Championing health and wellbeing

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Among the many hotly debated measures set out in the Health and Social Care Act one initiative remains uncontroversial: the introduction of health and wellbeing boards (HWBs).

It's not hard to see why, as Richard Humphries explains: 'If you look at the very complex architecture of the Health and Social Care Act, the health and wellbeing board is the only structure that brings together all the local organisations with a strategic approach to the challenges ahead.'

What are health and wellbeing boards?

Designed to integrate local action to improve health and wellbeing and run by local authorities, health and wellbeing boards offer a new and exciting opportunity to join up local services, create new partnerships with GPs, and make services more locally accountable. They bring together representaives from the local authority, clinical commissioning groups, health and social care services and other stakeholders to jointly plan how the health and social care needs of their communities can best be met.

What are local authorities doing to prepare for 2013, when all HWBs must be operational?

One early adopter is Lambeth Borough Council, which held its first formal HWB meeting in April 2012.

'We didn't rush in to setting up structures because we felt that, initially, building relationships was more important,' explains Kieron Williams, Lambeth's Head of Health and Services. 'We've been running workshops with the partners that will be on board, and are really concious of their different positions.'

Surrey is another local authority working busily, as Sarah Mitchell, Director of Adult Social Care, explains: 'We've been meeting for about a year now. Every month we hold a development meeting where we can discuss difficult issues to develop our learning and understanding. We've held workshops with all of our stakeholders, and have now narrowed the participants down to our key players.'

How well are these health and wellbeing boards progressing?

Research by The King's Fund shows that the overwhelming majority of local authorities are on track.

'I think some partners are worried about local authorities taking on the stewardship role of health strategy and commissioning because they think we don't know the NHS well enough,' acknowledges Sarah. 'But we already do a huge amount of commissioning and procurement. CCGs are starting to be anxious about the enormity of of the task, so we can support them with that.'

To help partners build a shared understanding, Surrey has been running development sessions on issues such as continuing health care. 'This is one area where we've made progress in joint work with primary care trusts, so we don't want to have to start again with CCGs,' Sarah explains.

What role will leadership play for the health and wellbeing boards?

Strong local leadership will be key to the boards' effectiveness. 'Our role is about setting the culture.' says Kieron. 'It's about ensuring that all of the health and social care partners are working towards a clear understanding of Lambeth, and looking at that in the round.'

Another important task is to analyse data to determine the priority needs of the local population. Each location faces different challenges. Lambeth has the highest level of HIV in the country – a factor that must be reflected in its services. Conversely, Surrey, despite being a comparitely affluent area, is home to seven of the country's top ten areas for alcohol misuse. So each board will set the commissioning framework for its priority areas, bassed on te evidence of 'what works', and will make sure the NHS Commissioning Board takes these local needs into account.

How will HWBs ensure that patients' needs are considered?

Health and wellbeing boards will play a critical role in ensuring that local services are accountable to the people they serve, and transparent about how commissioning decisions are made. Representatives of the Local Healthwatch will sit on each board to represent service users' views, and boards are running a range of initiatives to actively engage with the public.

No one has any illusions that the job ahead will be straightforward for these new structures. 'This is health and wellbeing in an age of austerity – and that's a tough climate for the boards to work in,' warns Richard. But there is cautious optimism that, given time, health and wellbeing boards could be a long-awaited opportunity to make local services more responsive, integrated and accountable to the communities they serve.

This article first appeared in Insight, a magazine produced by The King's Fund for the NHS Confederation Conference 2012.