A great deal rests on Health and Wellbeing Boards (HWBs), a new type of local partnership. These were established under the Health and Social Care Act 2012, to act as a forum in which leaders from the local health and care system could work together to improve the health and wellbeing of their local population and promote integrated services.
Last year, the House of Commons Communities and Local Government (CLG) Committee concluded that HWBs have a pivotal role and their success ‘is crucial to the new arrangements’. However, it also warned of the danger ‘that the initial optimism surrounding their establishment and first year or two in operation will falter and go the way of previous attempts at partnership working that failed and became no more than expensive talking shops’ (House of Commons CLG Committee, 2013 paragraph 22, 14). We examine these issues and the early development of HWBs in our recently published article in Local Government Studies.
While partnerships are seen to be a prerequisite for tackling ‘wicked issues’ (those issues so complex that their solution lies with a multi-agency response), historically they seem unable to break free from the ‘silo-based’ structures which govern how many UK public services are organised and delivered.
The official vision for HWBs from the Department of Health emphasises: joint local leadership between Clinical Commissioning Groups (CCGs) and local authorities; key roles for elected councillors, clinicians, and directors of public health, adults and children’s services; the enablement of greater local democratic legitimacy of commissioning decisions, and provision for opportunities for challenge, discussion, and the involvement of local representatives (Department of Health 2011 p15). However, HWBs have no formal powers, and their ability to influence others will depend upon their success in building relationships.
Established as sub-committees of local authorities, the exact membership of HWBs is not formally mandated, and locally HWBs can choose how they wish to work. Recent research (Humphries 2013) has suggested several features of HWBs which could potentially set them apart from previous partnership initiatives. These include: involvement and engagement of GPs; better governance and accountability (due to being sub-committee of the LA); encouragement of wider relations between the NHS and broader LA (not just Social Services); and opportunities afforded by the move of Public Health functions to local government. However similar initiatives have historically fallen short of initial expectations.
In the complex new system, resulting from the many changes under the Health and Social Care Act 2012, and characterised by potential fragmentation and confused accountability (see our other recently published paper from research with Clinical Commissioning Groups – Checkland et al 2013), HWBs are the one element within the new system with a specific mandate to encourage integration between local bodies. This has led to potentially unrealistic expectations that they can solve longstanding and intractable problems, such as joined up working between health and social care (Vize 2013), but also provides opportunities for them to work differently and make a difference locally to the health and wellbeing of local populations. Watch this space.
Anna’s article Joining it up? Health and Wellbeing Boards in English Local Governance: Evidence from Clinical Commissioning Groups and Shadow Health and Wellbeing Boards is published in Local Government Studies.
Anna Coleman is a Research Fellow in the HIPPO team (Health policy, politics and organisation groups), part of the Institute for Population Studies at the University of Manchester. HiPPO also constitutes, jointly with researchers from The London School of Hygiene and Tropical Medicine and the University of Kent, the Department of Health Policy Research Unit in Commissioning and the Healthcare System (PRUComm). PRUComm provides evidence to the Department of Health to inform the development of policy on all aspects of health-related commissioning.
Disclaimer: The research for both referenced papers is funded by the Department of Health. The views expressed are those of the researchers and not necessarily those of the Department of Health.