Phil Hunt on getting more out of Health and Well Being Boards
By common consent, the 2012 Health and Social Care Act is one of the worst pieces of legislation passed in the history of the NHS. Disowned by Downing Street and described by the highly respected King‘s Fund as damaging and distracting, it was the last thing our health service needed when hit by growing pressures and an unprecedented funding squeeze.
Ironically however, the one piece of the legislation that did get general support – the creation of Health and Well Being (HWB) Boards – may lay the foundations for a much more integrated health and social care system contributing to the economic development of communities. Made up of representatives from councils and the NHS, the HWB Boards are tasked with assessing the health needs of their local population, promoting greater integration of services through joint commissioning and pooled budgets. They have made a steady rather than spectacular start.
Recent King’s Fund analysis describes the impact of the HWB Boards to date as variable and limited, with little sign that they provide the collective leadership needed to tackle pressing issues. This isn’t altogether surprising. The current health and social care system is almost designed to put obstacles in the way of effective local leadership and integration of services. A series of different agencies, funding streams and conflicting targets makes working together much harder.
And yet, we know that this has to change. Twelve years ago, Derek Wanless’s health review warned that unless we took prevention seriously, the UK would be faced with sharp rises in the burden of avoidable illness. How right he was. That is why our proposals for whole person care are so important. They aim for real integration with joint ownership, budgetary alignment, and accountability through the HWB Board, alongside a much stronger emphasis on helping to improve people’s health.
By asking HWB Boards to lead local commissioning for the increasing number of people with complex and multiple needs, and by bringing together services to work around people, we will finally be able to link health policy with all the other local level policies that have a bearing on health. Most notably, housing, planning, education, employment, skills and leisure, which by combining forces could do so much more to build up more resilient individuals and communities.
An excellent series of essays launched today by The Smith Institute think-tank shows the potential. As Rose Gilroy and Mark Tewdwr-Jones of Newcastle University point out, there is a critical relationship between health and the economy. Indeed, the 2010 Marmot review identified both a strong case for reducing health inequalities and a compelling economic case. Health inequalities are estimated at more than £30bn a year in lost productivity and welfare/health costs.
One more positive outcome of the NHS and local government working more closely would be to recognise their massive potential as employers of over 10% of the workforce, including improving their health and well-being. Reaching out meanwhile, to local schools and colleges could encourage apprenticeships and support people onto the skills ladder.
The link between economic performance and the health of local communities is increasingly clear. But revitalised HWB Boards could be crucial in focussing on one of the biggest challenges we face.
Lord Phil Hunt of Kings Heath is Shadow Health Minister in the House of Lords. He tweets @LordPhilofBrum
Published 26th February 2015