On 1 April, shadow health and wellbeing boards went live. Unlike many other aspects of the Health and Social Care Bill, these proposals have been almost universally welcomed. Health and wellbeing boards are seen by many as the only element of the new and increasingly complex architecture of the reformed NHS that tries to bring together different organisations and interests to promote local collaboration and integration.
Their primary purpose is to promote integrated care, and it is widely agreed that this should become a major policy priority. But this vision is not new, and it is not the first time that new bodies have been created to help achieve this. Past efforts – including joint consultative committees, joint care planning teams and, more recently, local strategic partnerships – have achieved mixed results. Prior to the reforms, most local authorities and their NHS partners had a partnership board of some kind – but despite this, the track record on integrating health and social care has been patchy.
In the new landscape, CCGs will face a delicate balancing act. On the one hand they need to build and maintain strong working relationships with other members of the board. But on the other, the NHS Commissioning Board will be consulting the boards on CCG authorisation and their commissioning plans, and this has the potential to undermine those carefully built bridges. To successfully navigate these obstacles, CCGs need to take a prominent role in the health and wellbeing board from the outset, sharing leadership with the local authority to ensure that strategies are developed in tandem with the board, rather than in opposition to it.
It is too early to predict how health and wellbeing boards will operate in practice, their impact, and whether they will be able to achieve the aspirations set out in the health bill. There is also a wider question as to whether their role should be more sharply defined to ensure everyone is clear about what they are trying to achieve. If the boards are to be a genuinely effective vehicle for integration, it is vital local authorities look at new ways of working with local partners and avoid simply rehashing past partnership arrangements.
On a positive note, the advent of health and wellbeing boards may well provide an ideal platform to fully integrate primary care with prevention and public health. CCGs could use the joint strategic needs assessment developed by the board as a ‘live' document, continuously improving commissioning plans with up-to-date information from the local health economy, and draw on information on the wider determinants of health, such as housing and employment, when making decisions.
Faced with complex organisational change, unprecedented financial pressures and rising demand for services, will the boards be able to fulfil these expectations and achieve greater success than previous bodies? They begin their journey from an encouraging starting point, but only time will tell what the final verdict will be.
Lara Sonola and Amy Galea are researchers at The King's Fund
The King's Fund's new report Health and wellbeing boards: system leaders or talking shops? is published on 12 April
