There are rough and tough times ahead for councils’ newest committees, which will be meeting properly for the first time this spring.
Health and wellbeing committees were not the headline-makers of the health reform package but they are set to become the focus for local ambition and controversy.
This April’s changes bring councillors back into the health picture in the biggest way since the 1970s. Councils will have responsibility for the better health of their residents through the transfer of public health functions, the inside track on wider commissioning intentions, and extended powers to scrutinise and challenge all organisations funded by the NHS.
Health and wellbeing boards are the hubs of these new responsibilities and they have been meeting in shadow form for over a year.
The prime minister himself described them as bringing together everyone from clinical commissioning groups, adult social care, children’s trusts and public health to design local strategies for health and social care integration.
Early evidence from the King’s Fund suggests concerns about how national policy imperatives may trump locally agreed priorities and how boards will influence NHS England’s activity on primary care as well as national and regional specialisms.
The best boards already have a sense of how people’s needs are matched against existing services. They will be briefed on inequalities of access and outcome. They will also be aware of the early commissioning intentions or preferences of partners and the anticipated financial pressures they face.
Health and wellbeing boards have inherited decisions about how services are to be decommissioned - decisions previously made in isolation and sometimes opposed by councillors.
They will be aware of the potential clashes between clinical and managerial perspectives on what is good and safe and they will be familiar with issues of cost and public loyalty to local services.
Their biggest challenge is the context. The government and the NHS expect the boards to help provide cover for necessary changes.
They will be seeking to provide strong political leadership to a system facing unprecedented financial pressures, rising demand and complex organisational change.
Andrew Cozens, chair, Carers Trust