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