Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Health changes to put boards into 'eye of the storm'

  • Comment

Public opposition to radical reform of health care will put new local health and wellbeing boards “in the eye of the storm” and leave councillors “tested to the limit”, a report has warned.

The King’s Fund thinktank questioned representatives from 50 council areas on the progress of health and wellbeing boards (HWBs). The boards, which will be tasked with assessing the health needs of the local population, promoting integration and guiding commissioners, become fully operational next April. However, all 152 top-tier councils are expected to have shadow HWBs in place this month.

The King’s Fund noted that meeting the needs of an ageing population while facing budget pressures would, “require a radical shift from a model of care based predominantly on acute hospitals towards a more preventive approach that promotes self-care”.

That could lead to boards imposing “the unpopular rationalisation or even closure of some services [during which] the local authority will come under pressure to reflect local opinion and preserve valued local services”.

It warned: “In these circumstances, the local health and wellbeing boards will be in the eye of the storm…the political leadership of the board will be tested to the limit.”

Most boards that responded are chaired by a council leader, their deputy, a cabinet member or elected mayor, and have 12-20 members. Most have local commissioning groups represented but three quarters had excluded health care providers from participating.

While this trend was being driven by a desire to avoid potential conflicts of interest, the report authors warned it could damage integration between health and social care services.

They urged boards to avoid “a hard separation of commissioner and provider roles”, pointing out that “commissioners alone are unlikely to drive the development of integrated care at the scale and pace required”.

Boards should instead adopt governance arrangements that would highlight and contain any conflicts of interest, rather than simply seek to exclude providers, the authors said.

Difficulties might also arise from the unclear relationship between the local boards and the overall NHS Commissioning Board, which would remain a significant commissioner of local services.

Survey results showed “little optimism that the health and wellbeing boards will have any influence on its decisions”.

The report noted: “Anxieties about the role of the NHS Commissioning Board are fuelled by a deeper suspicion among respondents that, despite the rhetoric of localism, national policy imperatives could over-ride the local priorities agreed through health and wellbeing boards.”

King’s Fund senior fellow Richard Humphries said the survey showed the “unprecedented support for closer working between the NHS and local authorities”. However, he warned the lack of shared boundaries between councils and the commissioning support bodies being set up at the sub-regional level presented a “worry” as the latter may not be “well connected with the work that’s going on” with HWBs.

Groups on the boardYesNoTotal
Clinical commissioning groups49049
Social care teams48149
Voluntary/third sector groups282149
Public health professionals48149
Hospital trusts and secondary providers123749
Public and patient involvement groups45449
District councils628


Who leads the boards? (49 responses)Number*
Council leader14
Council deputy leader3
Elected mayor2
Councillor (relevant portfolio holder)25
Chair of NHS or primary care trust (two joint)3
Chief executive1
Director of public health1
Independent member1
Superintendent commander of police1

*        Total greater than 49 as includes two joint appointments

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions.

Links may be included in your comments but HTML is not permitted.