How are health and wellbeing boards shaping up to their new responsibilities?

As implementation of the government’s controversial health reforms draws near, health and wellbeing boards seem to have the ‘X-factor’ – they are one of the few features of the new system that have attracted growing popularity during the passing of time and legislation. In our survey of a sample of boards last year we found widespread optimism about their prospects, tinged with a hint of nervousness that top-down national imperatives might override locally agreed priorities.

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.

Keep up to date

Subscribe to our email newsletters and follow @TheKingsFund on Twitter to see our latest news and content.

Comments

#40190 Andrea Sutcliffe
Chief Executive
Social Care Institute for Excellence

Richard’s thoughtful analysis reflects findings from the research briefing Factors that promote and hinder joint and integrated working between health and social care services (www.scie.org.uk/publications/briefings/briefing41/) that SCIE published in 2012.

I distil from that research five key factors, all highlighted by Richard:

• Shared vision – so HWB’s having real ambition and a sense of purpose about outcomes

• Clear roles and responsibilities – HWB’s establishing a credible framework for commissioning

• Good communications – HWB’s investing time in developing relationships and understanding, and including providers in this

• Supportive leadership – HWB’s providing strong, credible and shared leadership

• Culture – the encouragement to move towards a style of influencing, collaborating and networking

I love Richard’s line that the remit for HWB’s may extend to achieving world peace as this may be slightly less challenging than the hopes and aspirations we have for them – but the prospects for success will almost certainly be enhanced by following these key principles.

#40205 Mark Newman
Assistant Director
EPPI-Centre , Institute of Education, University of London

I would support Andrea's view that Richard's comments are mirrored in research Findings from a systematic review on joint commissioning of health and social care carried out by the EPPI-Centre. (http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=3356)

This found that people perceived that the important factors for successful joint commissioning to be

-trusting relationships between commissioners built up over time by continuity of staff;
- clarity over responsibilities and legal frameworks, particularly in the context of any shared or pooled financial arrangements;
- coterminosity between organisational geographical boundaries;
- clear structures, information systems and communications between stakeholders.

What a pity though that field is still lacking in high quality evaluative research evidence to help inform choices about how to make new organisational arrangements effective and yet again there appears to be no rigorous evaluation strategy in place for these latest set of changes.

#40207 Dr Malcolm Rigler
General Medical Practitioner
NHS

The late Dr Eric Trimmer was a London GP. His very humerous articles often helped me get through the difficulties of my early years as a GP. It was only after his death that I read in his obituary that he had , as a medical student, been one of the first people to enter the Belsen Concentration Camp and witnessed scenes that would influence his whole life as a doctor. After qualification and inspired by the notion of "The Health Centre" he joined a new inspirational project in London based in a building that was to be called "A Health Centre" . The Local Govt. part of the building was separated from the GP part by a pair of double doors which initially were padlocked to prevent people from wandering from the clinical area of the building where the GPs were working to the Public Health area where the Health Visitors and Environmental Health people had their offices. He worked at the "Health Centre" for several decades until his retirement but those padlocks were never removed ! And so it is to this day. The early days of CCGs have already convinced me that both NHS GPs and the Public Health Community within Local GOvt. at management level urgently need to devote time, money and energy in the development of "partnership working" . The notion of the 6 hour coffee break needs to become a regular part of our lives as we attempt to remove the padlock that has divided us since 1948 - see link below.

[PDF]

Common Knowledge Coffee Break Report - Durham University

#545283 Kenneth Williams
Personal Trainer/ Nutritionist
Cmplementary Body Science

I'd have say I agree with some Mr. Richard Humphries, observations, CCG, in Coventry or Warwickshire is covered by Claire whom I met at locla NHS, conference who listened to my proposals and informed to contact her an impossible task or forward any details plan of action to hit the issues directly on the community level oppose to conferences. A team of personal trainers and NHS, screening team could achieve positive changes it time to listen to us who are able to make these positive changes the Health and Wellbeing board talk about but need action simple solution at street level, community action.

Add new comment