Department of Health | INLOGOV Blog

Anna Coleman and Julia Segar

A recent publication by the New Local Government Network (NLGN) looked at how local councils are preparing for the future and suggests depressingly that “there is simply no way that local government can reach 2018 let alone 2020 while still delivering the full range and quality of services currently on offer”(p6).

Simply put, we have an ageing population, with associated increasing demand for care services and draconian cuts in council budgets. The NLGN suggest we could be facing a future of “private affluence and public squalor”. However, it is not all doom and gloom. Perhaps austerity can be a strong stimulus for innovation? How would this work I hear you ask?

They suggest a new model being discussed around the country. The idea would be to mix technology, preventative investment, integration of council services with those of the NHS and others, alongside the creation of new partnerships between local government and local populations.

The NLGN report suggests three possible ‘landscapes’ for councils of the future. Firstly, a wasteland – a world of poorly prepared councils forced to cut services dramatically. Secondly, the wild meadow – councils provide core functions and rely on spontaneous public contributions to replace dwindling services. Finally, the common – the focus moves away from the council to places where it shares responsibility jointly with communities and businesses. This latter approach is seen as optimistic and would need to build on a strong social and voluntary economy.

This idea is timely for us as about a month ago Anna chaired, and Julia attended, a briefing event in the NW of England on Health and Wellbeing Boards (HWBs) and how (if at all) they were engaging with local voluntary organisations and local Healthwatch. Speakers at the event came from a local Healthwatch, a local overarching voluntary organisation and someone associated with Regional Voices. Speakers described their organisations and their relationships with their HWBs. They reflected on what could be done to improve these interactions to benefit all involved. So could we tap into some of these ideas for helping to build the idea of a common?

The official vision for HWBs from the Department of Health emphasised: 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. However, HWBs have no formal powers, and their ability to influence others will depend upon their success in building relationships and interacting with other organisations locally. See our previous blog (Coleman 2014) for further detail on HWBs.

On paper, then, HWBs look like ideal forums for enabling the growth of both vision and action for building local commons. Speakers at the NW event, suggested that a shift in emphasis needs to take place before such a vision can begin to be realized. They argued that a tokenistic place on a HWB is of little value either to the HWB itself or to voluntary sector organisations. The voluntary sector together with Healthwatch, can provide valuable information about needs, concerns and available assets from a range of voices within a local community, with evidence varying between robust data to insightful patient stories (National Voices 2014). In Manchester alone, there are over 3000 voluntary organisations delivering a wide range of services to diverse groups. The estimated worth of the sector in 2012 was £477 million drawing on the work of over 94,000 volunteers (Dayson et al 2013). So HWBs should consider carefully who might sit on (or with) the HWB, and at what level (Board or sub-group) to represent the views of the voluntary sector and how these individuals should be chosen.

It was suggested that HWBs are missing a trick if they don’t engage effectively with local Healthwatch (who have a seat on HWBs) and voluntary organisations (who may be invited to sit on HWBs).These organisations have valuable knowledge, local intelligence and capacity at community level. The speakers indicated that very rigid structures and ways of working do not always work and that having a seat at the table does not guarantee that organisations are heeded. In order to develop new ideas and innovative solutions for complex local health and wellbeing needs, HWBs need to devote time and attention to voluntary organisations and to Healthwatch. In the current state of austerity sharing resources, skills and information is vital and good practice both locally and nationally.

This briefing event asserted the role of the voluntary sector in improving the health and wellbeing of local populations. The contributions that they could make in helping realise the landscape of the common is also clear. Step one on this path is to see, hear and listen to these organisations on HWBs.

Now read:

Anna and Julia’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.

Julia Segar is a qualitative researcher in the Centre for Primary Care at the University of Manchester. Her previous projects were concerned with telehealthcare and with changes in the healthcare system. Julia part of the Health, Policy, Politics and Organisation (HiPPO) research group within the Centre.

Disclaimer: The research for referenced paper is funded by the Department of Health. The views expressed are those of the researchers and not necessarily those of the Department of Health.

Anna Coleman

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.

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.