The future for health and wellbeing boards: side show or system leader?

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Health and wellbeing boards have made good progress in establishing themselves but face a critical year that could define whether they develop into system leaders or are relegated to a side show according to the second survey of boards by The King's Fund, published today.

The report, based on a survey of nearly half of the 152 health and wellbeing boards, shows that local authorities have brought strong leadership to establishing the boards and report good relationships with clinical commissioning groups (CCGs). Most health and wellbeing boards have prioritised public health inequalities allaying concerns about the transfer of this remit to local authorities. However, there is little sign they have begun to grapple with more pressing issues, such as reconfiguration and integrated care with the latter only mentioned by nine respondents. Coupled with the requirement for boards to sign off local plans for the new £3.8 billion Integration Transformation Fund (ITF) there are some clear challenges ahead.

The ITF will be a big test of the readiness of boards to take on a stronger commissioning role. As the financial challenges facing local government and the NHS intensify, boards seem to recognise the need to change gear and achieve a firm grip on key challenges facing their local health and care systems – 62 per cent of respondents said they would like to have a greater role in commissioning services for their local populations. As one respondent said, we need to 'turn positive relationships and high-level strategy into tangible outcomes and benefits for people'.

Our survey suggests that boards face three options going forward. They could:

  • continue on their current trajectory and have a limited role as information sharer and high-level co-ordinator
  • fail to build consensus around their role and become sidelined or by-passed, with key decisions made elsewhere
  • develop into executive decision-making bodies with a remit to directly oversee more commissioning of services. This would have implications for their composition, size and the additional professional support they would need.

Our findings suggest that developing a strong and purposeful partnership between CCGs and the local authority offers the best prospects for the boards to make a real difference to their local population.

Richard Humphries, Assistant Policy Director at The King's Fund and the report's lead author, said:

'Our report shows that health and wellbeing boards have made good progress in their first full year, establishing positive working relationships with CCGs and agreeing local health and wellbeing strategies. Their challenge now is to move from development to delivery. Their role in signing off  the £3.8 billion joint investment in health and social care is a big opportunity to demonstrate their ability to offer credible leadership across the whole system of health, care and public health.'

In the previous health and wellbeing boards' survey one of the key concerns raised was whether boards would be able to deliver strong leadership across organisational boundaries. One year on they have made good progress with:

  • 93 per cent of respondents reporting a good relationship with their clinical commissioning groups
  • 83 per cent of boards are chaired by a local authority elected member demonstrating the importance local authorities attach to boards 
  • 48 per cent have a CCG member as their vice-chair

Many boards have recognised the need to invest time in developing themselves with 79 per cent having produced a joint strategic needs assessment (JSNA) and 88 per cent having produced a local health and wellbeing strategy.

Our survey also highlighted further issues boards need to consider. They need to:

  • address their relationship with NHS England so that it is an active and engaged partner – currently 77 per cent of respondents think their board has no influence over NHS England, which the establishment of urgent local care boards seems to confirm
  • further develop their priorities and include an enhanced role for public engagement 
  • better engage with housing leads – only 31 per cent of boards had a housing lead which is low given the importance of housing in health and wellbeing.

Read the paper: Health and wellbeing boards: one year on

Notes to editors

  1. The second annual survey of health and wellbeing boards was conducted in May 2013 and had a response rate of 46 per cent from 152 boards.
  2. Health and Wellbeing Boards: One year on by Richard Humphries and Amy Galea is available free to download or to purchase via our website.
  3. For further information, or to request an interview with Richard Humphries, please contact: Cara Phillips, Senior Press and Public Affairs Officer, at The King's Fund on 020 7307 2603 or email For out of hours assistance: 07584 146 035