Health and wellbeing boards are now well established in shadow form an
d a good number are already marking their first anniversary. After an initial focus on form, boards have quickly moved on to consider their function. What should they focus on? What should be their priorities for action? These are important considerations as all too often we can set up new structures because they are a statutory requirement, without spending time thinking about the value they can add.
In the case of health and wellbeing boards, there is a strong sense that they are inherently a good thing because they bring together the NHS and local government with a local Healthwatch member as a representative of the wider public. This aligns with the current big themes across the public sector: integration, user engagement, localism and so on. However, the inherent benefit of bringing the right people together dissipates very quickly if they don’t have a clear sense of their collective purpose.
Fortunately, most boards have understood this, and they are using the run-up to April 2013 to consider their role and priorities. The tasks they are required to deliver will help that process. Joint Strategic Needs Assessments enable the board to develop a shared picture of place; reviewing the collective evidence of needs and assets, sharing insights and experience and seeing the locality from other board members’ perspective. In turn, this helps the board to develop a genuinely shared vision and purpose, encapsulated in their Joint Health and Wellbeing Strategy. Done well, these processes will remind the board of the challenges that they face, but also highlight new opportunities for working together.
In defining their purpose and priorities, boards are also realising they cannot achieve their ambitions on their own. If they are going to make real and sustainable improvements in health and wellbeing, they need to engage with a wide set of partners, and the public. Whatever the priority of the board – transforming service provision, integrating care, tackling health inequalities – these cannot be achieved by the core members of the board acting in isolation. It requires the board to develop a coalition of the willing amongst local organisations, and to have a big conversation with local people, translating the local priorities into action.
I will come back to the theme of public engagement in a future blog because it is a huge issue in its own right. Focusing on the engagement of partners, there is a lot of debate at present about who should be members of health and wellbeing boards. In the NHS this tends to be around whether NHS providers should be board members, but there are equivalent debates about voluntary and community sector organisations, local housing and planning officers, Police and Crime Commissioners, and a range of other people and organisations.
There are no right answers; what is right for one locality will be different for another. However, there are some helpful questions which boards might ask themselves, and the Department has been working closely with the Local Government Association (LGA) to develop a self-assessment tool for that purpose (details below).
Boards need to be clear about their purpose to be clear about their membership; as I said at the beginning of this blog, “form follows function”. How many members can a board accommodate before becoming unwieldy, a talking-shop rather than an action-focused and decision-making body? What contribution will a potential member bring to the board? Membership carries responsibilities as well as influence.
There is also a more fundamental question; is this actually about board membership, or how well the board engages? As a health and wellbeing board Chair said at a recent conference, “we will do most of our business in workshops, not in formal board meetings”. So, perhaps this is as much about the way boards operate, as it is about their form and constitution? I am sure this debate will continue as boards move to take on their statutory form.
Additional resources
Before I sign off, I would like to take this opportunity to signpost two useful documents for health and wellbeing board members. Firstly, a new consultation document which has been published on local authority health scrutiny. The changes proposed in the consultation will update the arrangements and regulations for local authority health scrutiny and help to ensure that the interests of patients and the public are at the heart of the planning, delivery and reconfiguration of health services. Read the consultation and share your views on this.
Secondly, as mentioned above, a new development tool for health and wellbeing boards has been produced by the LGA, in partnership with the NHS Leadership Academy, Department of Health and other national organisations.
The tool builds on the achievements of previous self-assessment documents and aims to support boards to go beyond assessing their readiness, towards identifying how effective they are in practice and how that effectiveness can be improved. The tool is available to download at: http://webarchive.nationalarchives.gov.uk/20130402145753/http://www.local.gov.uk/web/guest/health/-/journal_content/56/10171/3638628/ARTICLE-TEMPLATE
Stay in touch
Join the National Learning Network for health and wellbeing boards group on the Knowledge Hub.
John Wilderspin is the National Director for Health and Wellbeing Board Implementation.