Health and wellbeing boards have had widespread support even amidst the controversy of the Health & Social Care Act. The shadow boards, which become fully fledged in April 2013, will bring together GP commissioners, local councillors, adult social care, children’s services, public health, providers, patients and the broader public. This new report endorses the objectives of the HWBs, but warns that they will need to evolve quickly and seek to build broader based partnerships.
The report, which includes chapters from leading experts and practitioners involved in the new HWBs, finds that:
- HWBs must build good relations with commissioners represented on the board. As they don’t have enforcement powers, the success of HWBs in influencing activity and spending will depend on the quality of these relationships.
- Worryingly HWBs don’t include the commissioners of primary care, dentistry and pharmacy – the NHS Commissioning Board – which should be bought into the fold.
- HWBs need to have providers round the table to ensure they are driving integration. Arguably they should include private and third sector providers of social care.
- There is a fear that HWBs will contradict and challenge commissioning plans, especially when they attempt to reduce unsustainable demand. This is a particular challenge for local politicians if it means decommissioning and closing local services which are popular with the public.
- There is a confidence that HWBs could help deliver greater integration of health and social care. If they work well they could also encourage joined up working with other services such as housing and education and minimise duplication of services.
- However, there are three separate funding streams - CCGs, local authorities and NHS Commissioning Board. Local authorities are in the middle of year-on-year cuts and, in effect, the NHS budget being reduced too with funding frozen and demand continuing to rise. In the past, introducing joint arrangements when budgets are being reduced leads to funds being used to plug gaps rather than to integrate services and invest in prevention.
- HWBs are a great opportunity to involve and listen to the concerns and priorities of the public and different users. However, HWBs need to be clear about how people can influence their work and give credible responses to what they hear. They also must publish aims and outcomes in forms easily understood by the general public.
- If they are to provide the leadership to drive integration (and engage meaningfully with the public) then sufficient resources will be required.
Paul Hackett, director of the Smith Institute, said: 'Health and wellbeing boards could play a leading role in enabling integrated care. But, given the cost pressure on NHS and adult social care budgets these new partnerships are going to have to demonstrate fairly quickly that they can make a difference and improve outcomes for local people.'
Sharon Cannaby, head of health sector policy at ACCA, added: 'Health and wellbeing boards offer the opportunity to develop health services targeted to meet the specific needs of local populations, but their success will depend on the commitment of all parties to improving service provision. The real test of their success however, will be whether all parties are still able to work together when difficult decisions have to be made around service redesign. With limited powers, only those built on strong relationships are likely be a success.'