Each council will have a health and well-being board that will bring together leaders from the health and social care system to improve the health and well-being of their populations and reduce health inequalities.
The boards aim to influence commissioning and strengthen local healthcare democracy, and will develop joint strategic needs assessments. These should cover healthcare, social care and public health, and address other services that impact on health and well-being.
What the BMA thinks
The BMA welcomes close working between local authorities and CCGs. A strong dialogue between policy makers and commissioners across health and social care will result in intelligently structured and efficient services.
- Responsive and streamlined structures
The Commons Health Select Committee raised serious concerns that the proposals to establish health and wellbeing boards were unnecessarily bureaucratic. The committee recommended in a report in April 2011 that the proposals should be dropped and that the production of the JSNA and the JHWS should be the joint responsibility of local authorities, CCGs and Public Health England.
The BMA shares the concern that the proposals could potentially result in a needless layer of bureaucracy, but believes that a specified forum for discussion could streamline the process of collaboration between stakeholders.
It is important that the boards encourage true partnership between local authorities and CCGs. To this end, the BMA recommends that health and wellbeing boards should be small, functional and responsible bodies.
CCGs need to participate fully in the workings of the board and be prepared to develop mutually supportive relationships. These relationships are particularly important given the scrutiny role that health and wellbeing boards will have in overseeing the commissioning plans of the CCG.
Further detail is needed relating to the CCG's requirement to consult the health and wellbeing board. We would urge flexibility in this process, in order to prevent overburdening the CCG with different measurements of quality or performance.
In order to guard against unnecessary delays and conflict, CCGs should be careful to involve the health and wellbeing board from the start of the commissioning process so that issues can be dealt with along the way.
CCGs should also be careful that the scrutiny function undertaken by health and wellbeing boards does not duplicate the role of the CCG's own governance committee. The governance committee of the CCG will have responsibility for ensuring the probity of the financial and commissioning decision making of the CCG.
This audit role differs from that of the health and wellbeing board, which should focus on the commissioning strategy adopted by the CCG. The value of health and wellbeing boards will be their attention to the integration of health and social care and public health aspects of a CCG's commissioning plans.
It is important that the advantages of clinician-led commissioning - placing doctors and other health professionals at the heart of the decision-making process – are not stifled by excessive interference in the clinical decisions a CCG takes.
The health and wellbeing board will most usefully focus on promoting collaborative working, bringing to the commissioning process appropriate and valuable input from social care and public health.
Local authorities have been given the freedom to determine how many local authority representatives sit on the board. We would urge an equal balance between local authority and CCG representatives, in order to avoid politicisation of the functioning of the board, and to foster balanced and collaborative working.
- The role of Local Medical Committees
The BMA has serious concerns that the membership of health and wellbeing boards does not include representatives of local medical committees (LMCs) and we have raised this with the government and in briefings with MPs and peers.
LMCs are the only statutory representatives of GPs and perform a crucial role in negotiations between local authorities and the local profession. LMCs represent the views of the local profession independently from the local commissioning groups and will be central to ensuring that CCGs have the support and engagement of constituent practices.
If an LMC has not been involved in the process thus far, they should actively seek engagement with the local authority.
Health and wellbeing boards are aligned with each upper tier local authority. This should pose no problems where a CCG’s boundaries are co-terminus with those of the local authority (mainly in the case of unitary local authorities).
In the case of county local authorities, the boundaries of which may encompass a number of CCGs, consideration should be given as to how the CCGs are represented on the health and wellbeing board.
One person could be elected to represent two or more CCGs in an area, to avoid unnecessarily large membership of the health and wellbeing board.
If this is the case, then it is vital that effort is made to foster strong relationships between the CCGs and this individual, and also between the CCGs and the health and wellbeing board itself.
See the new health and wellbeing board directory (King's Fund)
The transition period until 2013 will require a certain degree of flexibility as the structures involved establish themselves and CCGs seek authorisation. CCG representatives on the health and wellbeing board need to be mindful of the potential for conflict of interest as the board participates in the authorisation process.
CCG representatives should absent themselves from discussions relating to the readiness and ability of their own CCG or other CCGs in the area to take on commissioning responsibility.