The titles of the health and wellbeing board ‘state of the nation’ reports that Shared Intelligence has produced for the Local Government Association over the last three years say it all: Great Expectations, Stick with It and, most recently, The Force Begins to Awaken.
The story of the first two reports was unfulfilled potential laced with a healthy dose of frustration. In our most recent report, however, we concluded that a significant number of health and wellbeing boards are beginning to play a genuine leadership role across local health and care systems.
These boards have shifted their focus from particular conditions or areas of activity, such as diabetes or smoking, to the places as a whole. They have developed a shared view of the future of the local health and care system and are leading and reframing the debate on how to achieve it.
Most other boards are pursuing individually important initiatives and are keeping the show on the road in terms of the relationship between health and local government but they are not providing place or system leadership.
One board has provided a place in which people from the council and clinical commissioning group continued to work together despite a massive row over local health reconfiguration proposal. The board wasn’t driving the change, but it did play an important role in managing the fallout.
This focus on place is key to making this shift to becoming a truly effective board, as are committed leaders, a clear sense of purpose and a director of public health who enjoys the opportunities and challenges of being based in a local council.
We have also identified the importance of a factor we call “collaborative plumbing”. Boards are far more likely to be effective in places with a history of collaboration and good partnership working. Where this collaborative plumbing does not exist it can take a lot of time and effort to install.
This is a good news story, but there is a bitter twist in the tale. The emergence of some boards as effective leaders of place has coincided with NHS England adopting a more muscular approach in an explicitly top-down model. This is most stark in the requirements associated with the new sustainability and transformation plans.
Just as health and wellbeing boards have established a leadership role at one level, STPs are being produced across a wider geography with a different leadership. This is being done in a way which pays no respect to the effort that has gone into the development of boards by local councils and clinical commissioning groups. At best, this is something else for boards to work with. At worst it threatens to distract and destabilise them.
Phil Swann, executive chair, Shared Intelligence