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How to hold Commissioners to account

Blog Author Nick Stolls

Blog Date 12/04/2019

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At last we have moved on from a three-letter acronym, to one with four letters! So, what is an HOSC? If you haven’t come across this before, it’s the Health Overview and Scrutiny Committee. 

I have been working with our local HOSC in Norfolk for many years and in my region, the County Council committee consists of around 15 councillors from all political parties, often chaired by an ex MP. Physically, it resembles a House of Commons Select Committee in as much as the councillors sit behind a horseshoe desk with those giving evidence before them. Some of the councillors will have had a role in healthcare in their 'other life' but many are less well informed.

The HOSC is a public meeting but more importantly, the press will also be there and will report the proceedings and often interview those giving evidence outside the chamber once the scrutiny has completed.

The councillors are supported by an extremely well-informed management team and their role can be best compared with civil servants in national government. The senior manager will provide the councillors with an information pack based on previous HOSC meetings and will approach the commissioners, LDC, Healthwatch and LDN chairs for reports and request attendance from representatives of those organisations to give evidence. They will also provide the councillors with some direction over the Key Lines of Enquiry they might want to take.

The importance of HOSC is that it is an opportunity for the County Council to ask some searching questions of the commissioners in public and not allow them to wriggle out of subjects they would rather avoid.  It is also an opportunity for LDCs to submit a report as part of the bundle of papers for the councillors which can hold the commissioners to account.  Any report is in the public domain and I have featured in the print media when my report has been used as a basis for an article, or approached by local radio or TV to give an interview. The HOSC management are very careful with libel and will check reports before they are put into the public domain. One example recently included some comments I made about Capita's 'incompetence' where I was asked if I wanted to redact that wording.  My reply was 'no'!

HOSC don't scrutinise NHS dentistry that often, but I raise issues when I can.  I gave evidence in 2007 over the introduction of the new contract, in 2010 over problems of child oral health which was revisited by HOSC a year later, in 2013 over NHS access problems in the whole county, in 2018 over access problems for RAF service personnel in North West Norfolk and a return in 2019 to address questions and actions raised by last year's Committee meeting.

HOSC provides a very inquisitorial environment aimed at the commissioners who turn up mob handed. At the 2018 meeting the LDC proposed that the commissioners might use some of the burgeoning clawback money to commission in-hours emergency slots. HOSC demanded to know why the commissioners weren't considering this. This resulted not just in silence and red faces from the commissioners, but now there is an effort to commission these services so they can report back in a positive way to the HOSC.

The HOSC is not a vehicle that is used that often by the LDCs but it can be an extremely effective means to get information about commissioning intentions, or indeed where those intentions have been ignored, out in the public arena.

If you haven't engaged with HOSC in the past then it might be worth contacting the HOSC manager at your local authority, offering the dentists’ perspective on local commissioning intentions and how that might impact on a profession already under pressure nationally. They are keen to hear, and certainly from my perspective, are far more sympathetic towards LDC officials than NHSE staff.