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Annex 2 The preferred option: an independent scrutiny panel
Selecting Panel Chairs
1. A small pool of people with the skills and experience to lead an independent scrutiny process would be selected through the public appointments process. Panel Chairs should have the ability to analyse and assess evidence rigorously and independently, and be able to devote sufficient time and effort to what will be a demanding task.
2. To ensure independence, they should not come from a clinical background and should not be a resident of, or have links with the geography of the affected NHS Board area. If in employment, the Chair and their panel members would be offered payment at the centrally set rate for tribunal etc members.
Establishing a panel
3. An individual with no geographic or other conflict of interest in a proposed service improvement in the pool of Chairs would be asked to lead a panel with the necessary expertise to consider the clinical, financial and patient evidence for, and implications of, the options being developed by the NHS Board.
4. The Chair, with the support of the Secretariat, would select a panel of experts with the necessary mix of clinical, financial and public/consumer expertise to address the service change proposal under consideration. The panel members would be drawn from nominations from organisations such as:
- the Royal Colleges in Scotland
- the Chartered Institute of Public Finance and Accountancy or the Institute of Chartered Accountants of Scotland
- the Scottish Consumer Council.
The members selected would have no previous connection with the area or the issues involved. The panel should also have a majority of non-clinical members.
The Panel's remit
5. The panel would be asked to assess the safety, sustainability, evidence-base and value for money issues which emerged during the option development phase. The panel would examine the evidence from the NHS Board, and would also encourage the submission of alternative evidence-based perspectives from community and patient groups. Effectively the aim of this added 'challenge element' in the option development and appraisal process would be to ensure that local people and communities were satisfied with the quality of the evidence for a proposed change and that the full range of possible options were considered and tested.
The Panel's Report
6. The panel would provide a commentary on the evidence presented to them which would be published. The NHS Board would be able to reflect their conclusions in the final proposal for public consultation. The panel would be accountable to Ministers for its work, and the commentary would be available to Ministers in reaching decisions on service change.
Who should provide the central Secretariat?
7. The panel would require good quality support, to undertake research, prepare papers, undertake initial evaluation of material from Boards, and draft the panel's final report. We believe that the Scottish Health Council would be well placed to provide this support for the independent scrutiny process.
What would be the cost of introducing the Independent Scrutiny process?
8. The main costs of establishing an independent scrutiny process would lie in paying fees to panel members and in secretariat support costs. The total annual cost is difficult to determine, as this will depend on the frequency of referrals to scrutiny panels and the extent of their contribution.
9. Since it was established in April 2005 there have been 10 occasions when the Scottish Health Council has submitted a report on a major service change to Ministers. This suggests that there may be a requirement for up to 5 panels in any one year. On the assumption that 5 panels of 5-6 people would sit for up to 20 days each year, then the annual costs of the members and secretariat could be of the order of £500,000.
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