Early formation of health and wellbeing boards can quickly reduce wasted effort and result in clear strategic oversight of health issues - but they need to stay free from too much Whitehall interference, as Blackburn with Darwen Borough Council chief executive Graham Burgess explains.
During the 19th century, local government in Blackburn embarked on a radical programme of brokerage and intervention to improve the health of the local population, building 30 miles of sewers, providing waste disposal plants, purchasing infrastructure for water, gas and fire and supporting residents and volunteers to improve housing and tackle poverty. All of this had a dramatic impact on the health of the citizens of Blackburn.
Many of the themes from that period resonate today, including an enormous challenge to improve health outcomes. While the nature of health problems have changed fundamentally in the intervening century, the verve and determination of all sectors to improve health outcomes in Blackburn with Darwen is comparable.
It is for this reason that we were eager to become an early adopter of the new health and wellbeing boards as these would provide the impetus for us to remove any duplication across the borough and channel our energy more effectively.
By creating one body, chaired by the chair of Blackburn with Darwen Care Trust Plus, we are able to remove other groups that have been operating across the local strategic partnership and the local NHS, thus avoiding duplication of effort and giving the board clear strategic oversight of the health problems of the borough.
Health and wellbeing boards will be crucial in gaining the wider stakeholder engagement and accountability in the whole causal chain of improved health. Elected members working closely with the newly emerging commissioning consortia and the wider community will be able to develop more integrated models of service delivery to the most vulnerable.
A strategic public health service led by the director of public health will have a central role in challenging all stakeholders and bringing forward evidence based strategy for action. Blackburn with Darwen council and the care trust have already integrated the NHS and local government management teams as well as many of our back office functions to give us a huge advantage in more effectively coordinating the health resources we have, and also making significant financial savings for both organisations.
For the last three years we have opened up our leisure centres and gyms free of charge for people living in the borough and are seeing remarkable improvements in physical activity undertaken by those least likely to exercise.
It is also important that the health and wellbeing boards provide an effective challenge to the public sector organisations within the borough. We will also challenge the NHS Commissioning Board to ensure we are allowed to follow a truly localist model of service delivery.
It is of concern to us that the board is to retain a significant budget to deliver initiatives and programmes that it sees as a priority, particularly around children’s health.
Surely the best solutions to these problems will be found at a local level?
These cultural issues regarding Whitehall’s reluctance to pursue the government’s localism agenda threatens to curtail our ambitions.
By committing us to national public health strategies we are in effect being told to how we should allocate our funding - some of which would consume a significant amount of “local” prevention spend.
A similar argument is being made around the ring-fencing of public health budgets.
If health and wellbeing boards are to have influence over council services that have an influence over health outcomes, why would the public health budgets remain ring-fenced?
Not only will this promote silo working but it creates a barrier to any attempt to maximise the impact of pooling both the council’s significant health spend with public health.
In fact, in our borough we want to take this a step further by looking at ways of pooling all of our public sector resources, not just the council and NHS spend, ring-fencing, especially if a permanent feature, runs against this aspiration.
No doubt many of these issues will be resolved over time as the new structures begin to bed in.
However, when you consider an area like Blackburn with Darwen where we have the fifth worst male life expectancy and the tenth worst female life expectancy in England, time is something we don’t have.