Appendix C
Norfolk Scrutiny Network
19 June 2012
Health scrutiny and the Health and Social Care Act 2012
Note by Scrutiny Support Manager (Health)
This note explains current health scrutiny arrangements and the implications
of the Health and Social Care Act 2012 for the future.
1.
Current arrangements
1.1
Norfolk Health Overview and Scrutiny Committee (NHOSC) was
originally established under the Health and Social Care Act 2001 and
the Local Authority (Overview and Scrutiny Committees Health
Scrutiny Functions) Regulations 2002, which introduced health
scrutiny powers for upper tier local authorities.
1.2
The powers were vested directly in the health overview and scrutiny
committees, who could exercise them without recourse to or approval
from their local authorities.
1.3
The health scrutiny powers are:a) The right to be consulted by local NHS organisations about
proposals for substantial change to local services.
b) The power to call in and question local NHS managers.
c) The power to refer proposals to the Secretary of State for
Health for review (during which period the proposals cannot be
implemented).
1.4
NHOSC is a committee of Norfolk County Council with 8 county
councillors and 7 co-opted district council members, 1 from each
district in Norfolk, all with equal rights. Its constitution requires the
chairman to be a county councillor and the vice chairman to be a
district councillor.
1.5
All NHOSC councillors have the opportunity to suggest items for
scrutiny at each meeting and the chairman and full committee
decides whether or not to put them on the forward work programme.
District councillors can and do suggest items that have been raised
by their colleagues / councils.
1.6
Immediately after each meeting of NHOSC the district council
members are given a brief note of the outcomes and actions from the
Appendix C
meeting. This is intended to help them report back to their councils.
It is understood that some district councillors report back formally and
others do not.
1.7
NHOSC has the ability to delegate health scrutiny powers to district
councils and has done so on occasionally in the past, for review of
specific local subjects.
2.
Implications of the Health and Social Care Act 2012 for health
scrutiny
2.1
Under the new Act, health scrutiny powers continue to be held by
upper tier local authorities only. The ability to delegate health scrutiny
powers to district councils still exists as before.
2.2
The Act introduced two immediate changes :• Health scrutiny powers are now vested directly in the local
authority rather than in the health overview and scrutiny committee.
• There does not have to be a designated health overview and
scrutiny committee as the health scrutiny powers can be
discharged through any overview and scrutiny committee of the
upper tier local authority.
2.3
Other potential changes under the Act are dependent upon
regulations that have not yet been made. The two significant ones
are:• Extension of health scrutiny powers to all commissioners and
providers of health services, not just NHS organisations as in the
past.
• Restricting the power of referral to the Secretary of State for Health
to the local authority itself rather the overview and scrutiny
committee to which the health scrutiny powers are delegated.
The second one is significant because it would remove NHOSC’s
strongest power and put it in the hands of the County Council. It is,
however, worth noting that NHOSC has never yet needed to make a
referral.
3.
Other relevant implications of the Act
3.1
The Health and Wellbeing Board
3.1.1
The Act introduces the Health and Wellbeing Board as an
overarching strategic body responsible for developing the Joint
Strategic Needs Assessment and the Health and Wellbeing Strategy
for Norfolk, overseeing that commissioners act in accordance with the
Appendix C
agreed strategy and promoting the integration of health and social
care. It does not have health scrutiny powers.
3.1.2
The Health and Wellbeing Board will be fully established as a
committee of the County Council from April 2013. In 2012 it is
operating in shadow form, with quarterly meetings and the following
membership (* denotes statutory membership):Derrick Murphy (Chair)
Alison Thomas
David Harwood
Jenny Harries
David White
Lisa Christensen
Harold Bodmer
Patrick Thompson
Clinical Commissioning Groups
(5)
District Council leaders
Andrew Morgan
Sheila Childerhouse
Representation from the NHS
Commissioning Board
Voluntary/third sector
representatives
Simon Bailey
Norfolk County Council Leader*
Cabinet Member Children
Cabinet Member Community
Director of Public Health*
Chief Executive
Director Children’s Services*
Director Community Services
Chairman of LINK*
Representatives to be agreed
with CCGs*
All 7 District/City/Borough
Councils
Norfolk and Waveney PCT chief
executive
Norfolk and Waveney PCT chair
The arrangements for this will be
determined during the shadow
year
Three representatives from the
voluntary and third sector.
Deputy Chief Constable, Norfolk
Police
3.2
New NHS structures
3.2.1
The new local NHS structures are as follows:• Clinical commissioning groups (CCGs) – subject to
successful authorisation Norfolk will have 5:o North Norfolk
o South Norfolk
o Great Yarmouth and Waveney (cross border with
Suffolk, currently known as HealthEast)
o West Norfolk
o Norwich
These replace the two former Primary Care Trusts (PCTs),
which are currently clustered into one (NHS Norfolk and
Waveney). CCGs will commission most local NHS services,
with the exception of primary care (GPs and dentists). The
national process for authorisation of CCGs is currently
underway. HealthEast is in the first wave, which should be
Appendix C
completed by October 2012. The other 4 are in the third wave
which should be completed by December 2012. Those that are
successfully authorised will take on their statutory
responsibilities in April 2013.
• NHS Commissioning Board – is a national body that will have
a local presence. It will be responsible for commissioning
primary care and some other NHS services.
• Commissioning Support Service (CSS) – there will be one
CSS for Norfolk from which CCGs will purchase commissioning
support. CSSs will start life as NHS bodies but are expected to
move into the private sector by 2015.
3.2.2
NHOSC has previously focused primarily on the two PCTs as their
commissioning decisions affected services right across the county. In
future commissioning responsibility will rest with the CCGs and the
NHS Commissioning Board under the strategic influence of the
Health and Wellbeing Board. This means that there will be 7 bodies
active in the local commissioning process where there were 2 before.
4.
Future arrangements for health scrutiny
4.1
NHOSC, with its district council representation, is generally regarded
within the County Council as a successful and influential overview
and scrutiny committee.
4.2
The new Act positively encourages integration of health and social
care, which is already underway in Norfolk in both commissioning and
delivery of services. This raises the question of whether
arrangements for scrutiny of health and social care should also be
combined.
4.3
The forthcoming transfer of public health functions to the County
Council in 2013 also raises the issue of how these services will be
scrutinised in future. Currently NHOSC, with its district council
element, can scrutinise public health as an NHS service. It has yet to
be decided how public health will be scrutinised when it becomes a
County Council function.
4.4
Arrangements for scrutiny of the Health and Wellbeing Board’s
strategic decisions also need to be established.
4.5
All of these matters will be discussed by the County Council’s
Overview and Scrutiny Strategy Group in July 2012.