Health and wellbeing boards: from health improvement to helping make homes a place of safety for the frail
Health commentator and consultant Paul Corrigan, Adjunct Professor of Public Health at the Chinese University of Hong Kong and of Health Policy at Imperial College London, is a former health adviser to Number 10 under the Labour government. He is now part of the Integrating Care collective and here reports from a roundtable on health and wellbeing boards.
This article first appeared in the print edition of National Health Executive (July/August). Thanks go to the editor, Adam Hewitt, for his kind permission to reproduce the article here. The original piece can be found here: http://www.nationalhealthexecutive.com/
Health and Wellbeing Boards
In legal terms, Health and Wellbeing Boards and Clinical Commissioning Groups are only a year old and as Simon Stevens, the new CEO of NHS England has commented: a year just isn’t enough time for any organisation to really prove itself.
And yet, what we know about changes in public services is that organisations set up to do one thing can get quickly landed with doing another. When this happens, it’s not that the new activity is in any way wrong, but it is very different from what went before.
At the LGA/NHS Confederation/Integrating Care joint roundtable on 30 April, it became clear that this is what has happened to these new organisations. When Health and Wellbeing Boards were started in shadow form from 2012, it was clear that they were primarily involved in developing joint policies on health improvement.
For some, this re-found a local authority agenda (taken away in the 1970s) and was enthusiastically taken on board by many localities. I remember working with local government on early strategic partnerships in the late 1990s and nearly every councillor I met – from whatever political party - had an interest in improving the health of their constituents. This meant that many of them came to Health and Wellbeing Boards with a passion to develop new health improvement relationships.
Then, just a few months into their legal form, the boards were asked to supplement this work on health improvement by becoming the main joint planning organisation for the Better Care Fund. Given that in most locations this fund will be counted in the tens of millions, and given that most local authorities were being cut by similar amounts, this changed the nature of these organisations.
It’s not that local government people at the seminar on 30 April were moaning about this. They are wise enough to know that these things happen in government: you get good at doing one thing, so you must be good at doing something completely different.
The funding of the NHS for the year 2015-16 only adds up if there is a huge drop (of 15%) in the number of people who are admitted as emergencies into hospital beds. (Just a point of clarification: this is different from people turning up at A&E.) It’s very true that A&Es are under enormous pressure from a wide range of urgent care pressures, but the problem which will destroy the viability of the health service is not attendance at A&E, but the number of people who are admitted into in-patient beds as emergencies.
The Better Care Fund will have to play a significant role in commissioning services that will help those patients feel safe at home. This is the trick for modern care and healthcare services. We need to persuade people that we can surround them with sufficient care to help them feel safe at home. Over the last few decades we have persuaded people that the ONLY place of safety for people who feel very frightened about their health is the hospital.
The Better Care Fund will provide better care if it makes people feel safe in their home. To provide that place of safety we will not only need great care and healthcare, but this will have to be coordinated seamlessly to ensure that the service really does help people feel safe.
But the coordination of existing care will not be sufficient. We know that social isolation cuts into people’s feelings of safety. Really better care will ensure that the family and community assets that could help that experience of safety will be as important as the first class social and health care.
It is here where the work of the health and wellbeing boards could add significant value. Just as they recognise the crucial importance of community organisations in health improvement, so will they understand the importance of community organisation in creating safe homes for the frail elderly.
It’s true within a few months of inception, they were asked to achieve different things. But both health improvement and safe care in the home will only work if all our community assets are mobilised.