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.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 trusts (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) *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 groups (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
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 theComposition 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 clinical commissioning group * 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 theSee also
* Health and Social Care Act 2012References
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