As readers will be aware, NHS bodies are required to consult formally with the Health Overview and Scrutiny Committee (HOSC) of their local authority on any proposals for substantial variations or developments to local services. The DH has issued proposals for consultation on the future scope of local authority scrutiny of service redesign.

Any clients with experience of pushing through significant service redesign, especially when it involves decommissioning current services, will be aware of the challenges involved. We would urge all clients who play a role in service design to follow the link, read the consultation and consider responding, especially those who will be involved in commissioning from April next year. The consultation closes on 7 September...

The stated aim of the proposed changes is "to strengthen and streamline health scrutiny, and enable it to be conducted effectively."

Two changes in this area were consulted on during the passage of the Health and Social Care Act 2012. First, health scrutiny powers will be conferred on each local authority itself, rather than on an HOSC specifically. Local authorities will then be able to discharge their health scrutiny functions in a variety of different ways. Secondly, the scope of local authority scrutiny is to extend beyond the NHS bodies currently affected, to include independent sector providers of NHS commissioned services. This new consultation does not relate to these two issues, those policies have been decided and will be implemented in future regulations.

The new proposals aim to strike a balance "between allowing services to change and providing proportionate democratic challenge that ensures those changes are in the best interests of local people." The current powers of HOSCs enable them to refer proposed service changes to the Secretary of State (SoS) when they consider that they were not properly consulted, or that the changes are not in the best interests of local people. In practice, the SoS delegates the review function to the Independent Reconfiguration Panel.

The main proposals are these:  

  • To require local authorities to publish a timescale for making a decision on whether a proposal will be referred
  • To require local authorities to take account of financial considerations when considering a referral
  • To introduce a new intermediate referral stage for referral to the NHS Commissioning Board for some service reconfigurations; and
  • To require the full council of a local authority to discharge the function of making a referral

That last proposal has already attracted criticism that it will further politicise already highly charged debates about the future of health services. We will of course let you know when the DH publishes its summary of the responses, and keep you informed of the substantive changes when they are announced.