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Health and Wellbeing Boards - new structures for strategic
delivery of Health and Wellbeing
Ann Bullen
Health and Social Care Partnership
South East Health, Well-Being and Support Conference
10th April 2013
Introduction
• Health and Wellbeing Board development - looking at some possible scenarios
• Joint Health and Wellbeing Strategies - audit findings
• Questions for you…
Health and Wellbeing Boards
“Engine room” System
leadership
Body of commissioner
s
Mapping the new system
Local Government
Base Camp
Rising Star
Better lives
Business as usual
Means well
Talking shop
Empty seat
Faction Fracture
Big
Brother
Creative cats
FACTION FRACTURE
• All partners participate, have commitment & vision
• Factional conflict happens when personalities join together
• Fracture may occur here: - County vs District - elected members vs health commissioning - primary vs secondary health - provider vs commissioning - resource pressures vs priorities - social care vs health - user voice vs services - voluntary vs statutory services
• Governance breaking down
EMPTY SEAT
• HWB works reasonably effectively; governance works
• HWB understands new era of closer partnership working & better use of money across wider sectors; HWB is committed
• Local political map naturally excludes opposition party
• BUT key player (a locality or sector) is missing, where needs are not included despite overall ‘success’
BIG BROTHER
• One party dominates disempowering partners
• Business is ineffective with disengagement by partners
• Elected members overawed through lack of knowledge
• Scrutiny & safeguarding is not transparent
• Joint business is not done well, or in piecemeal way
TALKING SHOP
• HWB functions, but real decisions are done elsewhere in the locality
• Elected members fulfil duty, but no function
• HWB may be dysfunctional & goes round in circles with no opportunity to meaningfully participate in executive decision making
• Governance happens, but is two-dimensional
BUSINESS AS USUAL
• HWB exists
• Established Joint Commissioning continues as before without radical change
• No de-commissioning, little questioning
• Safeguarding disconnected from mainstream commissioning decisions
• Established governance has no impact
• Political acceptance, but no scrutiny
• Decisions made ratify current status quo
BETTER LIVES
• Mrs Smith & family are enabled to maintain their wellbeing, receiving person-centred care if needed
• Collective leadership across systems for public functions
• Partners sign up to comprehensive pooled budget
- underpinned by clear & wide-ranging partnership agreements, joint commissioning, pooled budgets – ‘Total Purse’
• Elected members engaged, informed & communicating strategic direction; recognition of whole, 3-tier local authority structure
• Shared risk taking & appreciation of whole system including Health and council services
MEANS WELL
• One party insists on leading, to general agreement of all, or in the face of lack of other candidates, but is ineffective in doing business. This may be due to: - underestimation of role - lack of experience, or skills - poor guidance - wrong starting position to appreciate wider picture
• Governance misses key issues
• Elected members supportive, but complicit
• Good engagement with stakeholders, but limited outcomes for Mrs Smith & her family
CREATIVE CATS
• HWB development has enthusiastic leadership & committed partnership
• Elected members supportive, but uninformed
• But no connection to process, actions and outcomes
• Governance is haphazard
• No systematic learning
RISING STAR
• Mrs Smith & family beginning to feel connected service provision
• All parties confidently participate in HWB
• Board used to generate aspirational strategy
e.g. children’s trust acts as delivery arm
• Increasingly joined up commissioning & de-commissioning
e.g. JSNA actively used to implement strategy
• Political will supports progress
• Increased integration & pooled budgets
• But, still a journey to make
BASE CAMP
• HWB functions & included in local health and council governance structure
• Some good starting points
e.g. joint arrangements and pooled budgets within specific areas
• Elected members on board & engaged
• Good awareness of safeguarding
• Good base to begin wider partnership working & moving on
e.g. refreshed JSNA ready for use for commissioning/de-commissioning
JHWS audit - South of England
• Joint Health and Wellbeing Strategy (JHWS) audit - commissioned by Public Health
• Audit of publicly accessible LA websites to ask:
February 2013
Is there a published Strategy?
What are the stated priorities?
What progress has been made?
What’s the input from the HWB?
JHWS audit - South of England
• Information found for 27/34 local authorities - variable ease of access
• Looking at the priorities, they show:
Range of:
Local community focus Individual focus
Range of:
Overarching aims Focussed areas for action
Number range: 3 - 19
JHWS audit - South of England
Common themes:
Children getting the best start in life
Ageing and living well
Health inequalities and healthy lifestyles
JHWS audit - South of England Some reference to: housing, employment & economic growth
JHWS audit - South of England Range of Board involvement:
Ratification only Dedicated workshops for board
Range of consultation:
With public via websites/meetings Limited groups
Turning priorities to action…
Some examples:
East Sussex
Turning priorities into action…
Kent and Dover
Aligning County and District
Council direction
Turning priorities into action…
Cornwall
Turning priorities into action…
Portsmouth
Turning priorities into action…
Oxfordshire
General resources
LGA Knowledge Hub - national learning network for health and wellbeing
boards
https://knowledgehub.local.gov.uk/
NHS Confederation - resources for health and wellbeing boards http://www.nhsconfed.org/Publications/Pages/lresources-health-wellbeing-
boards.aspx?utm_source=Web&utm_medium=Promo&utm_term=210612&utm_campaign
=4
The King’s Fund – bulletin for health and wellbeing boards
http://www.kingsfund.org.uk/
Presentations from recent conference: District Councils and Public Health
http://districtcouncils.info/2013/02/13/public-health-event-presentations-
knowledge-hub-group/
Questions for you…
• How familiar are you with your local Health and Wellbeing Board and Joint Health and Wellbeing Strategy?
• What are the challenges to engaging?
• What would help?