Health scrutiny, democracy and integration: Part of the same jigsaw?

Abstract

Set against the major restructuring of decision-making processes within local government and the wider modernisation agenda for public services, this paper suggests that the scrutiny process (specifically in relation to local authority health scrutiny) can be described in two analytically different, but not necessarily contradictory, ways. It could be seen as a process to increase the levels of local democracy or as a form of integration across different organisations/sectors. The article is informed from the first half of a three-year evaluation that includes interview and observational data from in-depth case study research in five local authorities and their associated Primary Care Trusts (PCTs). The research highlights examples of health scrutiny in terms of both democratic input and integration/joined-up working by organisations from different public sectors, to facilitate scrutiny reviews and resulting changes. It is suggested that further evaluation of the continued development of health scrutiny will be required to examine the potential longer-term impacts on local governance issues, partnership working and the health of the local population.

Acknowledgements

The author would like to thank Prof. Steve Harrison (Manchester University) and Prof. Caroline Glendinning (York University) for their support with this ongoing work, and the co-editor and referees for their helpful and constructive comments.