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If your name’s not on the HWB list, can you still come in?

If I don't get a place on the Health and Wellbeing board, I will not follow through any of its decisions.

This was the attitude of one acute trust manager relayed to last week's NHS Confederation annual conference by the DH's man in charge of health and wellbeing boards, John Wilderspin.

While the message in recent years has been almost a dogmatic ‘too much is done in secondary care', CCGs are tuning in about the need to take acute trusts with them through the changes ahead.

There are several reasons for this.

Quoting John Wilderspin again – most innovation comes from providers rather than commissioners and the public engages with providers in a mass way it never will with commissioners.

At the same event GP Dr Tim Dalton, who sits on the health and wellbeing board in Wigan, said decisions would not get implemented if providers were not in the room. The model they have developed however still doesn't give a seat to the provider but engages them in separate conversations and forums outside the HWB board meeting.

Engagement with acute trust providers doesn't require an actual HWB seat. And I think there are very good reasons for denying providers a place on HWBs.

Firstly numbers. We heard from a local councillor at the conference who once chaired a local strategic partnership meeting of 48 people. That isn't a board. I've been to public meetings with far fewer numbers.

Secondly, challenging the mindset that the hospital is at the centre of the NHS. It is a big part of local provision but hospitals must respond to local patient need rather than articulate what the need is. Too often in the past ‘the need' has been about the sustainability of the hospital itself. 

Sir David Nicholson's keynote address talked about his ‘grieving process' when he learned of what the health white paper contained. He quoted the stages of anger, denial and acceptance.  Sir David omitted perhaps the most relevant 'stage' to this health act – bargaining.

Sue McNulty is editor of Practical Commissioning

Follow Sue on Twitter @praccommed