Director of public health at Sandwell NHS Primary Care Trust Dr John Middleton told a Westminster Health Forum event yesterday that health and wellbeing boards were the least contentious part of the Health Act.
But he warned the delegates at the seminar, which looked at how the boards would be implemented, that GPs will have to get accustomed to local politics to get things done.
He said: ‘Clinical commissioning groups (CCGs) need to understand what local politics can do for them, how they can fall foul of it or how they can make it work to their advantage. Partnership and pooling of resources will be by consent, it won’t be required.
‘There is a need for even greater cooperation and commissioning. The box that various bits of services have been placed in won't be sufficient. For instance if we want to commission adequate alcohol related services, GPs and the CCGs will have to contribute to that even if local authorities have been given the principal lead and brief to doing it, and there are multiple benefits to alcohol commissioning.
‘GPs and councillors traditionally like to get their own way. So we need to get into some collaborative kind of way of working. Councils are not used to having officers as voting members. If it is not a collaborative venture, I think it will fail.’
The NHS Confederation’s deputy policy director Jo Webber said health charities would start lobbying health and wellbeing boards and councillors rather than the DH.
She said: ‘The place at which a lot of those decisions about priorities are going to be taken is the health and wellbeing boards. I think we are going to get a lot of the smarter single national issue charities lobbying health and wellbeing boards, lobbying councillors.
‘It will be a challenge for local councillors and MPs.’
On local government finances, she said: ‘There is an issue in the current financial times about the way in which the money is raised in the system and how much the local grant system is going to survive with all this doom and gloom.’
NHS reforms a ‘dog’s breakfast’
Dr Middleton called the NHS reforms as a whole a ‘dog’s breakfast’, adding: ‘The NHS Commissioning Board still has more public health money than local authorities do. They need to be involved somewhere too.
‘It is about accountability more than representation in a health and wellbeing board.’
Both Ms Webber and Dr Middleton said health and wellbeing boards were the least contentious part of the health reforms. Dr Middleton added: ‘They are almost universally supported. They have to be permissive rather than prescriptive and there is a great deal of local flexibility. There needs to be a unity in force in all the different organisations.
‘They are not unfamiliar territory. Health partnerships have existed before. There is a degree of permissiveness. It is the only coherent unifying force in that maelstrom of different commissioning organisations and it is something of a glue to stick the system together.’
But he warned local authorities that they need to understand the ‘entire health agenda’ more. He said: ‘A Mid Staffs on your patch and your watch will not be acceptable. Local authorities will be equally culpable and criticised in any incident of that nature.’