BLOG: Health scrutiny and the NHS’s current pressures

Posted on 25/01/2023 by Ed Hammond.

Over the past few months we have been working to better understand how the arrangements for scrutiny of health and care services will be changed by the 2022 Act. In particular, the Act removes the power for council overview and scrutiny committees (in unitary and upper tier authorities) to refer proposals for “substantial variation” in local health services to the Secretary of State, where specific, serious concerns are raised about those proposals.

We’re still waiting for clarity on these points from the Department for Health and Social Care.

At the same time, the NHS in England is in crisis. Huge pressures over the winter show no signs of abating – even if the situation has slipped off the front pages in the past couple of weeks. Ongoing strike action has called attention to the fragile state of the health and care system – at A&E and in the ambulance service, where problems are perhaps most visible, but also in social care, whose lack of capacity and resilience many consider to be the root cause of many of the challenges the system now faces.

This is not new, of course; although the pandemic has exacerbated the weaknesses in the health service, the knock-on impacts of poor health and social care integration has been understood for many years (and are in fact one of the core justifications for the current system reforms). Successive Governments have, however, been coy about the issue – either ploughing more funding unstrategically into acute services (where people failed by the care system end up, further exacerbating pressures) or assuming that minor, time-limited funding boosts will somehow “resolve” a crisis in social care that is systemic, and that has been well over a decade in the making.

Local authority scrutiny functions find themselves in an invidious position with regard to these issues. On the one hand, the idea of looking at system pressures, and understanding the impact they have on local people, is a no-brainer – an obvious thing for scrutiny to look at. The impact of A&E waits, stretched primary care services and serious worry for people with acute and chronic conditions demand some kind of intervention and understanding from council scrutiny functions.

On the other hand – what would such interventions achieve? It may sound fatalistic but we know the situation is dire – looking at it more closely won’t change that situation. It is already at the top of the priority list of most senior officers, and Cabinet members, in local government. Despite all our and their efforts there is clearly no solution in sight that is not national in scale and focus. What could scrutiny recommend that would provide solutions?

The answer may lie in finding small solutions to small, but pivotal, problems. The wider situation is overwhelming, seemingly unresolvable. But the way that the consequences of this national crisis hit home at local level may be something we can do something about – even if that “something” is small in the scheme of things. Scrutiny may be able to look at the resilience and capacity of local care providers, or the impacts of the pressures on those with complex needs who may be especially worried about what is happening in secondary and tertiary care. Scrutiny might listen to people who have had recent, poor experiences – not to magically find solutions but to find ways to at least mitigate the worst of these problems. Scrutiny can, of course, help to raise public understanding – and the understanding of councillors themselves – of the link between health and social care, and that “social care” isn’t something that is just “provided” to the physically infirm and elderly.

Even if the end of the winter – when it comes – may result in some easing of the present crisis, it is clear that without addressing the fundamentals, the crisis will not end, it will just recede in the public consciousness. Scrutiny can work to keep up political pressure for change. It can help to build and maintain positive and effective working relationships between the NHS and local government.

If you have been carrying out scrutiny work relating to the current pressures in the NHS, or are thinking of doing so, we are keen to hear from you as we would like to highlight this kind of work on our website. Please drop us a line at

About the Author: Ed Hammond

Ed leads CfGS's work on devolution, transformation and on support to councils and other public bodies on governance and accountability.