Birmingham Health and Wellbeing Board Experience

Alan Lotinga, Director of Health and Wellbeing

National Context

• The Health and Social Care Bill - getting the best from clinical commissioning and local democratic accountability

• One of few major new responsibilities for local government

• Public health transfer/transformation critical but not the only thing to lead on

National Context

• Health and Wellbeing Board (HWBB) crucial "common denominator" and vital to show leadership to manage system risks during massive change

• Requires new thinking and mindset beyond traditional committees. Its about capitalising on relationships, with offers and asks from key partners.

Birmingham Context

• Population of 1.1 million, relatively young, very diverse. 30%+  black and ethnic minority backgrounds

• Health inequalities - people generally sicker, younger and for longer

• From 4 PCTs to 3 to 1 to a ‘Cluster’, to 12, now 4, Clinical Commissioning Groups (CCGs) in just 8 years

Birmingham Context

• 13 Chief Execs of health commissioners

• Very large NHS Foundation Trusts across acute, community and mental health

• From 4,600 to 2,900 staff employed on adult social care

• 0 - 3 stars adults, 0 to 1 to 0 stars children

Experience to Date

• Early value of bringing together strategic management of health and care, with a true democratic mandate

• Closer links to communities with poorest health outcomes

• Birmingham would have to adapt more traditional approach to deal with large number of partners and interests and diversity

• Avoid ‘talking shop’ – get a balance between representation and decision-making

• Early adopter, Shadow HWBB

Experience to Date

• Worked with University of Birmingham Health Services Management Centre

• Workshops of Cllrs., GPs, Third Sector/LINk, NHS and BCC officers

• Expectations from the HWBB, how to achieve good outcomes from complex issues

• Scenarios, getting real added-value and buy in• Additional discussions with LINk, etc.

Experience to Date

• 9 months before Shadow HWB met, key players changed, need to return to "OD" work

• Necessary governance forming, meaty issues starting to be dealt with

• Crucial to relate to needs and aspirations of residents and engage truly with communities.

Some Challenges

• Integration of Children's Services and JSNA - HWBB must look across the lifespan

• Managing risks of unintended consequences • HWBB to agree its own measures of success • Public health transition not just about move to local govt. • HWBB's role in CCG authorisation process • HWBB can't be a ‘magnet’ for all considerations and

decisions

Some Challenges

• Make full use of existing and emerging networks and groups

• Ensuring political balance and stability for GPs around major policies

• Role of Scrutiny • Right balance between representation and manageable

numbers to make decisions e.g. CCGs, public and patient view, providers, third sector?

Early Wins?

• City Director of Public Health appointment well-advanced • 3 or 4 big early public health transfers in hand • Structures/networks in and around HWBB properly

‘wired in’ • Clear criteria for judging joint commissioning success

and agreed way forward in childrens’ and older adults’ joint commissioning and service integration

Early Wins?

• Clarity on shape and content of Health and Wellbeing Strategy

• Clarity on way forward on local HealthWatch • HWBB role in CCG authorisation confirmed and

happening • No more than 5 high-level HWBB performance/success

measures agreed e.g. regarding system risks and setting up new arrangements.