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ITEM CC9

COUNTY COUNCIL – 9 SEPTEMBER 2003

Oxfordshire Leaders Group - 1 September 2003

Health Overview and Scrutiny in Oxfordshire

Report of the Officer Working Group

1. The Oxfordshire Leaders’ Group has previously agreed in principle to the creation of joint arrangements between the County and District Councils for the Overview and Scrutiny of health. As the detailed arrangements to take this forward had not been developed, in January this year, the County Council approved the creation of a County Council Health Overview & Scrutiny Committee with one co-opted place for each of the City and District Councils, as an interim arrangement. At the same time an officer working group to take the development of the joint arrangements forward was formed. The membership of this group is set out in Annex 1. This is our joint report which sets out proposals for a joint County and District Council Oxfordshire wide Health Overview and Scrutiny Committee with 3 joint Sub-Committees. The report also sets out the key principles for the Overview and Scrutiny of health and proposals to ensure that the work programmes of the main joint committee and its sub-committees are co-ordinated and that the objectives which should underpin them are clear. This report has been endorsed by the current Health Overview and Scrutiny Committee who commend the proposals to the Leaders’ Group and to the constituent Councils. It has also been considered informally by the Chief Executives of the health bodies who also commend the proposals. If the Leader’s Group approve the proposals each of the constituent Councils will then individually need to approve them.

Principles of Health Overview & Scrutiny

2. The legislative framework is set out in the Health & Social Care Act 2001, The Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002 and Guidance issued by the Secretary of State for Health in May 2003. Whilst the powers in the legislation are conferred on the County Council they can be exercised through joint arrangements with District Councils and delegation of the powers to District Councils or other local authorities is possible, although such delegation must relate to specific issues. The health scrutiny powers are wide-ranging and the government and practitioners working in this area emphasise that health scrutiny is about looking at the health of the population in its broadest sense and not just scrutinising the activities of the NHS. The core functions of local authorities themselves for example, housing, education, leisure and environmental services and support for the local economy make them central to the health of local communities and to addressing the inequalities in health. Within that framework, the following principles will guide how joint Health Overview & Scrutiny will operate in Oxfordshire:-

• Health Overview & Scrutiny will be undertaken on the basis of mutual understanding and trust between the local authorities in Oxfordshire, with the health sector and others;
• Will seek to add value by maximising the involvement of non-executive members of the County and District Councils in the overview and scrutiny of health issues which affect the population of Oxfordshire;
• Avoid duplicating other NHS and local authority inspection processes and the work of the Patient & Public Involvement Forums;
• Will adopt a flexible approach to its ways of working as is consistent with legal requirements, be member led, open and transparent and will lead to evidence based outcomes;
• Will act independently of the constituent authorities and undertake overview and scrutiny activities on a consistent and co-ordinated basis.

3. In order to achieve these principles, the County Council wish to undertake health overview & scrutiny in partnership with the five District Councils. A structure which envisaged an overarching co-ordinating Committee scrutinising county wide issues with devolved responsibility to locally based arrangements accords with the principles of the report adopted by the Oxfordshire Committee in October 2001.
4. The Officer Group has looked again at the original proposals considered by the Oxfordshire Leaders’ Group in 2001 whereby there would be an overarching County Council co-ordinating committee and 5 district council based committees. The Officer Group consider that there are a number of reasons why that joint structure should be reconsidered. These factors include:

• Recognition of the scale of member and officer commitment required to support such a structure;
• The capacity of the Health Service in Oxfordshire to respond to local authority health scrutiny given the immense pressures which it faces;
• The move to closer working between the PCTs, in particular the Cherwell Vale and North East PCTs and the South East and South West PCTs;
• A need to reconcile to some extent the geographically dissimilar structures of local government and the health service in Oxfordshire;
• Recognition of the close working relationships which are developing between the City and District Councils and the PCTs despite the difficulties of different boundaries.

5. The officer group therefore consider that a structure which maximises District Council involvement but at the same time will be more manageable for both local government and the health sector will lead to a more effective process for scrutinising health issues across the county. The proposed structure therefore builds on the principles of a county wide structure with locally based arrangements which will cope better with the changing dynamics in the health service.
6. The proposed structure would involve the following:

	Oxfordshire Health Overview & Scrutiny Committee
	Cherwell/West Oxfordshire		Oxford City/Vale of White Horse/South Oxfordshire		South Oxfordshire/Vale of White Horse/West
	(Cherwell Vale PCT North East PCT)		(Oxford City PCT)		(South East Oxon PCT South West Oxon PCT)

The District Council/Primary Care Trust linkage is based on primary interest given the lack of coterminosity between the boundaries of the local government and health structures. Formally, the current Oxfordshire wide County Council Committee will become a joint committee between the County Council and the 5 District Councils and the district level bodies will be joint Sub-Committees of it. It is proposed that the composition of the current Committee should remain unaltered when it becomes a formal joint committee and that the District Councils appoint to the sub-committees to ensure an even balance between them. For the joint committee (although not sub-committees), the political balance requirement applies for each participating authority unless members of all authorities agree to waive it. A proposed composition for the structure is attached as Annex 2. Members should normally serve for a period of 4 years unless they resign or are replaced.

7. In order to ensure consistency and continuity between the main Committee and its sub-committees, six of the County Council members on the joint committee should each be on one of the Sub-Committees. The Chair/Chairwoman/Chairman of the Joint Committee should be drawn from the County Council members of it and as now elected on an annual basis. The Chair/Chairwoman/Chairman of the main joint committee should have the right to attend the sub-committee meetings and to speak but not to vote. The Chairs/Chairwomen/Chairmen of the Sub-Committees should be drawn from the District Council members of the main joint committee and their terms of office in that position limited to a period of 2 years, in order that the sub-committees could choose to appoint a member from another district as Chair/Chairwomen/Chairman for a further period of 2 years.
8. Within their respective geographical areas, the Sub-Committees should have the full range of powers that are available under the legislation to the main joint committee in order to carry out their work programmes within the framework agreed by the main joint committee. Subject to that, the formal terms of reference of the sub-committees should be the same as those of the main joint committee. These are set out in Annex 3 attached. In order to give clarity to the health sector, only the joint committee and its sub-committees will exercise the statutory powers in the Health and Social Care Act and its associated Regulations. Health issues could of course still be considered by other scrutiny committees of the County and District Councils as part of the local authorities’ well-being powers, but to avoid duplication there would be merit in ensuring that work programmes which included health issues were co-ordinated.

Development of Health Overview and Scrutiny Work Programmes

9. The development, implementation and management of the work programmes of the main health overview and scrutiny committee and the sub-committees and effective communication between members and the officers involved in supporting them will be key in ensuring that health scrutiny is effective, focussed and adds value and that clear objectives are set and regularly evaluated. There needs to be consistency of approach between the main committee and the sub-committees so that the health sector is not subject to unreasonable demands and workloads. Resources are limited both for the health sector and for Councils. It is important therefore that the scrutiny role is focused on real issues where investigations and reviews will highlight the potential to improve performance and add more value for individuals and communities.
10. The sub-committees can only exercise the functions of the main joint committee within the agreed work programme. The annual work programmes of the Joint Committee and its Sub-Committees should consist of core issues and responsive issues, such as consultations on significant reconfigurations of health services. The responsive issues will be included as they arise during the year. At least 75% of the work programme should consist of core issues; with the sub-committees having the flexibility to incorporate issues into their work programmes in-year as local issues arise. This will give flexibility to the members of the sub-committees to respond to local issues, whilst at the same time enabling a core forward work programme to be published so that the health sector, local authorities and others are clear about what work will be undertaken by which body and within what timeframe. The joint committee and the three sub-committees will agree the core work programme on an annual basis following a process of mutual consultation and negotiation between the sub-committees and the main joint committee. This process should avoid duplication, ensure the effective use of time and resources and reduce potential overlap between the sub-committees. The development of the core work programmes should include input from the health and other organisations such as Patient and Public Involvement Forums and the wider community. The Chair of the Joint Committee should have quarterly meetings with the Chairs of the Sub-Committees to undertake work programme planning and management. Operational protocols for determining the work programme and other aspects of the joint scrutiny process need to be developed and jointly agreed.
11. Core work programmes of the main committee and its sub-committees should consist of investigations and reviews of themes (such as access to health services, services for young people, partnership working, community engagement, public health), organisations (such as hospitals and PCTs) and performance. It is proposed that the main joint committee will normally deal with countywide issues whether or not these are led by one of the Primary Care Trusts. The sub-committees will normally lead on local issues specific to the PCT(s) to which they relate. Again, issues which relate to other NHS Trusts will be dealt with on a similar basis. Within this framework, decisions on whether the Joint Committee or the Sub-Committees take the lead on the overview and scrutiny of specific themes or issues will be achieved as part of the development and joint agreement of the core work programmes of the main and each sub-committee.
12. Overview and scrutiny should embrace all or a combination of past, current and future:

• Operational and financial performance
• Resource and priority allocations
• Health Inequalities
• Outcomes from resource investments
• Organisational development
• Strategy

13. The County Council will meet the running costs of the main joint committee, will provide dedicated staff support initially equivalent to 1.5 fte to service that Committee and to provide specialist advice and support to it. The District Councils will service the joint Sub-Committees and it is suggested that whichever authority the Chair/Chairwoman/Chairman is from co-ordinates the servicing of that sub-committee.

Timetable for Implementation

14. The proposals in this report have been considered by members of the Health Overview and Scrutiny Committee in July and the following timetable for implementation is proposed:-

1 September Consideration by Oxfordshire Leaders’ Group

September – November Formal approval by the County Council and each of the District Councils and members appointed

December – January Main Committees and Sub-Committees meet joint operational protocols agreed and put in place

January – March Work Programmes developed

April Formal start of work programmes

15. As part of this process it is envisaged that there would need to be some joint training and development activities which will include officers and members of the constituent authorities and also of the NHS and Patients and Public Involvement Forums.

RECOMMENDATIONS

16. The Leaders’ Group is RECOMMENDED:

1. to endorse the proposals set out in this paper and commend the constituent councils to approve:-

1. the formation of a Joint County wide Health Overview and Scrutiny Committee and 3 sub-committees, covering the areas set out in paragraph 6 and having the composition set out in Annex 2;
2. the operational arrangements for the joint committees and sub-committees together with the terms of reference set out in Annex 3 (amended as appropriate in relation to the areas to be served by the respective sub-committees);

2. to ask the officer group to continue to develop protocols and other procedures for approval by the joint committee and sub-committees once in place.

On behalf of the Officer Working Group

Derek Bishop
Head of Democratic Services, Oxfordshire County Council,

15 August 2003

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