Effective partnerships cannot be mandated
Will health and wellbeing boards be system leaders or talking shops? That was the question the King’s Fund posed when we interviewed 50 lead officers last autumn. Judging by the latest LGC survey, the jury is still out, with the results echoing many of the issues and themes we identified in our own report.
The 64-year history of the NHS and local government is littered with partnership initiatives that generally did not do what they said on the tin. Will the new boards fare any better ? The dark clouds of the Nicholson challenge and local government spending cuts have barely dimmed the sunny mood of optimism, especially in local government, about the boards. Many respondents see some important differences this time around: the clinical involvement of GPs; stronger governance afforded by the statutory basis of the boards as a committee of the local authority and a genuine desire to make things happen.
Many spoke about the opportunities to promote much closer integration of health and social care and to see local bodies operating as a more coherent whole system of care.
It is disappointing that the old chestnut of ‘political interference’ by local councillors has rears its head in this survey. And anyone familiar with process-obsessed ways of the NHS will struggle to take seriously worries that boards will get mired in council bureaucracy.
There is still a long way to go in achieving a better mutual appreciation of the different cultures and ways of working both within different parts of the NHS and between the NHS and local government.
Barely half-way through their shadow year, many of the concerns, such as the relationship with scrutiny, reflect issues that have yet to be worked through. It’s clear also that many local authority functions are not sufficiently involved in their board’s work – only 18% think housing figures from the local authority are sufficiently involved. Boards must rectify this to avoid recreating a narrow health and adult social care silo.
A surprising theme of the survey was the significant minority of respondents who feel that new boards need greater powers in order to be effective - although powers to do what is not exactly clear.
The permissive approach taken by government means that there is potentially no limit to what boards can do, as long as partners agree. That is the rub. The boards are vehicles for partnership, not part of the line management of the NHS. That would demand a completely different kind of structure, such as integrated local health boards - but further reorganisation is not going to happen any time soon.
Here there is a role for the Department of Health and the early implementers network in articulating a stronger message about the role of the board and promoting a model of shared leadership based on the soft skills of influencing and collaboration.
It’s worth remembering that the most successful examples of integrated services were achieved despite legislation, not because of it. Effective partnerships cannot be mandated from the centre.
Richard Humphries, senior fellow, The King’s Fund