Health and Wellbeing Boards- The must knows

Published on Thursday, 12 April 2012 09:32
Posted by Scott Buckler

Following Royal Assent of the Health and Social Care Act, shadow health and wellbeing boards are busy looking at how they can make good on a broad list of duties, functions and, quietly, unanswered questions about how the new system holds together

How have boards developed so far, what’s on their to-do list, and how does it all really work? We’ll be exploring this in more detail in the coming months, but here are headlines for now.

Elephants in the room – cuts, restructure, health inequalities and changing need

As new leaders of the system, GPs and local authority elected members will be keenly aware that delivering improved health and wellbeing outcomes and making headway against health inequalities is no mean feat.  After all, progress proved an elusive goal in a decade of unparalleled growth - with the current £20bn NHS efficiency drive -it is difficult to see how progress will be made without brave and innovative action.  Adding to the perfect storm are swingeing cuts across children’s services, adult social care, housing, support, and benefits which will drastically reduce the ability of the system to absorb shocks.

Worrying signs: board members have head buried in the sand and a sense of unfounded optimism

Positive signs: boards are energised but recognise the scale of challenges ahead

Duties – where does an ambitious board start?

The Act makes clear that how the board interprets its key duties -  to promote integrated working, prepare a Joint Strategic Needs Assessment (JSNA) and a joint health and wellbeing strategy (JHWS), and ensure local commissioners ‘have regard to it’ – is largely down to them. 

Our experience shows that whilst it’s still early days, different camps  are emerging – those who look set to grasp the nettle of evidence-based decision making, and sadly, those who seem to be hoping someone else will tell them how to do it. 

Worrying signs: persistent absenteeism and hurriedly signing off a host of retrofitted strategies and processes

Positive signs: key processes critiqued by the board and key officers from first principles with a clear and agreed local definition of the scope of board powers 

Leadership – behind the handshakes

Whilst the Act spells out the statutory members of the health and wellbeing board, the full invitation list is for local areas to decide.  Some include local authority and outgoing PCT chief executives, others housing, NHS trusts, voluntary sector, and local regeneration and planning, as well as district councils in two tier local authorities.  The merits of  an inclusive and joined up approach to health and wellbeing are clear, however, the next 6 to 12 months will be telling as tough decisions  start to flush out differences of opinion, conflicts of interests and relative levels of tolerance for public debate and controversy.

Worrying signs: myopic vision around potential conflicts of interest

Positive signs: lucid rationale distinguishing board membership from the importance of engagement as stakeholder

Governance - making it work

Regional surveys of emerging practice report a significant amount of early health and wellbeing board activity around mission statements and governance arrangements, suggesting a willingness in some areas to take time laying sound foundations for difficult times ahead.  It is still early doors, but this must be encouraging nonetheless; taking time to clearly set out the rules of the game implies at the very least, consideration of what you are trying to achieve, how and with whom. 

Worrying signs: quiet snoring when board discusses ‘governance’, belief that ‘things will work themselves out’

Positive signs: clear and robust governance arrangements with a clear sense of purpose, roles, responsibilities and lines of accountability

For further information, please contact Michelle Kane of HK Consulting at This email address is being protected from spambots. You need JavaScript enabled to view it. or 020 7324 6228

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