So, a year on, how are the boards shaping up to their new responsibilities? We will shortly be surveying all 152 boards to establish what they have achieved in the shadow year, their shape and size, how they are working, the priorities they’ve adopted for their first full year of operation, and the factors that will help and hinder their effectiveness. The Health Select Committee recently announced that the preparedness of health and wellbeing boards (including the definition of the role of the boards locally and the level of engagement by commissioners and health and care professionals) will feature in its new inquiry into the Health and Social Care Act.
It’s early days, but some clear pointers are emerging from our work in helping several boards and the research we did last year.
First, boards making the fastest progress seem to be those that are developing a real ambition and sense of purpose about the outcomes they want to achieve. They are taking a dynamic view of the needs of the local population (through revamped Joint Strategic Needs Assessments) and are producing a joint health and wellbeing strategy that offers a credible framework for commissioners, focusing on a small number of relatively high-impact changes; not rehashing long shopping lists of uncosted aspirations. These boards are seeking to add value rather than cost.
Second at the heart of every strong board is a partnership between clinical commissioning groups (CCGs) and the local authority, not a local government takeover of the NHS. As with most examples of effective partnership, investing time in developing relationships and understanding each other’s agendas will equip boards with the resilience to manage potential conflicts on specific issues, such as hospital reconfiguration, in parallel with strong combined action on agreed priorities.
Third, the modus operandi of an effective board will revolve less around its formal meetings than how it engages with patients, service users and the wider public about the tough choices and trade-offs we face across health and care services. Boards that look and behave like a traditional local authority committee will be repeating the mistakes of previous partnership boards and are almost certainly doomed to failure or irrelevance. The currency of effective boards will be influencing, collaboration and networking.
Finally, managing the inherent tension between their strategic role of creating a framework for commissioning and their duty to promote integration will require boards to think imaginatively about how they engage with providers, which will be central to driving forward integrated care. Reproducing hard separation of commissioner and provider roles at board level will reinforce barriers to change.
Many of these early indicators are supported by the lessons from experience of integrated care that we’ve just published. There’s no doubt that the challenges facing the new boards – from 1 April – are daunting. They are but one piece of a complex jigsaw of organisational change with major uncertainty about how it will all fit together. They begin their life in a financial climate that is deeply inauspicious. There is real risk that early hopes for the new bodies could collapse under the sheer weight of expectations placed on their shoulders. Cynics would not be surprised if their remit is extended to achieving world peace on the grounds that this is a slightly less challenging task than the remit in their own backyard.
The evidence of previous partnership approaches is not encouraging. But if health and wellbeing boards did not exist, they would have to be invented. As we have argued elsewhere, for example in our report on Transforming the delivery of health and social care, the challenges facing our health and care system are too big for local organisations to tackle on their own. The single biggest test for the boards is whether they can offer strong, credible and shared leadership that engages partners in making a real difference for local people. For health and wellbeing boards to work, they will have to be different.