What’s the point of Health and Wellbeing Boards?

You may have been following the changes to the NHS over the last few years. Or perhaps you are just a user of services, going to your General Practitioner and then to a local hospital. Either way, you should know that your local Council has been given some wide-ranging powers to provide local health and social care services. Who cares? It’s a reasonable response to all of the changes. But there are some things should concern you.

Look at these three data points about health services in England.

  • One in two hundred babies are stillborn in England
  • Young people can wait months to receive mental health services
  • In the UK young men die younger than in just about any other European Country.

in the light of these issues I want to look at what Local Health and Wellbeing Boards are discussing. Using a search engine of your choice, you will quickly find the papers of you local HWB on the internet. And that’s where it pretty much turns to rat shit. The jargon and impenetrable language are there in the first paragraph. Here is the explanation of what the HWB does in Brighton.

The purpose of the Board is to provide system leadership to the health and local authority functions relating to health & wellbeing in Brighton & Hove. It promotes the health and wellbeing of the people in its area through the development of improved and integrated health and social care services.

The HWB is responsible for the co-ordinated delivery of services across adult social care, public health, and health and wellbeing of children and young peoples’ services. This includes decision making in relation to those services within Adult Services, Children’s Services, Public Health and decisions relating to the joint commissioning of children’s and adult social care and health services (s75 agreements).

Are you any the wiser? Perhaps the focus on young people caught your eye.

Reading the Agenda and the Minutes of the meetings won’t help you. They are even more Delphic.

However, the most concerning element for any Public body are the meetings they held in camera. They regularly exclude the public from their discussions.

Members are often keen to show they have no conflict of interests, and it’s usually the first agenda item. But no one seems concerned that as mainly elected officials they are in conflict with their electorate for excluding them. You might also reasonably ask why there are so many doctors and so few nurses as members of your HWB. Perhaps too much interest all round.

So, if you have the time to attend an HWB meeting, go and listen to their arcane discussions, see if you understand what they are doing in your name.

The next meeting here in Brighton is in September. I will be there.

Integrated Care Networks

Why is it that the NHS sees each episode of care as unrelated.   The term “discharge letter”  seems to imply that the hospital is not expecting to see this person again.  A much better term would be a  “summary of care” letter, it suggests that care continues and the hospital is explaining its role to other professionals in the process of care.

The language that professionals use to explain what they are doing tells us what their intentions are.  People expect their care to be integrated, they want the next person to know that the last person they saw had diagnosed and the treatment plan embarked upon..  Sadly it seems that in the UK what we expect and what we get are very different.

The DOH is looking at a number of integrated care pilots involving social services, housing and local government.   My concern is that the NHS needs to integrate the care it provides between primary and secondary care long before it looks to involve others.

My principles for integrated care start with those defined by the WHO, they are:

        • universal access to care and coverage on the basis of need;
        • commitment to health equity as part of development oriented to social justice;
        • community participation in defining and implementing health agendas;
        • intersectoral approaches to health.

and I would add:

        • treatment, care and support to be person-centred, inclusive and holistic to address the wide ranging needs of the person

        • the service response to be needs-led and not limited by organisational or administrative practices

        • collaborative working between agencies and service providers at each stage in the progress of the individual in treatment, care and support, through to rehabilitation and reintegration into the community

The NHS should make sure its current provision maps to these principles.

Looking forward to 2009

image John Coulthard, director of healthcare at Microsoft UK, reflects on the challenges facing the health service in the year ahead. He argues the coming year will be dominated by the need to make extremely demanding efficiency savings, while delivering on the personalisation agenda set out by Lord Darzi.


The main theme of the coming year will be the recession, and for everybody involved in healthcare the challenge will be how to do more with less. The years of plenty are over, but delivery of the huge policy agenda set out by Lord Ara Darzi at the end of his Next Stage Review has only just begun.

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