Making collaborative bodies such as health and wellbeing boards work can be difficult. But approach the development of these local partnerships in the right spirit and much can be achieved, says Hay Group director of public sector practice Phil Kenmore.
Do you have an invitation to your local health and wellbeing board on your desk? Like many others, are you wondering how you can make this new recipe for local partnership work better for your community than the previous ones?
Health and wellbeing boards are intended to lead on improving the strategic coordination of commissioning across NHS, social care, and related children’s and public health services. Their make-up has been outlined in the Health Bill, the core membership defined and the Department of Health is now leaving it up to local authorities to decide how they are going to establish the boards. Early implementers are in place to see whether the idea flies or falls over.
Whether you are a new player to such bodies, say a new commissioning consortium lead or a HealthWatch representative, or an old hand such as a director of children’s services or council leader, the question remains the same. How are we going to ensure this is something which makes a difference? How to prevent it being another type of partnership board with no real teeth and no real influence on the organisations that turn up?
Yes, it is a statutory responsibility on local authorities to make sure the boards are set up. But that is no guarantee they will be an effective coming together of the local players – especially at a time of transition and significant resource constraints that can fracture even pre-existing and solidly built partnerships.
Shock of the new
Making such collaborative boards and functions work is notoriously difficult – and those taking part in these for the first time may be in for a shock. With so many players in attendance, so many varied agendas, priorities and pressures and so much uncertainty in the system, the health and wellbeing boards are ripe for talking-shop failure. Success is often about culture and leadership rather than any process or structure.
One of the core roles for the health and wellbeing boards are of course joint strategic needs assessments – and this is why commissioning consortia should be paying very close attention to ensuring their engagement and role at the health and wellbeing board is cemented early on.
How do you make your health and wellbeing board work?
The first action takes willpower: set aside any cynicism in the system from all those “old hands” who have been around for ages and “seen it all before.” Yes, it is another government mandated partnership but some of those involved are genuinely new and will bring new perspectives, ideas and grit into the mix.
Don’t resist it – embrace it as an opportunity for change. Setting aside the pre-existing views and world weariness is an act of explicit leadership. Don’t fall into the trap of paying only lip service to this change.
Second, take time out at the beginning (no matter how “urgent” everything feels) to work at establishing a genuinely shared vision for your collective impact on your community. There is a real opportunity here to re-engage the public and add new value through greater alignment of health and social care.
This is the glue that will hold you together as times get tougher and inevitable conflicts arise. Failure to do this at the beginning will put the brakes on the implementation of change.
Next, focus on building relationships. Regardless of the difficulties of the NHS transition phase, or the future structures under the bill, it is the strength of the relationships between commissioning consortia, providers and local authorities in particular that will drive success.
Investing in these relationships now will pay dividends. Focus on building trust, honesty and transparency. It is also important that senior leaders are consistently in the mix themselves – sending representatives shows a lack of true commitment.
Part of building relationships and transparency is being clear as a health and wellbeing board what the partners agree it is there to do and not to do.
What the organisations will not allow the board to do is as important as its agreed functions. This avoids straying into areas where commitment from members will be less – and they may not be open about – and keeps the core of activities to areas where there is a genuinely shared commitment that the health and wellbeing board is the place to do that business.
Finally, it is important to agree not just the “what” but also the principles of how the board is going to work. What behaviour do all the members expect from each other and how are we going to work through conflict? Discussing and agreeing some of this up front will make resolving issues much easier later on.
Like any new partnership group, it will take time for the real purpose and modus operandi to become embedded and accepted by all. Taking the time for the actions above at the start of the process will reap rewards in the medium and longer term, and generate better outcomes for the community around which the health and wellbeing board is centred.