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Health and wellbeing boards

System leaders or talking shops?

The reforms to the health and social care system set out in the recent Health and Social Care Act have emphasised the need for integration. Central to these reforms is the establishment of statutory health and wellbeing boards to encourage local authorities to take a more strategic approach to providing integrated health and local government services.

Past efforts to achieve the vision of joined-up, well-co-ordinated and jointly planned services have had only limited success. Faced with complex organisational change, unprecedented financial pressures and rising demand for services, will health and wellbeing  boards be able to fulfil these expectations and achieve greater success than previous bodies?

The King's Fund is well-placed to try to answer that question. We have supported several local authorities and their health partners to develop shadow boards, held a summit to discuss the issues with a range of professionals, and conducted a survey of 50 areas to find out how the new boards are being implemented. Health and wellbeing boards: System leaders or talking shops?  presents the findings from that survey and includes case studies based on the experience of two early implementers.

The paper assesses the ways in which local authorities have begun to develop new arrangements with their partners – the size, composition and ways of working emerging from the shadow boards. Respondents in our survey were generally very upbeat about their expectations of what the board would achieve against four objectives that reflect their core functions: delivering locally identified priorities; achieving closer integration, more pooled budgets, and improved planning of care pathways. There was a clear message that boards are more likely to succeed by using skills in influencing and relationship-building rather than through formal managerial control or accountabilities (health and wellbeing boards have no powers to sign off the commissioning plans of clinical commissioning groups, for example). There were concerns –eg, about budget constraints and about whether national imperatives will over-ride locally agreed priorities and about the extent to which boards can influence decisions of the NHS Commissioning Board.

Local authorities and their health partners can learn valuable lessons from this survey and about the issues that need to be addressed and the implications for policy.