Scrutiny of Health Activities
An overview
The Sub-Committee Members and support staff have worked hard to engage with the local NHS Trusts and the Patient Forums. Closer working relationships have developed with Croydon Primary Care Trust (PCT), Mayday Healthcare NHS Trust, South London & Maudsley NHS Trust (SLAM), which provides mental health services, and the Patient Forum. Members would like to gratefully acknowledge the time and support given by these bodies to Croydon Scrutiny.
Scrutiny Members have focused on the general health and well-being of local people, and their experience of using health services. This does not include taking up individual complaints (there are separate services to do this), but would include for example, looking at booking systems or whether high level reorganisations are likely to impact on service users and their carers. Scrutiny does not have a role in clinical matters which are governed by professional inspectorates.
The Sub-Committee also includes Social Services within its remit. This reflects the increasing joint working between health and social services e.g. in mental health and older people's services.
The Chief Executives of all the local health trusts and the Cabinet Member and Director of the Social Services Department, regularly attend the Sub-Committee for question and answer sessions and for specific agenda items.
Health scrutiny in Croydon
Major pieces of work have included:
A review of teenage pregnancy
This work was prompted in part by the 2002-3 Annual Report of the Director of Public Health which showed that the Teenage Pregnancy rate for Croydon is higher than the national average and that the health and economic well-being of teenage parents and their children are poor in comparison to the rest of the population.The review looked at the accessibility of information, advice and services relating to contraception, termination of pregnancy, support for young mothers and fathers in parenting, continuing their education and finding and sustaining employment.
This cross-cutting review made recommendations aimed at contributing to the reduction of unplanned teenage pregnancies, achieving greater equality and consistency across schools in sex education, improving support services to young parents and their children and securing the funding to ensure the sustainability of services which have been show to be more effective than short-term or one off services.
Scrutiny of audiology services
A Member's question on Croydon's Audiology Services obtained a response revealing unacceptable waiting times for adult hearing assessments. Further exploration revealed that the Adult Audiology service is not Consultant-led or subject to any Government targets. There is a national shortage of audiology staff which has meant significant recruitment problems for Mayday Hospital.
Other sub-committees
The cross-cutting nature of Scrutiny work and the new power introduced by the Local Government Act 2000 for local authorities to promote the economic, social and environmental well-being of their communities, have led other sub-committees to scrutinise issues with health implications.
In particular, a number of the Scrutiny reviews conducted in Croydon have included research into health-related issues:
- The Scrutiny review of services to Asylum Seekers included an investigation of health services and advice provided to asylum seekers living in Croydon.
- The Scrutiny review of Support to Gardeners examined the physical and mental health benefits of gardening and its particular suitability as a hobby or line of work for people with mental health problems or learning disabilities. It also explored the help required by people with mobility problems to keep their gardens well maintained and the consequences of leaving gardens ill-kempt, including an increased risk of burglary.
- The Scrutiny review of School Sports was a topical issue, suggested by a member of the public, against a background of concerns about decreasing physical activity among young people in Britain and growing obesity in children.
Consultation on Changes to Health Service Provision
Scrutiny Members have been particularly keen to ensure the robustness of consultation with service users and local people on changes to their local health services. Health bodies are required to consult with the Scrutiny Committees in all the boroughs whose residents will be affected when they plan "a substantial variation" to existing services. Croydon Members have joined forces with their counterparts from other local authorities and formed Joint Health Scrutiny Committees when proposed changes will affect several boroughs, e.g. changes at the Royal Marsden Hospital.
Since the introduction of health scrutiny, Croydon has taken part in a number of joint health scrutiny consultation exercises including:
- The Royal Marsden NHS Trust's application for Foundation Status
- The inclusion of Surrey Oaklands NHS Trust with mental health trusts in Surrey and parts of Hampshire to form the Surrey & Borders Partnership NHS Trust
- The 'Better Services - Closer to Home' consultation which proposed a radical reorganisation of Wandsworth, Sutton, Merton and north-east Surrey hospital provision
- The South-West London & St. George's Mental Health Trust
Development impacting on health scrutiny
Patients' Forums and LINks
Patient Forums were set up at the dissolution of Community Health Councils (CHCs), locally based organisations which provided a link between communities and local health services. Patient Forums took on many of their functions, including the power to visit health establishments and to refer issues they choose directly to local Scrutiny Committees. These in turn can refer unresolved matters to the Secretary of State.
Central Government now proposes to replace Patients' Forums with Local Involvement Networks.
A public meeting held in September to consult local residents and stakeholders on the proposed abolition of Patient's Forums was attended by over 70 people. Their views were included in the Sub-Committee’s reply to the Department of Health consultation, 'A Stronger Local Voice'. Minister Rosie Winterton published a response in December 2006 which included recognition of the concern raised in Croydon at the proposed reduction in statutory powers to monitor and inspect health premises.
Local authorities will be expected to set up the support arrangements for the replacement Local Involvement Networks (LINks) although it is not yet known when these will come into being, or what the level of funding for this will be.
Annual health checks
Last year (2006) saw a major change in the way health trust performance is assessed and is reported. The Healthcare Commission, responsible for this process, published Guidance explaining how health trust performance is to be assessed and how the Patients’ Forums and Scrutiny Committees will be involved.
The process requires all health trusts to self-assess their performance against 24 core standards in seven areas. Strategic Health Authorities, Patient Forums and Scrutiny Committees are asked to contribute their own comments based on their direct experiences. The trusts are obliged to include these comments unedited within their declarations. The final ratings given to each trust by the Commission are partly dependent on this process. The March 2007 Sub-Committee meeting included agreeing the Croydon Scrutiny's comments for inclusion in each of the three local health trusts declarations.
Looking ahead
The health economy in Croydon is a similar size to that of the whole Council. It is a challenge trying to conduct health scrutiny in Croydon without any extra resources. The changes to the boundaries of Strategic Health Authorities, the abolition of Patients' Forums and the introduction of LINks will also impact on local services and therefore on the work of Scrutiny Members.
