Scrutiny and the Voluntary and Community Sector Health Inequalities in London event 29 October 2014 Jessica Crowe Centre for Public Scrutiny

who are CfPS? Founded in 2003 to: promote accountable public services influence policy and practice Now a charity, we are a national leader in ideas about accountability and scrutiny in public services: our principles: accountability, transparency & involvement support cross-sector, cross-government learning networks

What do we do? Operate in 5 fields of work: Children & Young People (school governance, safeguarding scrutiny) Health & Social Care (funded by DH/NHSE, CQC to support networks & better PPI) Involvement (tenant scrutiny, welfare reform) Local Accountability (council scrutiny practice in England & Wales) Thought Leadership (advocating stronger scrutiny & accountability) Offer skills training & development, governance evaluation & support, online services/briefings, network support & events

contents What is scrutiny How can health scrutiny help VCS? Using council scrutiny to have an impact on health inequalities CfPS: Accountability Works! 2010

what is scrutiny? Fundamentally: scrutiny is based on the principle that someone who makes a decision… …shouldn’t be the only one to review or challenge it

Local authority scrutiny Aims and objectives A core element of local democracy Provide ‘critical friend’ challenge Enable the voice and concerns of the public to be heard Carried out by independent members Drive improvement in public services Gives councillors powers to review, scrutinise and make recommendations for any matter relating to the planning, provision and operation of health services locally. Scrutiny is at its most effective when it can influence and improve service design and delivery – CfPS’s ‘Return on investment’ model of scrutiny helps do this in an inclusive, citizen-focused way

Health scrutiny is able to connect different bits of the system – when it works well Using democratic mandate & legitimacy Scrutiny >> accountability Overview >> makes connections and helps see whole system It’s about relationships

An inclusive way to scrutinise and improve health inequalities Phase two of our Health Inequalities Programme developed and piloted a new approach with councils which provided: –Robust scrutiny based on impacts, outcomes, measurements, costs. –Integrated Marmot Policy objectives into a review model and a council’s work. –Focused on the wider determinants and their impact on health –Forecast the impact of scrutiny recommendations Result was a model that embeds scrutiny as an effective public health tool and identified potential savings Extended beyond health inequalities: welfare reform & education governance

Background - Marmot Review ‘Fair Society, Healthy Lives’ Proposed an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age which can lead to health inequalities: Giving every child a good start in life Enabling all children, young people and adults to maximise their capabilities and have control over their lives. Creating fair employment and good work for all. Ensuring a healthy standard of living for all. Creating and developing healthy and sustainable places and communities. Strengthening the role and impact of ill health prevention.

Introducing the scrutiny model What it helps areas to do The model is based on five stages of a “scrutiny journey”, utilising a variety of tools: 1.Identifying and short listing topics 2.Prioritisation 3.Stakeholder engagement and scoping 4.Undertaking the review, measuring impact and calculating the Return on Investment 5.Making recommendations using ROI and influencing services

Stage two Prioritisation Stage two – has three steps: Producing an Impact Statement Using a “scoring matrix” to choose the topic for review Considering what to measure The impact statements help councillors focus on the policy objectives of the Marmot Review of Health Inequalities

Stage 2 - Impact scoring matrix – case study

Stage three Stakeholder engagement and scoping Stage three has two steps: Stakeholder engagement Getting started with the review The stakeholder engagement has proved to be an innovative way to engage a wider group of citizens within the review and ensures that Councillors focus on the whole system

Stage 3 Stakeholder engagement wheel

Stakeholder engagement wheel Identifying gaps and overlaps

Benefits – what users thought! Scrutiny is well placed to influence a range of partner agencies and promote more joined-up working Different way of prioritising topics - highlighting a ‘hidden’ issue Raises awareness of the issue – value of networking Good stakeholder engagement looking at difficult and sensitive issue – helps to get all of the right people together Explored issues ‘on the ground’ and agreed a set of recommendations to help improve services Able to demonstrate a return on investment, including: input and output costs, potential cost savings from improving service coordination

Case study: scrutiny of maternal health needs of gypsy & traveller population South Somerset: -facilitate networks -focus on patient experience & access -link bigger picture to local experience -provide neutral space -champion marginalised

Publications – all on our website

Any questions?

To find out more - register on-line or via forms for: - e-newsletters, e-digests & scrutiny exchange - reviews library, on-line forum, latest news - Policy and Skills Briefings or for helpdesk Tipping the scales: 4.pdf Valuing inclusion: n_v5_Web_final_amends.pdf Checking the nation’s health: ine.pdf