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Health and Wellbeing Boards - new structures for strategic delivery of Health and Wellbeing Ann Bullen Health and Social Care Partnership South East Health, Well-Being and Support Conference 10 th April 2013

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Page 1: Health and Wellbeing Boards - new structures for strategic ... pdfs/Presentations... · Health and Wellbeing Boards - new structures for strategic delivery of Health and Wellbeing

Health and Wellbeing Boards - new structures for strategic

delivery of Health and Wellbeing

Ann Bullen

Health and Social Care Partnership

South East Health, Well-Being and Support Conference

10th April 2013

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Introduction

• Health and Wellbeing Board development - looking at some possible scenarios

• Joint Health and Wellbeing Strategies - audit findings

• Questions for you…

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Health and Wellbeing Boards

“Engine room” System

leadership

Body of commissioner

s

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Mapping the new system

Local Government

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Base Camp

Rising Star

Better lives

Business as usual

Means well

Talking shop

Empty seat

Faction Fracture

Big

Brother

Creative cats

FACTION FRACTURE

• All partners participate, have commitment & vision

• Factional conflict happens when personalities join together

• Fracture may occur here: - County vs District - elected members vs health commissioning - primary vs secondary health - provider vs commissioning - resource pressures vs priorities - social care vs health - user voice vs services - voluntary vs statutory services

• Governance breaking down

EMPTY SEAT

• HWB works reasonably effectively; governance works

• HWB understands new era of closer partnership working & better use of money across wider sectors; HWB is committed

• Local political map naturally excludes opposition party

• BUT key player (a locality or sector) is missing, where needs are not included despite overall ‘success’

BIG BROTHER

• One party dominates disempowering partners

• Business is ineffective with disengagement by partners

• Elected members overawed through lack of knowledge

• Scrutiny & safeguarding is not transparent

• Joint business is not done well, or in piecemeal way

TALKING SHOP

• HWB functions, but real decisions are done elsewhere in the locality

• Elected members fulfil duty, but no function

• HWB may be dysfunctional & goes round in circles with no opportunity to meaningfully participate in executive decision making

• Governance happens, but is two-dimensional

BUSINESS AS USUAL

• HWB exists

• Established Joint Commissioning continues as before without radical change

• No de-commissioning, little questioning

• Safeguarding disconnected from mainstream commissioning decisions

• Established governance has no impact

• Political acceptance, but no scrutiny

• Decisions made ratify current status quo

BETTER LIVES

• Mrs Smith & family are enabled to maintain their wellbeing, receiving person-centred care if needed

• Collective leadership across systems for public functions

• Partners sign up to comprehensive pooled budget

- underpinned by clear & wide-ranging partnership agreements, joint commissioning, pooled budgets – ‘Total Purse’

• Elected members engaged, informed & communicating strategic direction; recognition of whole, 3-tier local authority structure

• Shared risk taking & appreciation of whole system including Health and council services

MEANS WELL

• One party insists on leading, to general agreement of all, or in the face of lack of other candidates, but is ineffective in doing business. This may be due to: - underestimation of role - lack of experience, or skills - poor guidance - wrong starting position to appreciate wider picture

• Governance misses key issues

• Elected members supportive, but complicit

• Good engagement with stakeholders, but limited outcomes for Mrs Smith & her family

CREATIVE CATS

• HWB development has enthusiastic leadership & committed partnership

• Elected members supportive, but uninformed

• But no connection to process, actions and outcomes

• Governance is haphazard

• No systematic learning

RISING STAR

• Mrs Smith & family beginning to feel connected service provision

• All parties confidently participate in HWB

• Board used to generate aspirational strategy

e.g. children’s trust acts as delivery arm

• Increasingly joined up commissioning & de-commissioning

e.g. JSNA actively used to implement strategy

• Political will supports progress

• Increased integration & pooled budgets

• But, still a journey to make

BASE CAMP

• HWB functions & included in local health and council governance structure

• Some good starting points

e.g. joint arrangements and pooled budgets within specific areas

• Elected members on board & engaged

• Good awareness of safeguarding

• Good base to begin wider partnership working & moving on

e.g. refreshed JSNA ready for use for commissioning/de-commissioning

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JHWS audit - South of England

• Joint Health and Wellbeing Strategy (JHWS) audit - commissioned by Public Health

• Audit of publicly accessible LA websites to ask:

February 2013

Is there a published Strategy?

What are the stated priorities?

What progress has been made?

What’s the input from the HWB?

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JHWS audit - South of England

• Information found for 27/34 local authorities - variable ease of access

• Looking at the priorities, they show:

Range of:

Local community focus Individual focus

Range of:

Overarching aims Focussed areas for action

Number range: 3 - 19

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JHWS audit - South of England

Common themes:

Children getting the best start in life

Ageing and living well

Health inequalities and healthy lifestyles

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JHWS audit - South of England Some reference to: housing, employment & economic growth

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JHWS audit - South of England Range of Board involvement:

Ratification only Dedicated workshops for board

Range of consultation:

With public via websites/meetings Limited groups

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Turning priorities to action…

Some examples:

East Sussex

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Turning priorities into action…

Kent and Dover

Aligning County and District

Council direction

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Turning priorities into action…

Cornwall

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Turning priorities into action…

Portsmouth

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Turning priorities into action…

Oxfordshire

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General resources

LGA Knowledge Hub - national learning network for health and wellbeing

boards

https://knowledgehub.local.gov.uk/

NHS Confederation - resources for health and wellbeing boards http://www.nhsconfed.org/Publications/Pages/lresources-health-wellbeing-

boards.aspx?utm_source=Web&utm_medium=Promo&utm_term=210612&utm_campaign

=4

The King’s Fund – bulletin for health and wellbeing boards

http://www.kingsfund.org.uk/

Presentations from recent conference: District Councils and Public Health

http://districtcouncils.info/2013/02/13/public-health-event-presentations-

knowledge-hub-group/

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Questions for you…

• How familiar are you with your local Health and Wellbeing Board and Joint Health and Wellbeing Strategy?

• What are the challenges to engaging?

• What would help?

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Ann Bullen

Health and Wellbeing Partnerships

Health and Social Care Partnership

[email protected]