What are they?
The 130-plus health and wellbeing boards are part of the new apparatus of the post-Health and Social Care Bill NHS. As statutory bodies, each top-tier and unitary authority has its own board - effectively a local government committee - which draws up the joint strategic needs assessment and joint health and wellbeing strategy for the area to encourage commissioners to work in a more joined up way.
In terms of membership, the Health and Social Care Bill 2012 mandates a minimum of:
- one local elected representative
- a representative of local Healthwatch organisation
- a representative of each local CCG
- local authority directors for adult social services, children’s services and public health.
Boards can expand their membership to include a wider range of perspectives and expertise, such as representatives from the charity or voluntary sectors.
There is a statutory requirement that CCGs consult health and wellbeing boards throughout the commissioning process.
What is the rationale behind them?
Ostensibly, making the NHS more democratic. According to the Department of Health, health and wellbeing boards are meant to ensure ‘stronger democratic legitimacy and involvement, strengthen working relationships between health and social care, encourage more integrated commissioning of services and help give communities a greater say in understanding and addressing their local health and social care needs’.
From the local government perspective, they represent a chance to have a much bigger say than previously in the NHS. Unfortunately, with the financial pressures the NHS is currently under, that could mean local politicians having to take responsibility for closing hospitals, decommissioning services or other major service reorganisations - previously the province of the Health Secretary and Department of Health.
Advocates of the boards believe they offer the answer to achieving more integrated working across health and social care, integration which is increasingly urgent given what the King´s Fund has identified as ‘a rising tide of long-term conditions, dementia and fraility’.
Where are they in terms of development?
Health and wellbeing boards have been working in shadow form since April 2012 and take on their statutory functions from this April.
What are going to be the tricky bits to digest/get agreement on?
Unless astutely run, the boards could conceivably become either political battlegrounds or worthless talking shops. To fulfill their actual purpose of making the NHS more democratic they need to be somewhere in between these two extremes.
There are already concerns over the political independence of health and wellbeing boards and that local councillors could exercise undue influence over their decisions. The worry is that local politicians could undermine GPs´ commissioning clout.
Critics are also concerned about whether the involvement of Health and Wellbeing Boards in drawing up JSNAs will mean excessive political scrutiny of CCGs´ commissioning plans.
What remains to be seen is how they will act over potentially controversial service reconfigurations which many believe CCGs will need enforced. National politicians are notoriously shy of getting involved in hospital closures. Time will tell if local politicians will be any different.
Alisdair Stirling is a freelance journalist
