Health and wellbeing boards are statutory bodies introduced in England under the

Health and Social Care Act 2012 The Health and Social Care Act 2012 (c. 7) is an Act of Parliament (UK), act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service (England), National Health Ser ...

, whose role is to promote integrated working among local providers of healthcare and social care.

Establishment

The 2012 Act required each upper-tier local authority in England to form a health and wellbeing board as a committee of that authority; more than 130 "shadow" boards were created before April 2013, when they all became fully operational.

Duties

The aim of the boards is to improve integration between practitioners in local health care, social care, public health and related public services so that patients and other service-users experience more "joined up" care, particularly in transitions between health care and social care. The boards are also responsible for leading locally on reducing

health inequalities Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...

Joint strategic needs assessment

Each board produces a joint strategic needs assessment (JSNA) for its local authority area, replacing the JSNA formerly prepared by local authorities and

primary care trust Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...

s (PCTs), under Section 116 of the Local Government and Public Involvement in Health Act (2007). A JSNA provides local policy-makers and commissioners with a profile of the health and wellbeing needs of the local population. The aim of the JSNA is to improve commissioning and reduce health inequalities by identifying current and future health trends within a local population. It is expected that the JSNA should be based on analysis of: * demographic data about the local population (such as age, gender and ethnicity) * social, economic and environmental determinants of health (such as housing, crime and employment) * behavioural determinants of health (such as smoking, drinking and dietary habits) *

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...

(such as life expectancy, quality of life, and prevalence of diseases and conditions) * access to services and use of services (such as admissions, discharge and usage data) * evidence of effectiveness (such as guidelines of the

NICE Nice ( ; ) is a city in and the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative city limits, with a population of nearly one million Department of Health guidance recommends that JSNAs are refreshed every three years.

Joint health and wellbeing strategy

The boards are also responsible for producing a joint health and wellbeing strategy. The first of these were published by the "shadow" boards at the end of 2012. Priority areas identified from JSNAs are key for the development of joint strategies, which in turn feed into commissioning plans. The boards also look at which areas may need deprioritising and decommissioning. The strategic direction of implementation and service delivery for health and wellbeing boards is outlined in the joint strategy documents.

Involvement in commissioning

Health and wellbeing boards have no statutory obligation to become directly involved in the commissioning process, but they do have powers to influence commissioning decisions made by

clinical commissioning group Clinical commissioning groups (CCGs) were National Health Service (England), National Health Service (NHS) organisations set up by the Health and Social Care Act 2012 to replace Strategic health authority, strategic health authorities and NHS pr ...

s (CCGs). However, CCGs and local authorities may delegate commissioning powers to health and wellbeing boards so that they can lead on joint commissioning. JSNAs and joint health and wellbeing strategies, produced by the boards, are key tools that CCGs use in deciding what public health services need to be purchased. In this sense the boards have a role in shaping the local public health landscape, and helping CCGs to commission services in an effective and targeted manner. An early survey of 50 local authorities found that the majority of the respondents thought that joint health and wellbeing strategies would be influential in relation to the decisions of CCGs. There is also a statutory requirement that CCGs consult health and wellbeing boards throughout the commissioning process in order to align with the local joint health and wellbeing strategy. The boards can also report any concerns regarding commissioning decisions to the national body responsible for the governance of CCGs, the NHS Commissioning Board.

Structure and composition

Structure of the health and social care system

From April 2013 the changes enacted by the

saw the creation of new local and national bodies within the system, such as health and wellbeing boards,

s and the NHS Commissioning Board. Within the local health and social care system, health and wellbeing boards sit below

local authorities Local government is a generic term for the lowest tiers of governance or public administration within a particular sovereign state. Local governments typically constitute a subdivision of a higher-level political or administrative unit, such a ...

and clinical commissioning groups. However, the boards sit above local Healthwatch groups and health and social care providers.

Structure of the boards

Health and wellbeing boards sit within unitary and top-tier local authorities as committees of those authorities. Although they hold responsibility for public health at the local level, the administration and governance of the boards is not part of the

NHS The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

Composition of the boards

There is a minimum membership required for a health and wellbeing board, as follows: * a local elected representative * a representative from the local Healthwatch * a representative from each local

* the local director of adult social services * the local director of children's social services * the local director of public health * a representative nominated by the NHS Commissioning Board Beyond this minimum membership other interested local stakeholders may also be invited to hold membership of a health and wellbeing board. These may include representatives of third-sector or voluntary organisations, other public services, or the NHS.

Future possibilities

The boards could be put in charge of commissioning combined health and social care services if they beefed up their contingent of clinicians according to Kate Barker, who chaired the

King’s Fund The King's Fund is an independent think tank, which is involved with work relating to the health system in England. It organises conferences and other events. Since 1997, they have jointly funded a yearly award system with Smith Kline Beecham ...

commission on the future of health and social care.

Andy Burnham Andrew Murray Burnham (born 7 January 1970) is a British politician who has served as Mayor of Greater Manchester since 2017 Greater Manchester mayoral election, 2017. He served in Gordon Brown's Brown ministry, Cabinet as Chief Secretary to th ...

suggested that the boards could be in charge of the process of integration of health and social care which he wants to see.

Clinical commissioning group Clinical commissioning groups (CCGs) were National Health Service (England), National Health Service (NHS) organisations set up by the Health and Social Care Act 2012 to replace Strategic health authority, strategic health authorities and NHS pr ...

leaders were not enthusiastic about Labour suggestions of making health and wellbeing boards “system leaders” for services for people with multiple long term conditions, disability or frailty. In March 2015

London Councils London Councils is the collective of local government in Greater London, England. It is a cross-party organisation that represents London's 32 borough councils and the City of London. It was formed in 1995 as a merger of the London Boroughs A ...

called for Health and wellbeing boards to be handed responsibility for managing pressures in the health and social care system next winter.

References

External links

Department of Health - Early implementers of health and wellbeing boards announced

Department of Health - Public health for local government factsheets

NHS Confederation - Operating principles for health and wellbeing boards

{{NHS England National Health Service (England)