Professor Alan Maryon-Davis, honorary professor of public health at King’s College, London, told a Westminster Health Forum conference on health and wellbeing boards in central London last week that their minimum composition should include an elected council member (at unitary authority and not district council level), a Healthwatch representative (public voice), a representative from each CCG in their area and directors of adult social services, children’s services and public health (the last three to be all council positions). Members can be co-opted, which could give voluntary sector representatives a voice.
Tasks will include agreeing health and wellbeing strategies, to consider commissioning support arrangements and agree joint commissioning intentions.
Professor Maryon-Davis said threats to them were local authority cuts, NHS efficiencies, and the multiplicity of commissioners.
Health and local government have traditionally been very separate entities. Health and wellbeing boards will have no real power over CCGs (although they could clearly make life difficult for them) so the best management style is likely to be collaborative, with the danger that they become ‘talking shops’ and members withdraw. There will be considerable advantages to a CCG planning a controversial reconfiguration decision which could include a hospital closure if the health and wellbeing board can be convinced of its merits.
Dr John Middleton, vice president of the Faculty of Public Health and director for public health at Sandwell NHS PCT in the West Midlands, told the conference which included many health and wellbeing board representatives: ‘A Mid Staffs on your patch will not be acceptable. GPs and councillors traditionally like to get their own way. We need to get into a collaborative way of working. This will be the most important partnership forum for a local authority. We have to make life expectancy as important as dog shit and crime to local authorities.’
There has been much national focus on the pooling of health and social care budgets that has been pioneered in Torbay, south Devon.
Dr Derek Greatorex, co-chairman of the South Devon and Torbay CCG, said: ‘One of the benefits of health and wellbeing boards is to set our CCG priorities in another context. The more I do this job, the more I realise that there’s a lot going on out there that I don’t know about. Seeing what’s happening in another context is a very valuable part of their role. For example we can go beyond using leisure centres on prescription’
South Devon and Torbay CCG tries to embed consultation and public involvement at all levels rather than it being ‘bolted-on’ as an after thought.
Kieron Williams, head of health and wellbeing in the London borough of Lambeth, stressed the importance of collaborative work between the 100 GP practices, hospitals and social care in his area. He told the conference about a quick win that had been enjoyed locally. A problem raised by hospital staff was locals arriving for treatment heavily drunk. Staff thought they were not receiving the care interventions that would be most beneficial for them: help to drink moderately. A community organisation developed a programme to help people moderate their drinking. Mr Williams added: ‘Help for these problems wouldn’t have progressed if we hadn’t focused on the relationships first.’
Compelling change narrative
John Wilderspin, the DH’s national director of health and wellbeing board implementation, talked about the value of integration and getting the most out of each pound spent in a local community. He described the need for a compelling narrative for change, making the best use of collective resources.
‘Strong relationships are key within the board but also with stakeholders. We need to ensure they’re not just talking shops. GPs will walk away followed by everyone else.’
Away from the conference, GP Dr Theresa Eynon posted a warning she flagged up on social networking site Twitter: ‘Short-sighted politicians, with an election looming, may prioritise cutting council tax. Don't let them take money from health-related activities. CCGs need to be wise to political ways of working and ensure they can argue their corner.’
So health and wellbeing boards are unlikely to be new entities that CCGs should be afraid of. In fact they have been described as the least controversial element of NHS reforms.
What they do offer CCGs who collaborate well with them is a fresh perspective on both the problems of the area and how they can be solved; and support when presenting a controversial service change proposal to an unhappy public.