MPs back wellbeing boards to be 'system leaders'

In a report released last week the committee warned the NHS was at risk of failing the “Nicholson challenge” of year-on-year efficiency savings to meet rising care demand and said there had not so far been the “transformative change” needed to make services financially sustainable.

To facilitate this it calls for a much more prominent role for health and wellbeing boards, the ring-fencing of the social care budget, and for the government to make sure competition law is not getting in the way of “necessary change”. 

In its report, the committee blamed “fragmented commissioning structures” for preventing the growth of integrated services. To overcome this it says HWBs should provide an “integrated commissioner’s view” of the change needed across the health and care system. 

In the committee’s opinion the HWBs also represent the best candidates to be the “system leaders” who will drive the necessary change to make the NHS sustainable. The reports says: “Without a body which can take charge of decisions about reconfiguration and integration of services, change which needs to be made to maintain and improve services will not happen.”

In a press briefing, Mr Dorrell said the incoming chief executive of NHS England Simon Stevens should look at what needs to be done for HWBs to become “commissioners of joined-up health and care services”. He said it might require some “relatively minor” legislative changes, but stressed the committee was not calling for “another blockbuster piece of legislation to make this happen”.

Speaking to HSJ later, Mr Dorrell said the expansion of HWBs’ responsibilities would be a “process not an event”.

He added that different localities would pursue integration in “slightly different ways”, and that in some areas HWBs might not be the most appropriate organisations to lead integration.

Mr Dorrell said: “If there is nothing else that is going to deliver a more joined up commissioning process, then it ought to be the HWB and we should be encouraging HWBs to develop that function”.

The committee repeats a previous recommendation that social care spending should be ring-fenced, claiming that without it “there is a serious risk to both the quality and availability of care services to vulnerable people in the years ahead”.

While the report does not explicitly state that competition law is preventing service change, the committee call for the government “examine the background” to the  Bournemouth and Poole merger – which was prevented on completion grounds – “in order to ensure that unnecessary impediments to necessary change are removed”.

The committee also evaluates efforts made to meet the challenge first outlined by NHS England chief executive Sir David Nicholson, who said that increasing demand for care combined with a static budget meant the NHS had to generate 4 per cent year-on-year savings.

The committee found that the NHS hit its target over the first two years of the quality, innnovation, productivity and prevention efficiency programme, saving £10.8bn.

However, the report says the growing number of trusts reporting underlying deficits “represents evidence that the pace of change has not been sufficient”.

It also says that pay restraint “contributed substantially” to the savings already achieved, which according to the committee does not represent a “prudent” or “just” solution to maintaining efficiency over the long-term, although chairman Stephen Dorrell confirmed the committee would not be “aligning [itself] with particular pay negotiations”.