Changes to the Health and Social Care Bill: local authorities and health and wellbeing boards

The comparison below sets out the Health and Social Care Bill's initial proposals as regards local authorities and health and wellbeing boards, what has now changed and some key questions that remain unanswered.

The original proposals in the Health and Social Care Bill

  • Health and wellbeing boards to be established in upper-tier local authorities and to be responsible for developing joint strategic needs assessments and a joint health and wellbeing strategy.
  • Scrutiny powers of local authorities to be restricted; they would be able to use their power of referral to the Secretary of State only for significant changes to designated services.

What has changed in the proposed reforms?

  • Health and wellbeing boards to have a stronger role in promoting joint commissioning and can act as lead commissioner for some services.
  • Health and wellbeing boards to play a stronger role in the development of commissioning plans and will be able to refer plans back to the NHS Commissioning Board or commissioning groups if they are not satisfied with them.
  • Health and wellbeing boards will have a formal role in the authorisation of clinical commissioning groups and will lead on local public involvement.
  • Restrictions on scrutiny powers of local authorities lifted.  Consideration to be given to the feasibility of the NHS Future Forum's recommendation to develop citizens’ 'right to challenge' poor services and lack of choice.

What is still unanswered?

  • Legal powers for lead commissioning and pooled budgets have existed for more than 10 years but few local authorities have used them – is a more prescriptive approach needed?