisations to establish if a proposal is
substantial in nature. It is not, nor is it intended to be, a ‘blueprint’ for
engagement between the OSCs and the NHS as the timing of consultation and
methods of engagement may vary from proposal to proposal.
3)
The
framework draws on the following documentation:
a)
Overview
and Scrutiny of Health – Guidance (July 2003)
b)
Overview
and Scrutiny of Health-Supplementary Guidance (July 2003)
c)
Strengthening
Accountability –Policy and Practice Guidance (Feb 2003)
d)
Keeping
the NHS Local- A new direction of Travel (Feb 2003)
e)
Independent
Reconfiguration Panel- Guidance & Template (Feb 2004)
4)
The
regulations supporting the health scrutiny function do not define
‘substantial’. This needs to be determined locally and will be dependent on the
impact that the changes will have on people using, or who have the potential to
use, the service in question.
5)
The
role of the OSCs working with local NHS bodies and the duties for engagement
and involvement placed on the NHS require that new working relationships
develop. These are evolving across Hampshire and the Isle of Wight and the
intention is that this document makes a positive contribution to supporting the
effective delivery of these arrangements. It will therefore be reviewed by the
participating OSCs and NHS organisations in 12 months. During this time all
participants will work to explore the scope for developing a local mechanism
for resolving any contested change.
6)
New
arrangements for the scrutiny of health services introduced in January 2003
made local authorities with social service departments responsible for the
overview and scrutiny of health services in their area. Where the NHS plans to
substantially change or vary health services for which it is responsible, the
OSCs whose populations are affected are statutory consultees.
7)
The term
‘substantial’ is not defined in the legislative framework supporting the role
of the OSCs. The guidance supporting arrangements for Patient and Public
Involvement in the NHS, and that relating to health scrutiny is clear that
there is an expectation that the NHS body responsible for the proposal should
initiate early dialogue with the OSCs affected by the proposal to determine:
a)
If the
change constitutes a substantial variation or development
b)
The
timing and content of the consultation process.
8)
Where
it is agreed that the proposal does constitute a substantial change the
response of the OSCs to the subsequent consultation process will be shaped by
the following considerations:
a)
Has
the consultation process been appropriate in terms of timing and content,
including the delivery of Section 11 requirements
b)
Is the
change proposed in the interests of the health service in the area
9)
The
framework attached at Appendix 2 identifies a range of issues that may inform
both the discussion about the nature of the change and the response of the OSC
to the consultation process. The intention is that this provides a simple
prompt for assessing proposals, explaining the reasons for the change and
understanding the impact this will have on those using, or likely to use, the
service in question.
10)
The
framework is not a ‘blueprint’ that all proposals for changing services from
the NHS are expected to comply with. The diversity of the health economy across
Hampshire and the Isle of Wight and the complexity of service provision need to
be recognised, and each proposal will therefore need to be considered in the
context of the change it will deliver. The framework can therefore only act as
a guide. It is no substitute for an on-going dialogue between the parties
concerned. It is designed for use independently by the NHS in the early stages
of developing a proposal, or provide a basis for discussion with OSCs regarding
the scope and timing of any formal consultation required.
11)
The
development of the framework has taken into account the introduction of new
arrangements for patient and public involvement in the NHS and other regulatory
developments including:
a)
The right of the Patent and Public
Involvement Forums to refer issues of concern to the OSC in their area;
b)
The
statutory duty on the NHS to involve and engage with local people in planning
and operating services (often referred to as section 11);
c)
The
impact of the proposal on vulnerable populations using public services. (e.g.
Race (Amendment) Act requirements, issues identified in public health equity
audits)
12)
The
guidance supporting OSCs provides for some flexibility in the length of time
the consultation will last and the methods to be used, taking into account
local needs. Whilst it is good practice to follow Cabinet Office Guidelines,
and this will be normal practice, there is scope to vary the consultation
process. Early discussions with OSC are essential if this flexibility is to be
used to benefit local people.
13)
Any
request to reduce the length of formal consultation with the OSCs will be
underpinned by robust evidence that the NHS body responsible for the proposal
has engaged, or intends to engage local people in accordance with section 11
requirements. These require the involvement of service uses and other key stakeholders
in developing and shaping any proposals for changing services. ‘Strengthening
Accountability- policy and practice guidance’ summarises the duty to involve
patients and the public:
a)
Not
just when a major change is proposed, but in the on-going planning of services
b)
Not
just when considering a proposal, but in the development of that proposal, and
c)
In
decisions that may affect the operation of services
14)
All
proposals shared with OSCs by the NHS should therefore be able to demonstrate
an appropriate consideration of Section 11 responsibilities.
15)
Within
Hampshire and the Isle of Wight an ambitious programme for service
reconfiguration in the form of ‘HealthFit’ and ‘Beyond HealthFit’ has been
developed. Initial drivers for change included the need to conform to the
European Working Time Directive and modernisation agenda. Financial pressures
in terms of a significant underlying deficit and the affordability of the
current configuration of services are also significant factors. It is essential
that local people are able to contribute to any change to health service
provision that results from the implementation of this programme. This
framework is therefore designed to complement the changes that will result from
these initiatives, providing a clear template against which the NHS can share
proposals with the OSCs to:
a)
Explain
the rationale behind proposals for change and the options considered
b)
Demonstrate
how services users, their families and other key stakeholders have contributed,
or will contribute, to the development of the proposal.
16)
Different
ways of working are beginning to emerge to support this process in Hampshire
and the Isle of Wight. New relationships are being established between the NHS,
the OSCs in their area and increasingly Patient & Public Involvement
Forums. This framework capitalises on these emerging networks to draw together
the different strands of involvement and engagement needed to support service
change and identifies the issues to be taken into account by the NHS and OSCs
when considering such proposals.
17)
The
guiding principles set out below will also inform these discussions.
Guiding Principles
18)
The
four OSCs in Hampshire & the Isle of Wight have worked closely together
over the last year to build effective working relationships and share good
practice. This has extended to the way in which the OSCs interact with the
local NHS. Arrangements for joint working, which is required under statute
where a proposal from the NHS spans more than one OSC area, have been established.
19)
All OSCs in Hampshire and the Isle of Wight recognise that, for
the scrutiny process to be credible and influential it must
a)
Be challenging but not confrontational
b)
Be based on evidence and not opinion
c)
Contribute to improvements in services
d)
Be consistent and proportionate to the issue to be addressed
e)
Take account of the total population affected
23)
The
absence of this information may result in the proposal being referred back to
the responsible NHS Board for further action.
DENISE HOLDEN
Health Review Manager – Hampshire
County Council