In his second blog, John Wilderspin, National Director for Health and Wellbeing Board Implmentation, talks about what shadow health and wellbeing boards are doing to make sure patients and the public are involved in local decision-making.
Last summer, we did our own listening exercise with emerging health and wellbeing boards. We wanted to find out what was on their minds so that we could design the national learning network in a way which best met their needs, based on the key themes of interest and importance to them. One of the recurring themes was ‘how do we “hardwire” public engagement into the work of the Boards?’
Interestingly, this wasn’t just raised by members of Local Involvement Networks (LINks) and other organisations representing the public, or by elected members of local authorities. It was also raised by the clinicians who were forming clinical commissioning groups (CCGs), by local authority directors, and by directors of public health. And they all had similarly compelling reasons for wanting it on the agenda:
- If the reforms are genuinely about shaping services around the needs of individuals and communities, then service users and the public must have real influence when big decisions are made.
- Local Healthwatch will have seat on each board, but that’s not enough; public engagement needs to be embedded in the way the board operates.
- Boards will be making some contentious decisions. If the public are to accept these decisions, they need to feel that decision makers have listened to their views.
But there was one other factor which was particular to the aspirations of the health and wellbeing board community. They are really keen to ensure that the new boards make a real difference, and don’t just turn into talking shops.
To meet this aspiration, boards need to have new and different people involved, with fresh ideas and the ability to challenge the status quo. If the public and service users are thoughtfully engaged in the way the boards operate, they will bring that freshness and challenge, and help keep the boards on their toes.
What are boards doing to make sure public involvement is part of their DNA?
One crucial opportunity for health and wellbeing boards is to support the development of local Healthwatch. Not only will Healthwatch have a formal role of involving the public in major decision making around health and social care, it also has natural connections with the development of health and wellbeing boards. Local Healthwatch will:
- have a representative sitting on the board
- come into being at the same time as the boards do
- be commissioned by local authorities who are also leading the development of boards.
Therefore, in parallel with the establishment of health and wellbeing boards, many local authorities are giving careful thought as to how best to develop local Healthwatch, either on their own, or by working with others.
An example of this work is Shaping Local Healthwatch – the actions and findings of nine local authorities in England, which was a piece of work supported by PPI Solutions. For anyone thinking about how to engage their local public and stakeholders in the design of Local Healthwatch, this report offers some thought-provoking insights.
Another area that encourages innovation and new ways of involving the public is the development of CCGs. Health and wellbeing boards have a role in the authorisation of CCGs, but much more than that, want to support CCGs to become highly effective partners in local decision-making.
Like the boards themselves, CCGs will draw part of their legitimacy from the way they involve the public. As members of boards they will be able to draw on the public’s views as presented to the board, for example as part of the JSNA and joint health and wellbeing strategy process. Equally, they will be developing their own means of engaging the public in their planning and decision-making. In turn, the evidence they glean can be fed back to the health and wellbeing board to inform collective decision-making.
In the south east, a methodology and resource pack has been developed to help aspirant CCGs embed robust patient and public engagement practice into their activities. This will be critical to CCGs obtaining authorisation from the NHS Commissioning Board and will provide a sound basis on which to involve their communities in their commissioning decisions. It is important that CCGs learn from the experiences of PCTs in this area so that the quality of engagement can be raised even higher.
An clear connection between health and wellbeing boards and the public involvement agenda is the presence of local authority elected members on the board. In most authorities this includes members of the Cabinet, in some, the elected Mayor, and in two-tier authorities, elected members from district councils. Not only does this enhance the democratic legitimacy of the board and the decisions it takes, it also means that those members of the board come into regular contact with the public that they represent. This is clearly of benefit, but it also creates tensions that need to be managed so that the board still develops the strong community relationships which are essential.
One tension is about cultural differences; the NHS members of the board may not be used to working in a political environment, and board members will need to spend time to share and understand each others’ viewpoint.
Another challenge is between the role of local Healthwatch in representing the views of the public, and the role of local authority members as elected representatives of that same public. Potentially, this means that the board will have access to a broad range of public perspectives, but there will need to be clear understanding of the different contributions of elected members and Healthwatch for this to work well. Some of the 75 Healthwatch pathfinders are exploring this issue and will share learning in the coming months.
So, how will boards harness these advantages to ensure that public engagement really is hardwired into the way they operate?
In part it will be down to each board’s local approach, but it will also be through sharing ideas and experience amongst the boards, and from existing best practice.
What ideas, experiences and best practice can you share? How are you going to share it? What do you want to know from other boards?
That is what the National Learning Network is for. If you’re not involved already, email us to ask for an invite to the Community of Practice.
If you are signed up but don’t know what to do next, here are some ideas.
Further information
- The Local Government Association has recently set up a dedicated Healthwatch Implementation team who will be supporting local authorities to establish robust and credible Local Healthwatch organisations. For further information contact Lorraine Denoris, Programme Director at lorraine.denoris@eastcoastkent.nhs.uk
- Views are sought on JSNA and joint health and wellbeing strategies draft guidance by 17 February
- Stay in touch with the latest discussions, news and events on the official National Learning Network for Health and Wellbeing Boards. Follow this link to sign up: http://webarchive.nationalarchives.gov.uk/20130402220826/http://www.communities.idea.gov.uk/c/10113659/home.do
- Follow John and his team on Twitter:
@johnwilderspin – National Director for Health and Wellbeing Board Implementation
@AmyatDH – Local Government Communications Lead
@edwardsginny – Programme Lead for the National Learning Network
@JanineatDH – Communications Manager for Health and Wellbeing Board Implementation