The Health Bill places duties on clinical commissioning groups (CCGs) to take part in and collaborate with new local health and wellbeing boards, described by the NHS Future Forum as 'the focal point for decision-making about local health and wellbeing'.
The boards are to be charged with driving population-level analysis of local need, leading critical, objective thinking about alternative investments, and improving integrated working to improve outcomes for patients. To bind CCGs closely to them, the Bill specifies duties to boards in CCG authorisation, performance management, and the drafting of CCG commissioning strategies.
CCGs need to consider quickly how they propose to play a leading role in boards, how they might help drive quality and performance in the NHS, and what other partners are likely to demand from them.
Health inequalities are NHS business
Core business for health and wellbeing boards will include leading a new generation of joint health and wellbeing strategies, with health inequalities a major backbone for any local outcomes and priority setting frameworks they support.
There should be plenty of shared interests for CCGs and other board members to discuss: health inequalities are thought to drive £5.5 billion per year in increased treatment costs to the NHS, and there are many prominent, related indicators in the NHS Outcomes Framework such as local life expectancy, morbidity and mortality, against which traditional healthcare interventions alone can only have so much influence.
Board members should also have considerable shared interests in the equally challenging perspectives of rising demand, changing demographics and unprecedented public sector budget cuts to the health and wellbeing system.
However, just as for many others about to take their seats, taking shared leadership and responsibility for board business means a steep learning curve for many CCGs. Board members will be required to engage in a population-level debate about wellbeing and the wider determinants of health, and negotiate a common vision for how local priorities will link to and exist alongside the different national frameworks for health, social care and public health.
What do you want from your board?
Just like other partners, CCGs should start thinking ahead about what they want from boards, as well as what they may be asked to contribute.
It may be helpful to first consider the histories, professional cultures, terminologies and outlooks of the board's membership - which will be elected members, HealthWatch, directors of public health, adult social care and children's services as a statutory minimum.
Stronger partnerships across the wider determinants of health, such as housing, planning, police, education, environmental health, probation and others, can be built to drive improvement and efficiency in the NHS through increased patient satisfaction and reduced service usage.
There are, for example, excellent case studies on the potential for cost-effective housing-related interventions to improve wellbeing and cut emergency admissions and readmissions.
|Housing-led team interventions in Newcastle and Wakefield
Hospital discharge teams in Newcastle
Accordingly, NHS Newcastle and Newcastle City Council established a multidisciplinary team to address issues around hospital discharge and homelessness in the city; both had a mutual interest because preventing homelessness was a priority for the local authority and improving health and wellbeing for vulnerable groups was high on the NHS agenda.
The programme has reduced the average wait for priority need cases from making an application to moving into appropriate accommodation from 179 to 29 days.
Although the programme is yet to be subjected to robust cost modelling, it is clear that reduced hospital stays and readmissions, along with increased sustainable tenancies and appropriate housing of vulnerable people, have realised substantial savings and improved outcomes across the system.
Early intervention in the community - Wakefield's health inequality workers
NHS Wakefield commissioned Wakefield District Housing to run a pilot network of five health inequality workers to run outreach, co-ordination and early intervention programmes through their existing housing services to identify these individuals out in the community, address their needs better and help prevent high-level dependency and crisis before it happened.
The team offer mentoring and intensive support based on a person's individual needs, often referring people on to NHS and voluntary sector services, such as counselling, smoking cessation, benefits advice, GPs and others.
A recent study by the University of Bradford showed the service has made a difference to people's lives.
Examples of successful partnerships
To build genuine partnerships that really effect change, health must have an understanding of others' perspectives and recognise them as legitimate partners in health improvement.
It is worth reflecting on how to, and who can, make a contribution to the early intervention and prevention agenda, and can deliver better management of long-term conditions, especially for vulnerable groups.
As the eight new clinical indicators spanning diabetes, mental health, asthma, depression, and smoking are introduced, CCGs should use the opportunity to ask around to see who can help.
- Ed Harding and Michelle Kane are from commissioning experts HK Consulting, www.hkconsulting.co.uk