Acute trusts absent from local wellbeing boards

The King’s Fund study shows for the first time that while senior councillors and GPs are widely participating in the bodies intended to offer a democratic input into the NHS, the overwhelming majority of health and wellbeing boards have no representation from acute providers.

All 152 top-tier councils are expected to have shadow boards in place this month. They will become fully operational in April next year. The boards will be tasked with assessing the needs of their local population, promoting integration and producing a local health and social wellbeing strategy to guide commissioning plans.

The King’s Fund survey of 50 shadow board lead officers found that 25 of the bodies were led by the council’s portfolio holder for health, adult social care or children’s services. Seventeen are led by either the council leader, deputy leader or elected mayor.

Of the 49 who answered a question on sectors represented on the board, all said that local clinical commissioning groups were involved and all but one had representation from social care and public health.

A narrow majority have third sector representation but only 12 have secondary care providers represented, against 37 who do not.

Richard Humphries, lead author of the report and King’s Fund senior fellow on social care, said the lack of provider representation on the boards was “OK, as long as the boards are engaging with providers in other ways”.

But Foundation Trust Network chief executive Sue Slipman said: “Health and wellbeing boards will not be able to influence the development of patient pathways unless they involve providers in their debates and work closely with them to get the outcomes everyone will want on behalf of patients and service users.

“If boards fail to involve providers, there are likely to be unintended consequences in large measure.”

The survey also found that 49 of the 50 respondents claimed that the bodies would deliver on their identified priorities; 42 said they would lead to increased pooling of commissioning budgets and 48 said they would help achieve greater service integration.

Mr Humphries said: “The boards represent a great opportunity to bring together different stakeholders in the new health and social care system but they’ve got some formidable obstacles to overcome – the worst financial conditions in memory and the complexity of organisational change.”

He warned the lack of shared boundaries between commissioning support services and local authorities presented a “worry” with the development of CSSs “not well connected with the work that’s going on” with HWBs.