Presentation on Health and Wellbeing Boards made at the Health Policy and Politics Network - HPPN event in September 2012

1. Will Health and Wellbeing
Boards deliver rational
decisions ?
Event Health Policy and Politics Network
Venue Magdalen College, Oxford
Date 5th September 2011
Neil Nerva
Associate
Frontline Consulting Associates
www.frontlineconsulting.co.uk

2. The context
● Eye watering savings required
● Controversial legislation .........
● ...........But Health and Wellbeing Boards
thought to be a good idea
● Unresolved issues about local v national
decision making
● Power of the National Commissioning Board
● Cluster – cross authority approach to service
reorganisation and pathway modernisation

3. Key responsibilities 1
Future Forum report published in June 2011 envisaged
HWBs exercising authority and formal role in:
● Accreditation process of GP Clinical Commissioning
Groups – CCGs
● CCG Annual assessment process
● CCG commissioning plans
The Bill sent to Lords in September 2011 envisages
HWBs being able to refer lack of agreement on these
issues to the National Commissioning Board.

4. Key responsibilities 2
In addition HWBs will need to establish competencies in:
● Development and use of JSNA
● Understanding the impact locally of the QIPP agenda
● Local Accounts – local performance and accountability
framework
● Relationships with Health Scrutiny and HealthWatch
● Championing public health and health inequalities
● Enabling involvement of mainstream services
● User engagement

5. Is this new ?
Yes and no ........
● Joint Consultative Committees – Joint Finance – JCC
● User specific joint plans and pathways – National
Service Frameworks (NSFs)
● Section 31/75 pooled budgets
● Local Strategic Partnerships
● Total Place
● Joint Strategic Needs Assessment (JSNA)
● Health Scrutiny

6. What is different ?
● Harsh financial climate
● Specific tasks and powers
● Awareness that stand alone services and
sectors can’t do it alone
● Return of Public Health to Local Authorities
● Opportunity for innovation
● Need to negotiate and define relationships at
local level

7. Diverse stakeholders
In order to be an effective body, HWBs will need
to be able to mediate the diverse expectations
of:
● Users and professionals
● Members, clinicians and officers
● Commissioners and providers
● Adults and Children Services.
● Mainstream services

8. Challenges - For GPs / CCGs
1
Sum of independent practitioners
● Size and coverage of CCGs
● More than CCG in one local authority area
● Who does the Council Executive speak for
● Ownership and engagement by rank and file
GPs
● GP sign up to pathway reform

9. Challenges - For GPs / CCGs
2
Managing underperforming GPs
● Role of National Commissioning Board
● Impact of CCGs delegating
commissioning responsibilities
● Ability to deliver the whole GP cohort
● Willingness to be challenged and ability to
respond

10. Challenges - Local Authorities
1
● Weberian – rational bureaucracies
● Adopting the leadership role
● Willingness to be challenged
● Engagement of mainstream services -
ownership across LA of wider health
improvement agenda
● Ability to sign up to long term change

11. Challenges - Local Authorities 2
● Maximisation of local influence over CCGs
● Willingness to let members lead - varying
quality and knowledge of members
● Officer / member divide
● Role of opposition
● Link to Scrutiny function
● Devolving decision making outside the LA

12. Challenges - Local Authorities
3
For elected members – need to mediate
roles
and mandates derived from
● Political group - administration /
opposition
● Elected member responsibilities –
executive and scrutiny
● HWB Membership

13. Challenges – for Users
● Who speaks for users – a variety of
stakeholders
● Place on board syndrome
● Role and success of local HealthWatch
● Willingness of LAs and NHS to embed
engagement in wider work eg in continuous
improvement, expert patient, personal budgets
● Not just about current activity but shaping future
services
● Willingness to be challenged

14. Working well
● Membership have agreed and shared
expectations
● Appreciation by HWB members of each
others’ role and responsibilities
● Key issues and desired early well-being
priorities agreed
● Reporting mechanisms established to
share information with parent bodies and
the public

15. What is rational ?
● Evidence based and open to new ideas
● Good use of public resources
● Seeks to address inequalities
● Willingness to think and invest long term if real
payback can shown
● Sector neutral
● Not simply reactive to local media and short term
political needs
● Willingness to user powers to advance these
objectives

16. Conclusions
● Be upfront about expectations
● Go for bite size whole system change to build
trust and understanding
● Avoid being caught up in process and standing
orders .........but recognise that HWBs are the
main arena for public critical friend challenge
........ this could be the best way of ensuring
accountability for the local health and social
system.

17. Contact us
Neil Nerva Associate
Frontline Consulting Associates
Mobile: +44 7812 250901
Email: neiln@frontlineconsulting.co.uk
Web: www.frontlineconsulting.co.uk