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Tim Gilling looks at how overview and scrutiny can be used to promote health initiatives. This spring, the Centre for Public Scrutiny (CfPS) is sponsoring four ‘overview and scrutiny' projects to undertake reviews of health inequalities in their areas. The projects are funded through the centre's health scrutiny programme, supported by the Department of Health. Over the last five or six years, scrutiny committees have built up a strong reputation for holding health and social care managers to account for the way services are planned and delivered. There's plenty of evidence that scrutiny committees have actively reviewed service provision, but we wanted to encourage a broader look at what executives are doing to improve health and care, and focus on what can be done to stop people falling into the health and care system in the first place. The centre already has a track record of supporting innovation and learning in health scrutiny – publications such as Sharing the learning and Learning together show that with the right support, scrutiny committees can achieve a great deal of success. However, a search through the CfPS scrutiny library reveals few reviews dedicated to ‘health inequalities'. I believe that is because health inequalities are complex. The problems are well known, the issues seem intractable, and it often takes time to show evidence of success. It's possible that non-executive councillors feel they can't make a difference. We wanted to demonstrate the potential for them to bring about change. They are actually well-placed to ensure that a range of agencies work in partnership to target and reduce inequalities in their areas. Local authorities' influence on health and health inequalities is wide ranging, and overview and scrutiny committees can act to assess the local authority's own contribution to ‘place-shaping' through improving health and social care. Health scrutiny provides a channel for councillors to reflect on local and national evidence of ‘what works', and make recommendations for local improvements. Health scrutiny provides a mechanism to support the shaping and achievement of shared local targets, such as those in local area agreements around health inequalities. They can also assess how well partners are co-operating to include the views of local people about what matters to them. Overview and scrutiny committees can make sure local authorities and PCTs have excellent information and intelligence about lifestyles, health and aspirations of their communities. Health scrutineers can then ‘hold commissioners to account' about the extent to which decisions have been made on the basis of the knowledge base. Needs assessments and commissioning strategies are often impenetrable to local people. Scrutiny committees can ask some simple questions such as, ‘What's it like to live round here?' and, ‘How would like things to change?' in order to bring a reality check on behalf of local people. At a recent CfPS event, scrutiny practitioners heard about the experience of Leicestershire CC's adult care and health overview and scrutiny committee, which reviewed commissioning across the county. Anne Mitchell, senior policy and research officer for health at the council, says: ‘The committee was supported in the review by the GP leads for practice-based commissioning on the professional executive committee of the PCT. ‘We visited two general practices in Leicestershire, and were also able to talk to the local medical committee. The support and evidence from GPs enabled us to put forward evidenced-based recommendations about how to take commissioning forward in our communities, including an emphasis on non-medical treatments when considering new schemes'. One of the current CfPS-sponsored reviews is in North Lincolnshire, also looking at practice-based commissioning – this time assessing its capacity to tackle health inequalities. This will incorporate an examination of health inequalities across the council area, and will test the potential for allocation of resources through practice-based commissioning to reduce or increase inequity. Dean Gillon, scrutiny support officer, says: ‘The project will play a key role in ongoing local efforts to tackle health inequalities in two ways. First, it will seek information about how current and planned primary care budgets are allocated and used through practice-based commissioning, and second, it will explore the use of preventative spending by GPs. We want to work with GPs and practice managers, the PCT, practice-based commissioning groups, and local communities to discuss the decisions and methodology surrounding budget allocations, and the accompanying impact on people's health and wellbeing. Tim Gilling is health programme manager at the Centre for Public Scrutiny

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HEALTH

Check-ups for health provision

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