Health issues for local scrutiny

There was a lot of national media commentary and coverage about the role of the NHS at the General Election, which was unsurprising given all the commitments major political parties were making – boosting NHS funding, more doctors and extra GP appointments, rebuilding hospitals, and so on.

However, I think that members of overview and scrutiny committees, of all political parties, know the NHS and health is always a major issue in their areas. And that’s not just because of the casework we receive from constituents or because health and the NHS tend to fill up a lot of the space on the work plans of our scrutiny committees.

Local government is part and parcel of NHS structures in many areas, with directors of public health and of adult social care sitting on the executives of clinical commissioning groups (CCGs).

And let’s not forget that many elected councillors are involved outside the local authority in the governance structures of their local NHS providers; I will declare an interest, as I am a lead governor of Central and North West London NHS Foundation Trust.

In local government, we have a view of the NHS from the root up and – dare I say – probably a more detailed picture than those operating at a national level. It shows that every area has its own strengths and weaknesses, which may or may not align with the national picture.

“In local government, we have a view of the NHS from the root up”

Now we are settling back into the business of scrutiny, there are three areas I think many health overview and scrutiny committees will be focusing on during 2020; they look a little different to the recent national debate.

First, the quality of services, particularly of primary care, is a growing area of importance, alongside access to services. The Care Quality Commission (CQC) publishes ratings for each of the primary care providers in each area, so it’s always worth keeping up to date with the local picture and, in particular, how ratings change.

What you will want to see is an improvement in these figures and fewer GP providers being placed in special measures as a result of an inadequate CQC rating. If the statistics are heading in the opposite direction in your area, it might be time to ask why.

Second, working at scale is increasingly the big challenge for the NHS. On the commissioning side in north west London, there are plans to merge eight separate CCGs into one body by April 2021.

That will mean a single operating model  – and, I assume, some commissioning arrangements – working at scale, and commissioning services across many different boroughs. That’s something we will be tracking with care.

Finally, workforce is an issue frequently raised at health overview and scrutiny meetings. We’ve heard a lot about problems nationally of recruiting to specialist posts, as well as vacancy rates for nurses. But is it time to ask about the local pressures on recruitment and retention in the hospitals of the big provider trusts in your area?

Now the national political tremors have settled, let’s re-focus on the local health scrutiny issues for 2020. Who knows, they may be very different from the national picture?

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