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Health and Wellbeing Boards HWB: WORKING WITH PARTNER ORGANISATIONS RELATIONSHIPS AND RESPONSIBILITIES The London Health and Wellbeing Board Partnership Support Programme Aims of this slideset • Clarify role and functions of Health and Wellbeing Board (HWB) partner organisations and other agencies • Develop understanding of how and when HWBs will need to work with each agency • Help HWBs to manage this set of relationships over time HWB relationships in their local context This slideset is designed to be tailored to the local context. The box on „relationships‟ on each slide can be edited to address specific local issues. The summary matrix at the back of the slideset can similarly be edited to highlight relationships with partner bodies and other agencies that are most important to the HWB at any point in time. HWB relationships – the drivers For HWBs to be „system leaders‟ its membership needs to understand what drives each key player in the system Pressures on each body or agency will take different forms: • needs and demands of users and public • vertical accountabilities to national government • local accountability to the electorate • limits on available powers or resources RELATIONSHIPS AT THREE SPATIAL LEVELS NATIONAL, SUB-REGIONAL AND LOCAL Department NHS of Health Commissioning Public Health Board England Public Health Care Quality NHS CB London Commission England, London NHS Provider Monitor Mayor LSP Trusts Community Voluntary and Monitor And GLA NHS CB London Safety Community providers Delivery Team Safeguarding Private sector LHIB Children and young people Health and social Borough HWB CCGs care professionals Council Healthwatch Health scrutiny England Local NICE Council Healthwatch Social enterprises London Departments Patients Carers and Clinical Sub-regional The Public COMMUNITIES Service users Senate Partnerships Neighbourhoods Community groups London Clinical LETBs LOCAL Networks Health London AHSCs Education London PAN LONDON OR and AHSNs England CSUs SUB-REGIONAL NATIONAL Adapted (with permission) from LGA national diagram, Nov 2012 HWB RELATIONSHIPS AT NATIONAL LEVEL HWB RELATIONSHIP WITH NHS COMMISSIONING BOARD NHS CB UNDERSTANDING THE RELATIONSHIP NHS CB London • The relationship between Borough HWBs and the NHS CB NHS CB London Delivery Team HWB will largely be conducted through the Delivery Team The NHS CB is an autonomous non-department public body which operates within the wider health and social care. It • At the local level the NHS CB will support HWBs through the assumes its full responsibilities in April 2013, on the production of the JHWS, to identify how efficiencies can be dissolution of SHAs and PCTs. reinvested into preventative services and the wider determinants of health to improve outcomes across the system The Board‟s overarching role it to ensure that the NHS delivers better outcomes for patients within its available • Although the relationship will be largely through the London resources, provide leadership for the NHS, commission Area Team, HWB members may also engage with the services and champion patient and carer involvement. NHS CB through other emerging national and sub-regional networks, such as the Clinical Senate (see later slide), the The Board will: NHS Quality Board, or through the National Leadership Groups • assess, assure and hold CCGs to account for delivering their statutory responsibilities RELATIONSHIP ISSUES • commission certain primary services (e.g. dental, pharmaceutical) • NHS CB Delivery Teams will be operating to a NHS • commission specialised services (e.g. specialised Single Operating Model cancer, haemophilia) • commission armed forces and offender health care • The aim is to „support consistency not standardisation‟ but it is • commission certain health services on behalf of not yet fully clear what flexibility the Delivery Teams will have to Public Health England (e.g. screening and respond to very different needs across London immunisation) • The extent to which HWBs and CCGs will be able to exert The London region of the NHS CB will include one of any upwards influence on the NHS CB also remains to be 10 „enhanced‟ Area Teams, with an estimated seen Budget of £4.2bn for Direct Commissioning. Dr Anne Rainsberry is the NHS CB Regional Director for London. HWB RELATIONSHIP WITH NHS COMMISSIONING BOARD Directorate Design Principals – The NHS CB will have 9 directorates Prof Malcolm Grant, Chairman Sir David Nicholson, Chief Executive Jane Cummings, Sir Bruce Keogh, Chief Nursing Medical Director Officer Ian Dalton, Dame Barbara Tim Kelsey, Bill Jo-Anne Paul Chief Hakin, National National McCarthy, Wass, Operating Baumann, Director of Director of National National Officer and Chief Finance Commissioning Patients and Director of Director of Deputy Chief Officer Executive Development Information Policy HR HWB RELATIONSHIP WITH PUBLIC HEALTH ENGLAND UNDERSTANDING THE RELATIONSHIP Public PHE Health HWB • PHE is intended to work with a ‘culture of subsidiarity, England London focussed on support for local accountability’ (DH) • Chief Executive Designate Duncan Selbie has been clear that the organisation will not be in the business of running a performance management regime The role of Public Health England (PHE) is to be ‘the • PHE will not sit on the sidelines if performance against authoritative national voice and expert service provider on the PH Outcomes Framework is seriously adrift in individual public health‟. PHE is being set up from an amalgamation of boroughs previous bodies (health observatories, Health Protection • In such circumstances, intervention is likely to be pursued Agency, National Treatment Agency). through the LGA/London Councils self-improvement framework, as would be the case for adult social care or The organisation will be established from April 2013 as an childrens „services executive agency of DH, responsible to the SoS and Permanent Secretary. It will provide a public health service to RELATIONSHIP ISSUES the NHS CB, while being defined as operationally • Analysis of 2010/11 public health spend across Boroughs independent. shows huge variance (£19 in Bexley to £117 in Tower Hamlets) •The final allocations for 2013/14 are a key concern for HWBs The proposed structure of PHE includes an Operational • Some Boroughs question whether there will be sufficient Directorate, organised in 4 regions and 15 centres. London budget to deliver their new statutory responsibilities while will have an „integrated region and centre‟. also coping with demand-led services such as sexual health Operations Directorate will be responsible for: • In London, a number of Boroughs have chosen to share a • performance of PHE delivery chain DPH post, and some have yet to appoint. The pool of suitable • focusing on the Public Health Outcomes Framework expertise is small • securing engagement of all agencies in public health improvement Public health interventions require planning and delivery over • leading alignment of PHE resources in support of local time frames of many years. HWBs are likely to experience initiatives pressures for delivery over shorter (and politically-driven) timescales. Politicians will need to show long-term vision to take full advantage of „a generational opportunity‟. HWB RELATIONSHIP WITH CARE QUALITY COMMISSION Care Quality Commission HWB The Care Quality Commission began operating on 1 April 2009 UNDERSTANDING THE RELATIONSHIP as the independent regulator of health and adult social care in • Given that the CQC has already been operating for 3 years, England. It replaced three earlier commissions: the Healthcare its role will be familiar to local authorities Commission, the Commission for Social Care Inspection and • For GPs, now being registered by CQC, the relationship the Mental Health Act Commission. is new • The span of CQC responsibilities has widened significantly The Commission was established by the Health and Social stretching its capacity Care Act 2008, which sets out its duties and responsibilities. Its • CQC is moving towards „regulating different sectors in legal status is that of a NDPB of the Department of Health. different ways‟ to meet an increased workload within the same resources All health and social care facilities are required to register with • CQC has been consulting on its strategy for 2013-16 the CQC. The Commission carries out inspections and has (consultation concluded 6 December) powers to enforce standards set by Government on quality and safety.. RELATIONSHIP ISSUES • CQC has had a difficult 18 months in terms of maintaining The CQC began in September 2012 to register 8,500 GP public and Parliamentary confidence in its registration and practices as the last stage in completing registration of all inspection regime health and care bodies. • CQC will be using its role as the parent body for Healthwatch England to strengthen feedback from the public on The Commission receives a £60m grant and is completing how it should operate in future recruitment to a staff of 995 inspectors. David Behan is the • Individual London HWBs should not need to develop a close chief executive. David Prior was recently appointed as the new working relationship with CQC unless there is an example of Chair of CQC. major failure of a hospital or care facility in the borough HWB RELATIONSHIP WITH NICE NICE HWB UNDERSTANDING THE RELATIONSHIP • NICE is a national source of authoritative and respected guidance, which should help HWBs in drawing up the JHWS NICE provide independent, authoritative and evidence-based and in developing multi-agency initiatives
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