Health and wellbeing boards are an important feature of the reforms introduced by the Health and Social Care Act 2012. All upper-tier local authorities set up shadow boards in April 2012, which became fully operational on 1 April 2013.
The boards are intended to bring together bodies from the NHS, public health and local government, including Healthwatch as the patient's voice, jointly to plan how best to meet local health and care needs, and to commission services accordingly.
In our previous report on health and wellbeing boards, published shortly after the shadow boards were established, we concluded that the single biggest test would be whether they could offer strong, credible and shared leadership across local organisational boundaries. One year on, expectations of what the boards should deliver have never been higher. This report examines how the boards have used their shadow year, what they have achieved, and whether they are providing effective leadership across local systems of care.
Local authorities have shown strong leadership in establishing the boards. Most are being chaired by a senior elected member, with an emerging pattern of vice-chairs coming from CCGs. Nearly all boards have produced joint strategic needs assessments (JSNAs) and joint health and wellbeing strategies (JHWSs).
The financial climate plus confusion about the roles of new organisations are the biggest impediments to progress.
Public health and health inequalities are the highest priorities in the JHWSs of most boards, but they have not yet begun to grapple with the immediate and urgent strategic challenges facing local health and care systems.
Most boards want to play a bigger role in commissioning services, and the requirement for them to sign off local plans for the integration fund will be an important test of their readiness for this.
There are opportunities for boards to evolve into joint commissioning bodies without further reorganisation. Their powers and duties should be sharpened so that there is clearer understanding of their purpose.
There is a danger of unrealistic expectations about how much health and wellbeing boards can deliver and how soon. In the absence of formal statutory guidance, boards are uncertain about their role and powers. There are tensions between their role in overseeing commissioning and promoting integration, between high-level strategic planning as opposed to involvement in the operational management of pooled budgets or integrated services, and between tackling population-level health issues and driving forward service changes.
The legal powers and duties of health and wellbeing boards are largely permissive and discretionary, which makes them vehicles for partnership rather than executive decision-making. The government’s proposal that boards should sign off on local plans for the Integration Transformation Fund offers boards an unprecedented opportunity to shape key spending decisions, and could, in time, lead to their overseeing the total health and social care budget.
NHS England must change perceptions about its involvement so that it is seen as an active and engaged partner in its commissioning role. It will otherwise be difficult for boards to lead the development of integrated care, which is intended to be their primary purpose.