Will Health and Wellbeing Boards deliver rational decisions ?Event Health Policy and Politics NetworkVenue Magdalen College, OxfordDate 5th September 2011 Neil Nerva Associate Frontline Consulting Associates www.frontlineconsulting.co.uk
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
Key responsibilities 1Future Forum report published in June 2011 envisagedHWBs exercising authority and formal role in:• Accreditation process of GP Clinical Commissioning Groups – CCGs• CCG Annual assessment process• CCG commissioning plansThe Bill sent to Lords in September 2011 envisagesHWBs being able to refer lack of agreement on theseissues to the National Commissioning Board.
Key responsibilities 2In addition HWBs will need to establish competencies in:Development and use of JSNAUnderstanding the impact locally of the QIPP agendaLocal Accounts – local performance and accountability frameworkRelationships with Health Scrutiny and HealthWatchChampioning public health and health inequalitiesEnabling involvement of mainstream servicesUser engagement
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
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
Diverse stakeholdersIn order to be an effective body, HWBs will needto be able to mediate the diverse expectationsof:• Users and professionals• Members, clinicians and officers• Commissioners and providers• Adults and Children Services.• Mainstream services
Challenges - For GPs / CCGs 1Sum 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
Challenges - For GPs / CCGs 2Managing 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
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
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
Challenges - Local Authorities 3For elected members – need to mediate rolesand mandates derived from• Political group - administration / opposition• Elected member responsibilities – executive and scrutiny• HWB Membership
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
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
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
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.