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 board||Yes||No||Total|
|Clinical commissioning groups||49||0||49|
|Social care teams||48||1||49|
|Voluntary/third sector groups||28||21||49|
|Public health professionals||48||1||49|
|Hospital trusts and secondary providers||12||37||49|
|Public and patient involvement groups||45||4||49|
|Who leads the boards? (49 responses)||Number*|
|Council deputy leader||3|
|Councillor (relevant portfolio holder)||25|
|Chair of NHS or primary care trust (two joint)||3|
|Director of public health||1|
|Superintendent commander of police||1|
* Total greater than 49 as includes two joint appointments