Scrutiny and the Voluntary and Community
Sector
Health Inequalities in London event
29 October 2014
Jessica Crowe
Centre for Public Scrutiny
who are CfPS?
Founded in 2003 to:
• promote accountable public services
• influence policy and practice
Now a charity, we are a national leader in ideas about
accountability and scrutiny in public services:
• our principles: accountability, transparency & involvement
• support cross-sector, cross-government learning networks
What do we do?
• Operate in 5 fields of work:
• Children & Young People (school governance, safeguarding
scrutiny)
• Health & Social Care (funded by DH/NHSE, CQC to support
networks & better PPI)
• Involvement (tenant scrutiny, welfare reform)
• Local Accountability (council scrutiny practice in England &
Wales)
• Thought Leadership (advocating stronger scrutiny &
accountability)
• Offer skills training & development, governance evaluation &
support, online services/briefings, network support & events
contents
• What is scrutiny
• How can health scrutiny help
VCS?
• Using council scrutiny to have
an impact on health inequalities
CfPS: Accountability Works! 2010
what is scrutiny?
Fundamentally:
scrutiny is based on the principle that
someone who makes a decision…
…shouldn’t be the only one to review or
challenge it
Local authority scrutiny
Aims and objectives
• A core element of local democracy
• Provide ‘critical friend’ challenge
• Enable the voice and concerns of the public to be heard
• Carried out by independent members
• Drive improvement in public services
• Gives councillors powers to review, scrutinise and make
recommendations for any matter relating to the planning,
provision and operation of health services locally.
• Scrutiny is at its most effective when it can influence and
improve service design and delivery – CfPS’s ‘Return on
investment’ model of scrutiny helps do this in an inclusive,
citizen-focused way
Health scrutiny is able to connect
different bits of the system
– when it works well
• Using democratic
mandate & legitimacy
• Scrutiny >>
accountability
• Overview >> makes
connections and
helps see whole
system
• It’s about
relationships
An inclusive way to scrutinise and
improve health inequalities
• Phase two of our Health Inequalities Programme developed
and piloted a new approach with councils which provided:
– Robust scrutiny based on impacts, outcomes, measurements, costs.
– Integrated Marmot Policy objectives into a review model and a
council’s work.
– Focused on the wider determinants and their impact on health
– Forecast the impact of scrutiny recommendations
• Result was a model that embeds scrutiny as an effective
public health tool and identified potential savings
• Extended beyond health inequalities: welfare reform &
education governance
Background - Marmot Review
‘Fair Society, Healthy Lives’
Proposed an evidence based strategy to address the social
determinants of health, the conditions in which people are born,
grow, live, work and age which can lead to health inequalities:
• Giving every child a good start in life
• Enabling all children, young people and adults to maximise their
capabilities and have control over their lives.
• Creating fair employment and good work for all.
• Ensuring a healthy standard of living for all.
• Creating and developing healthy and sustainable places and
communities.
• Strengthening the role and impact of ill health prevention.
Introducing the scrutiny model
What it helps areas to do
The model is based on five
stages of a “scrutiny journey”,
utilising a variety of tools:
1. Identifying and short listing
topics
2. Prioritisation
3. Stakeholder engagement and
scoping
4. Undertaking the review,
measuring impact and
calculating the Return on
Investment
5. Making recommendations using
ROI and influencing services
Stage two
Prioritisation
Stage two – has three steps:
• Producing an Impact Statement
• Using a “scoring matrix” to
choose the topic for review
• Considering what to measure
The impact statements help
councillors focus on the policy
objectives of the Marmot Review of
Health Inequalities
Stage 2 - Impact scoring matrix – case study
Stage three
Stakeholder engagement and scoping
Stage three has two steps:
• Stakeholder engagement
• Getting started with the review
The stakeholder engagement has
proved to be an innovative way to
engage a wider group of citizens
within the review and ensures that
Councillors focus on the whole system
Stage 3
Stakeholder
engagement
wheel
Stakeholder engagement
wheel Identifying gaps and overlaps
Benefits – what users thought!
• Scrutiny is well placed to influence a range of partner
agencies and promote more joined-up working
• Different way of prioritising topics - highlighting a ‘hidden’
issue
• Raises awareness of the issue – value of networking
• Good stakeholder engagement looking at difficult and
sensitive issue – helps to get all of the right people together
• Explored issues ‘on the ground’ and agreed a set of
recommendations to help improve services
• Able to demonstrate a return on investment, including: input
and output costs, potential cost savings from improving
service coordination
Case study: scrutiny of maternal
health needs of gypsy & traveller
population
South Somerset:
- facilitate networks
- focus on patient
experience & access
- link bigger picture to
local experience
- provide neutral space
- champion marginalised
Publications – all on our website
Any questions?
To find out more
www.cfps.org.uk - register on-line or via forms for:
- e-newsletters, e-digests & scrutiny exchange
- reviews library, on-line forum, latest news
- Policy and Skills Briefings
Twitter: @CfPScrutiny
info@cfps.org.uk or 020 7187 7362 for helpdesk
Tipping the scales:
http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/L12_379_tipping_the_scales_v
4.pdf
Valuing inclusion:
http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/L13_30_CfPS_Valuing_inclusio
n_v5_Web_final_amends.pdf
Checking the nation’s health:
http://www.cfps.org.uk/domains/cfps.org.uk/local/media/downloads/CfPS_Nations_Health_final_onl
ine.pdf