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 guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation. • The extension of the role of NICE into public health and social

NICE was originally set up in 1999 as a Special Health care should assist HWBs to deliver a more integrated Authority and is due to become a non departmental public response across the health and care system body under DH from April 2013. NICE is now taking on new responsibilities to produce guidance for social care. RELATIONSHIP ISSUES • The NHS CB will be supported by NICE in the development of On public health, NICE is issuing a series of public health its Commissioning Outcomes Framework. This will bring NICE briefings for local government. These cover specific topics, closer to NHS CB performance management of the overall designed to identify actions which are effective and give system, which may in turn impact on HWB/CCG relationships value for money (e.g. alcohol, sexual health). • HWBs and London‟s sub-regional partnerships (see separate On social care, NICE is developing guidance and quality slide) may choose to develop a two-way relationship with standards. NICE is currently piloting quality standards on NICE, feeding back practitioner views and evidence via sub- two subjects: regional partnerships or LHIB • care of people with dementia • health and wellbeing of looked after children • For example, Ealing Council, on behalf of the West London Alliance councils, has been working with care home providers Local government will pick up a vast amount of the work to learn more about the NICE role in developing guidance on for the new public health system. NICE will have an social care important role to play in this, through making its evidence based guidance a standard resource for public health • Beyond the above, individual HWBs are unlikely to need to responsibilities. develop a close or direct working relationship with NICE

HWB RELATIONSHIP WITH HEALTHWATCH ENGLAND

Healthwatch Local England Healthwatch HWB UNDERSTANDING THE RELATIONSHIP • Local Healthwatch will have its own vertical referral and reporting relationship with Healthwatch England. HWBs will need to respect this relationship Healthwatch England will be a national body that enables the collective views of everyone who uses NHS and social • Issues of concern raised up the line may relate to the care services to influence national policy, advice and social care services provided by the local authority, or the guidance. primary care commissioned by the CCG, in addition to acute

care or other NHS activities Healthwatch England will have three main functions:

• to provide leadership, guidance and support to local Healthwatch organisations RELATIONSHIPS ISSUES • to escalate concerns about health and social care • There will be times when the HWB may wish to form an alliance services raised by local Healthwatch to the CQC with their Local Healthwatch in flagging up joint concerns and escalating these to Healthwatch England . • to provide advice to the SoS, NHS CB, Monitor and • Local Healthwatch will have specific levers to escalate such English local authorities, all of which are required under the HSCA 2012 to respond to that advice concerns • Boroughs act as commissioners of Local Healthwatch The SoS for Health is also required to consult Healthwatch services so will have a contractual performance England on the mandate for relationship with their local service. This may result in councils the NHS Commissioning Board. approaching Healthwatch England when performance issues cannot be resolved locally Healthwatch England launched in October 2012 and starts work in April 2013. It is being established as a statutory Beyond this, individual HWBs are unlikely to need to develop committee of the Care Quality Commission (CQC). a close working relationship with Healthwatch England.

HWB RELATIONSHIP WITH MONITOR

RELATIONSHIPUNDERSTANDING ISSUES THE RELATIONSHIP Monitor HWB Monitor can potentially remove barriers to integrated care, Newand also role incentiviseof Monitor wasintegrated a controversial care, through aspect its ofapproach the HCSA to Billtariffs during and toits licensing.passage. There were concerns that Monitor The HCSA 2012 makes changes to the way health care is would pursue competition as an end in itself. The Government regulated. Monitor's role will change significantly as it takes on The chair of Monitor has defined its role in these terms: The HCSA 2012 makes changes to the way health care is amended the Bill on this point. a number of new responsibilities. • Creating incentives for all parts of the NHS – commissioners regulated. Monitor's role will change significantly as it takes on a and providers - to work together better and to deliver the best number of new responsibilities. Monitor will have the power to impose licence conditions on It will become the sector regulator for health care, which possible care for their patients; providers where it feels that patients are not benefitting from means that it will regulate all providers of NHS-funded services • Making sure information is available that will help them do It will become the sector regulator for health care, which means a level playing field in terms of competition. Monitor‟s „Fair in England, except those that are exempt under secondary this, and which will help patients get the best out of the NHS; that it will regulate all providers of NHS-funded services in Playing Field Review‟ is in progress as of autumn 2012. legislation. It will also have a duty to „enable‟ integrated care, • Setting down ground rules for all those who provide NHS England, except those that are exempt under secondary parallel to the duty conferred on HWBs. services to increase the quality of care and improve the legislation. Details of the role are here. Chair of Monitor has defined its role in these terms: experience for patients – thereby encouraging greater • creating incentives for all parts of the NHS – commissioners Monitor‟s main duty will be to protect and promote the co-operation and co-ordination within health care services Monitor‟s main duty will be to protect and promote the interests and providers - to work together better and to deliver the best interests of people who use health care services by promoting and between health and social care services of people who use health care services by promoting effective possible care for their patients; effective and economic service provision. It will license and. economic service provision. It will license providers of NHS • making sure information is available that will help them do providers of NHS services in England and exercise functions services in England and exercise functions in four areas: this,RELATIONSHIP and which will help ISSUES patients get the best out of the NHS in four areas: setting prices; • Thesetting primary down aims ground of Monitorrules for as all stated those abovewho provide align closely NHS with • setting prices enabling integrated care; servicesthose of HWBsto increase the quality of care and improve the • enabling integrated care preventing anti-competitive behaviour; and experience• At an earlier for stage patients of the – thereby HSCA Bill,encouraging the Future greater Forum argued • preventing anti-competitive behaviour, and, supporting commissioners to maintain service continuity. cothat-operation the duty toand be co placed-ordination on Monitor within tohealth „promote care competition‟services • supporting commissioners to maintain service continuity andshould between be replaced health by and a dutysocial to care provide services. the best care for

It will also have a continuing role in assessing NHS trusts for patients. The Bill was amended accordingly It will also have a continuing role in assessing NHS trusts for foundation trust status, and for ensuring that foundation trusts These• Individual objectives HWBs align may closelyneed to with engage those with of a Monitor HWB. Theif there are foundation trust status, and for ensuring that foundation trusts are financially viable and well-led, in terms of both quality and rolelocal of issues Monitor of servicein exercising continuity, a regulatory arising fromrole overthe financial providers are financially viable and well-led, in terms of both quality and finances. (andfailure to by some a provider extent bodycommissioners) will shape the HWB finances. relationship• In such an withevent, CCGs Monitor and willwith support HWBs, commissioners which could become to adversarialensure that ifservices . continue to be available to those who need The Chairman and Chief Executive Designate of Monitor is them Dr David Bennett.

HWB RELATIONSHIP WITH HEALTH EDUCATION ENGLAND

HEE LETBs HWB

Health Education England (HEE) is the new national leadership organisation responsible for ensuring that UNDERSTANDING THE RELATIONSHIP education, training, and workforce development achieves • London HWBs are unlikely to have much direct involvement high quality public health and patient outcomes. with HEE, and will normally be working through the LETB for their sub-region HEE began operating in shadow form in June 2012, working as a shadow Special Health Authority and due to take on RELATIONSHIP ISSUES full responsibilities from April 2013. • London-wide issues on training and workforce development, linked to recruitment and retention may well surface over the . HEE‟s Chairman is Sir Keith J Pearson and Chief Executive coming period, as the NHS reforms bed down is Ian Cumming. •Shortfalls in particular categories of staff, worsened by HEE and shadow Local Education and Training Boards took London‟s housing market, may reach levels sufficiently acute on delegated authority for 2013/14 planning functions for for HWBs to address directly with Health Education England workforce planning, education and training from 31 October 2012. RELATIONSHIPS AT PAN-LONDON AND SUB-REGIONAL LEVEL HWB RELATIONSHIP WITH THE NHS CB LONDON DELIVERY TEAM (1)

NHS CB NHS CB London HWB London Area Team UNDERSTANDING THE RELATIONSHIP

All Area Teams will share core functions as the NHS • The Area Team will support local mechanisms for CB around CCG development and assurance, HWBs and their CCG members to ensure that CCG emergency planning, resilience and response, plans are aligned to the relevant JHWS, and where quality and safety, configuration, system oversight possible encourage services to be jointly and partnerships and stakeholder engagement. commissioned

In London there will be an integrated structure • There is also an expectation that HWBs should be between the NHS CB central and operational arms, involved in developing and agreement of CCG with overall pan-London arrangements for direct commissioning plans commissioning and functions supporting the delivery • When published, these plans must contain a of service innovation. statement from the HWB about whether the These arrangements reflect both the distinct nature commissioning plan takes proper account of the JHWS of the London region and the need to ensure effective working with partners at both a borough • Similarly the LA‟s commissioning plans and London-wide level. will be expected to be supported by HWBs and public health plans, to be in line with those produced by Public Health England.

HWB RELATIONSHIP WITH THE NHS CB LONDON DELIVERY TEAM (2)

NHS CB NHS CB London HWB London Delivery Team RELATIONSHIP ISSUES

• NHS CB representation on HWBs has yet to take effect. It will apply after April 2013, when HWBs are preparing JSNAs or JHWS or dealing with NHS CB commissioning functions Anne Rainsberry NHS CB London Director • The NHS CB will be responsible for a very substantial budget for direct commissioning and the HWB will need to have an understanding of how this budget Simon Weldon is being applied, to get the full picture of commissioning Operations and Delivery Director, NHS CB London across the borough

• The NHS CB Delivery Team representative will have Penny Everett Vicky Scott [Interim] this wider picture of overall commissioning across (South London) (North West London) London

Peter Coles [Interim] • Borough Leaders have some concerns that the (North Central and East London) dynamics of HWBs could be affected in the same way as when Government Office of London attended local partnership bodies to oversee LAA preparation and implementation. Early discussion on terms of engagement should provide reassurance

HWB RELATIONSHIP WITH NHS CB LONDON AREA TEAM

HWB RELATIONSHIP WITH PUBLIC HEALTH ENGLAND LONDON

PHE HWB UNDERSTANDING THE RELATIONSHIP London • The 4 regions and 14 centres of Public Health England will work to a common Operating Model, and this will apply also to the London integrated centre • The London situation will differ in that the Mayor and GLA also Public Health England (PHE) will have its main centre in undertake public health work. PHE London see this as adding London. It will not have a separate regional office. The centre value to what they will be doing will bring together the delivery functions with assurance and • PHE London will be tracking progress against the measures in professional support functions to provide an integrated the Public Health Outcomes Framework. Under-achieving or service for London. outlier boroughs can expect extra support and other interventions

PHE are working with the Greater London Authority to ensure that the Mayor of London has access to high-quality public RELATIONSHIP ISSUES health advice to drive health improvement in the capital in • Since the publication of „Healthy Lives, Healthy Living’, London partnership with boroughs and their directors of public health. Councils and its member Boroughs have had concerns over the

degree of freedom and flexibility that Boroughs will have to vary

PHE are also engaging with Boroughs on the setting up of public health services the London integrated centre. • If Boroughs are used simply as the local commissioning

vehicle for PHE prescribed services, the scope for responding In Dec 2012, Yvonne Doyle was appointed as Regional to London‟s widely varying demographics and health needs will Director for London. be constrained • Hence PHE London will need a sufficient level of autonomy from the centre • LAs are seen generally as having a good understanding of the social determinants of health, and of taking a „lifecourse‟ approach • Public health staff transferring to or appointed to LAs, the working culture will be different from that of PCTs (eg. political leadership of organisation, decision-making via formal processes which can have long timescales)

HWB RELATIONSHIP WITH LONDON HEALTH IMPROVEMENT BOARD

LHIB HWB UNDERSTANDING THE RELATIONSHIP The shadow London Health Improvement Board (LHIB) first met in July 2011. It is chaired by the Mayor of London. The Assuming the Improvement Board continues as a non-statutory board provides an opportunity to complement health forum between the Mayor, the Boroughs, and the NHS, it could improvement work delivered at a local level through pan- still have a significant role to play. London approaches where these will provide added value or benefit. RELATIONSHIP ISSUES Membership includes London Councils, the NHS and the Greater London Authority (GLA). The Board prioritised action on obesity (particularly in children), problematic use of • The extent to which LHIB can fill some of the gaps on pan- alcohol, and cancers in the capital. Information transparency London issues, following the demise of NHS London, will to drive choice is a fourth theme. This work programme was depend largely on the level of political commitment given to it allocated a budget for 2012-2013 of up to £2m from the NHS. by the Mayor and Borough leaders

The original plan was for the Improvement Board to become • The Board has asked for a more in-depth review of the a statutory body, and GLA/London Council officers worked outcomes achieved through the present work programme, before with DH to draft clauses for inclusion in an appropriate Bill. any decisions are made for 2013/4 However, as of mid 2012 Ministers dropped these proposals and the shadow LHIB has continued in its present form as a • Achieving consensus across all 33 boroughs on a level of non-statutory grouping of the Mayor, Boroughs and the NHS. contribution to LHIB will be a key issue for 2013/14

• Other possible pan-London issues include the impact of illicit The current LHIB projects have ongoing costs equivalent to tobacco and continuation of the Healthy Schools programme around 0.5% of each borough‟s expected public health grant. LHIB has agreed in principle to continued pan-London working, but is not in a position to commit to a 2013/4 work programme at this stage. HWB RELATIONSHIP WITH LONDON MAYOR AND GLA

Mayor and GLA HWB

The Mayor has no direct control over London's health and social care services, but has a statutory duty to prepare a UNDERSTANDING THE RELATIONSHIP Health Inequalities Strategy for the capital. The Mayor and GLA also have statutory powers to spend on health issues. • The Mayor of London has a profile and political leadership Hence the Mayor and GLA works closely with the NHS, position that can influence change on the full range of citizen boroughs and other organisations on actions to reduce health behaviours, critical to improving public health outcomes inequalities. The Mayor also has an impact on health • The range of health issues on which the Mayor and GLA through his powers over planning, housing and transport and become involved, in the future absence of NHS London, will be through the Olympic legacy. a matter for political decision by the Mayor • The relationship between the London Mayor and the Boroughs The 2010 version of the Mayor‟s Health Inequalities Strategy is not institutionalised via permanent structures, and varies included an accompanying „first steps to delivery‟ plan, between incumbents of the Mayoralty related to five broad objectives. This set out partnership • London Councils has played a significant part in strengthening plans to 2012 and has fed into discussions at the London relationships and in building opportunities for regular dialogue Health Improvement Board. RELATIONSHIP ISSUES At present the Mayor has a small policy team to advise on health issues. DH is required to nominate a Mayoral adviser • Relationships between HWBs and the London Mayor will be on health, and discussions are in progress to put this role in developed mainly via the London Health Improvement Board place for the post April 2013 system. (see earlier slide)

PHE London and the Mayor are in discussion on future roles, so as to ensure full coverage of public health issues, with no duplication. Co-location of some staff is being considered. HWB RELATIONSHIP WITH LONDON AHSCs and AHSNs

London AHSCs UNDERSTANDING THE RELATIONSHIP HWB An AHSC’s prime focus is on innovation and the discovery of new ideas for healthcare, but is less focussed on adopting and London AHSNs translating these innovations for widespread use in practical Academic Health Science Centres (AHSCs) developed out of healthcare delivery settings. That will be a key purpose for the 2007 Darzi review, bringing together universities/medical AHSNs, which will also have a focus on community based care schools with hospital trusts. Three of the five existing AHSCs (from LMC briefing. Aug 2012). are in London. They are major players in London‟s health economy: The AHSNs will be a major influence on the education and • Imperial College HealthCare training commissioned by Local Education and Training Boards • Kings Health Partners (see separate slide). The AHSN desire for co-terminosity of • UCL Partners these bodies.

As part of the NHS reforms, Government now expects a total All NHS bodies in an area are expected to affiliate with the of between 12 and 18 new Academic Health Science relevant AHSN.

Networks (AHSNs) to be formed between NHS providers and universities. These are expected to be designated by May RELATIONSHIP ISSUES 2013, and will hold a five-year licence. London bids for • It is not clear how CCGs will feed into the critical process of AHSN status have been submitted by: workforce planning undertaken via LETBs and AHSNs. HWBs • South London AHSN (Kings Health Partnership/St Georges and LHIB may have a useful role to play here NHS Trust) • UCL Partners • GPs are concerned that secondary care representation will • Imperial College Health Partners dominate LETB and AHSN boards and their membership groups DH guidance explains the six functions of AHSNs as research participation, translating research and learning into • HWBs will want the research and innovation programmes of practice, education and training, service improvement, the AHSNs to be well aligned with priority health needs in London, information and wealth creation. rather than weighted towards more academic research

The networks will receive significant funding from the NHS • This significant investment needs to be carefully directed at a Commissioning Board. time when resources across the system are heavily constrained

HWB RELATIONSHIP WITH LONDON CLINICAL SENATE

LONDON CLINICAL HWB SENATE UNDERSTANDING THE RELATIONSHIP • The London Senate sees its role as being the collective Government confirmed early in 2012 that clinical senates clinical leadership body for London, linking closely with CCGs should be established across the country, to provide expert and the London Clinical Commissioning Council clinical advice to CCGs and the NHS CB. There will be around 15 senates across England. • It will continue to operate as an advisory body, providing expert clinical advice to CCGs, the NHS Commissioning Board, London established a senate in 2010 which has Public Health England, NHS providers and other bodies reviewed and refocused its role during 2012. with health and healthcare responsibilities in London, including the London Health Improvement Board The role of senates is to ‘to take an overview of health and healthcare for local populations and provide a source of expert support and advice on how different services fit RELATIONSHIP ISSUES together to provide the best overall care and outcomes for • The Senate will not be aligned exclusively to commissioning patients’. (NHS London, April 2012). or provider interests, and will bring together clinicians with both commissioner and provider perspectives Senate membership includes doctors, nurses, and other clinical professionals along with public health specialists and • It will promote inter- organisational care pathways and advise social care experts. on the development of integrated care

Senates are hosted and supported by NHS Commissioning • HWBs are not likely to need a close working relationship with Board and are accountable to the Board for delivery of an the Senate, but will need to track its work programme to agreed work programme. benefit from its advice and expertise on London health related issues The London Senate is co-chaired by Dr Andy Mitchell and Dr Caroline Alexander. A small multi-disciplinary Senate Council will meet regularly, probably bi-monthly.

HWB RELATIONSHIP WITH STRATEGIC CLINICAL NETWORKS

Strategic NHS CB London Clinical Networks Area Team HWB

UNDERSTANDING THE RELATIONSHIP Strategic clinical networks, hosted and funded by the NHS CB, The relationship will primarily be between CCGs and the will cover conditions or patient groups where improvements can Strategic Clinical Networks, rather than with the HWB. be made through an integrated, whole system approach. Strategic Clinical Networks (SCN) will work to a Single These networks will help local commissioners of NHS care to Operating Framework (DH Nov 2012). reduce unwarranted variation in services and encourage innovation. The conditions or patient groups chosen for the first Active involvement and engagement of CCGs in the SCNs strategic clinical networks are: will not be mandated, but is expected as part of assurance • Cancer that CCGs are meeting their core purpose of quality • Cardiovascular disease (including cardiac, stroke, diabetes improvement. SCNs should help CCGs to: and renal disease) • Maternity and children‟s services. • address big issues • Mental health, dementia and neurological conditions • support achievement of outcomes and financial stability • provide a source of expert clinical advice These networks will be non-statutory bodies, and will not have • facilitate clinical leadership, engagement and patient voice a legal duty to commission health services. Where clinical commissioners are not actively engaged and These networks will exist for up to five years and will be as a consequence not achieving the improvements required, managed by a locally based support teams for the London there will be opportunity for the SCN support team to raise region. This team will provide clinical and managerial support for concerns through their responsible Area Team Medical strategic clinical networks and clinical senates in the area. The Director. support teams, funded by the NHS CB, will be located in the local area team office. HWB RELATIONSHIP WITH COMMISSIONING SUPPORT UNITS

London HWB CSUs UNDERSTANDING THE RELATIONSHIP • As at November 2012, the three London Commissioning A shared NHS service, Commissioning Support for Support Units, formerly known as Commissioning Support London (CSL) had a work programme aimed at supporting Organisations, are at an early stage of development London‟s health and health care . The organisation was closed on 31 March 2011. The „London Health • CSU‟s will sit within the NHS CB for 3 years, and the name Programmes‟ is a set of initiatives that continued with change made by NHS CB is intended to differentiate these several former functions of CSL. bodies from the wider market in commissioning support

Following the Health and Social Care Act 2012, three new • The NHS CB intend that CSUs should collaborate to provide Commissioning Support Units (CSUs) are being certain services „at scale‟ for national consumption. The three established in London. These are the North and East London units will collaborate to provide business intelligence London CSU (launched in shadow form in October 2012), Services in this way

North West London CSU, and South London CSU.

RELATIONSHIP ISSUES

Their managing directors (designate) are Andrew Ridley, • To date, HWB members feedback suggests relatively little

Sarah Whiting, and Nick Relph, respectively. contact with the CSUs • It is not the statutory role of CSUs to undertake Commissioning Support Units will provide CCGs with: commissioning, but instead to support the CCGs and LAs • business intelligence and IT who do. Yet should individual CCGs falter during 2013/14, • communications might CSUs move in to fill the vacuum? • service redesign • Councils, and groups of councils, which have themselves • procurement and market management proffered support services to CCGs have so far met with mixed • quality and provider management success. RB Kingston is an example of where this is happening. • corporate services including finance Overtures from the West London Alliance, north-west sector were rebuffed CCGs will have a choice on where to buy support.

HWB RELATIONSHIP WITH SUB-REGIONAL LONDON LETBs

London LETBs HWB

UNDERSTANDING THE RELATIONSHIP The main function of LETBs is to commission education, • London ended up with three LETBs after debate over other training and workforce planning for providers and options (from one to five) professionals in their area. Each of the three London LETBs • The three academic health science centres (AHSCs) lobbied for is likely to evolve differently to reflect local needs. co-terminosity with their boundaries • The AHSCs are expected to work closely with the LETBs The three are North West, North Central and East and because Trust Chief Executives will sit on both South London. They will assess the collective workforce • Each LETB is expected to run with about £1.2m of running costs requirements of healthcare providers to meet the needs of the population as well as commission the education and RELATIONSHIP ISSUES training programmes required to meet those requirements. • The way that existing NHS London funds for training/education

will be split between the three LETBs has yet to be finalised Currently London receives £1.164bn of the national £4.9bn • The new distribution formula at national level will also be Multi -Professional Education and Training Levy (MPET). The contentious, as London is seen by many to receive more than its size of the MPET budget and allocation to individual LETBs fair share from 2013/14 onwards will be determined during 2012/13 • There are concerns from London GPs that the leadership of through discussion with the Department of Health. the London LETBs will be too skewed towards secondary and

tertiary care (HSJ May 2012) Boards have the task of reducing the MPET by a significant • HWBs will need to develop a relationship with the LETB in their amount. Health Education England will in future use a tariff area, given that workforce planning and related training will be based system for education and training. The new system is important during a period of major change to the health and care due to start from April 2013. system

Many of the London Deanery functions will need to transfer over from NHS London to the LETBs.. HWB RELATIONSHIP WITH SUB-REGIONAL BOROUGH GROUPINGS

Sub- Regional HWB groupings

During the two years in which NHS London has operated with its sectoral model, many of the relationships between UNDERSTANDING THE RELATIONSHIP Boroughs, GPs, and the NHS have developed around sector arrangements. • Sub-regional groupings of Boroughs primarily focussed on economic development and transport, but have also involved These NHS sector arrangements will disappear in April 2013 themselves in health and social care (and have already been scaled down as a result of NHS staff leaving posts or moving to different roles). • The West London Alliance and the North London Strategic Partnership are now involved in multi-borough collaboration on There will be no direct replacement of sectoral or sub- the commissioning of adult and childrens services, and on regional bodies dealing with health and social care. There are procurement of shared support services already a number of groupings of boroughs at sub-regional level, operating with varying degrees of formality in terms of RELATIONSHIP ISSUES their own structures. • There is potential for support functions to CCGs to be These include the West London Alliance, the North London provided through these sub-regional groupings as an Strategic Alliance, and the South London Partnership. alternative to the three London CSUs (see separate slide)

These bodies are likely to be used in future by Borough • To date, initial overtures from the West London Alliance have Councils wishing to collaborate with neighbouring boroughs, not been met with enthusiasm by the NHS. on public health and social care issues.

Other groupings of London Boroughs include the Triborough arrangements developed across LB of Westminster, RB of Kensington and Chelsea, and LB of Hammersmith and Fulham. These involve sharing of DAS, DCS and DPH posts and jointly commissioned contracts for adults and childrens services.

RELATIONSHIPS AT LOCAL LEVEL HWB RELATIONSHIP WITH CLINICAL COMMISSIONING GROUP

UNDERSTANDING THE RELATIONSHIP

HWB CCG CCGs will become statutory organisations once authorised but „unlike anything the NHS has seen before‟. London already has examples of well developed CCGs, through which shared CCGs will hold real budgets and commission the majority leadership of the Borough‟s HWB is being built. of NHS services for their patients (including elective hospital CCGs have to manage a complex network of their own care, rehabilitative care, urgent and emergency care, relationships, as well as thinking about how the HWB relates most community health services, and mental health and outwards. HWBs will need to understand this context, and the learning disability services). time challenge, it places on CCG representatives.

CCGs will be held accountable by the NHS CB against, A key duty on HWBs is to promote integrated working to improve a Commissioning Outcomes Framework, which will ensure services, reduce inequalities and make the best use of collective transparency and accountability for achieving quality and resources. Technical and legal obstacles to pooling of resources value for money (DH guidance). between local govt and CCGs remain significant and HWBs may need to find creative solutions. In terms of legal status, CCGs (once authorised) will be statutory bodies, i.e. established by statute to RELATIONSHIP ISSUES carry out a specific purpose with duties and powers conferred CCGs will have a primary, formal line of accountability to the but limited to that purpose. NHS Commissioning Board. They will also be accountable to their constituent GP practices, and as a public body, to the As with PCTs in the past, London has the benefit of having local population they serve. CCG representatives on nearly all CCGs coterminous with Boroughs. Hackney HWBs will have to balance these separate interests, which will and City of London share a CCG. The West London CCG not always coincide. covers 12 practices in LB of Westminster as well as RB of Kensington and Chelsea. The role of HWBs in CCG authorisation and assurance process also has the potential to create tensions in the relationship. CCGs are being required to use the common standard financial system (ISFE) developed by the NHS and Steria. The Act requires that CCGs must „have regard‟ to HWB views in the preparation of commissioning plans. There are precedents for DH has published a model constitution for CCGs, which they „have regard‟ rules in legislation (e.g. LAAs) but their statutory can adapt (within limits) to meet their requirements. force has yet to be tested in earnest.

London’s Clinical Commissioning Groups

Source: NHS Commissioning Board

HWB RELATIONSHIP WITH NHS PROVIDERS AND TRUSTS

NHS PROVIDERS HWB UNDERSTANDING THE RELATIONSHIP & TRUSTS • If HWBs are to develop an influential role as „system leaders‟ they will need to understand how the overall system works, including key providers NHS Providers do not have a statutory seat on the HWB, but • Providers (large and small) are a constant source of it remains open for councils/HWBs to include them. Most innovation within the health and care system. HWBs need to shadow boards have chosen not to, for several reasons:- tap into such innovation • Providers are major influencers of resource flows through • The board would become too big (London HWBs currently the system average 15 members. This is already above what the Future • The integration goal may involve rethinking care pathways at Forum envisaged when it advocated „lean‟ boards their front end, with prevention and intervention before • The problem of choosing which providers to include, given problems become medical or acute (e.g. loneliness and social that provider bodies may be competing against each other isolation) and the impact it will have on providers • Concerns over potential conflicts of interest (although this has not surfaced as a major problem on those HWBs which RELATIONSHIP ISSUES include providers) • The catchment areas of providers will frequently be different

from the boundaries of the HWB CCGs are increasingly aware of the need to take acute trusts • Major hospital reconfigurations are a big political issue in many with them, in implementing the NHS reforms. Alternative parts of London, with HWBs becoming involved to very forms of engagement can be found, such as a „provider varying levels forum‟ working in support of the HWB. • Elected members may want the HWB to distance itself in order

that the council can take a political position on local campaigns . As of mid 2012, 9 of the 33 shadow HWBs in London include CCG's view will be shaped by clinical evidence, nd he LHW providers on the shadow body. The remainder use view by patient and user experience alternative arrangements for engaging with providers. • There is an obvious risk of HWBs being ‘at the eye of the storm’

in these situations. The board will need to develop a clear understanding of its relationship to the politics of the council (see separate slide on relationship with council)

HWB RELATIONSHIP WITH LOCAL HEALTH WATCH

HWB UNDERSTANDING THE RELATIONSHIP • The majority of London Boroughs are commissioning their local Healthwatch Healthwatch afresh, rather than managing a transition from LINks Each Local Healthwatch (LHW) is required to be an • Following tender processes, some London provider independent body, commissioned by the local authority, set agencies may end up delivering the Healthwatch service to up as a corporate body, not-for-profit, with statutory several Boroughs functions and able to employ staff. The local Healthwatch • LHWs will be a „network of networks‟ in each area, bringing will carry forward all existing LINks functions, including together evidence and the public and patient voice from a wide acting as a consumer champion. LHW will also have two range of existing sources new ones: • HWBs should recognise that LHWs is not another version of 1. advice and information about access to and choice in LINks. LHWs will be autonomous bodies with some unique health and social care services, and statutory powers that can be of value to the HWB in bringing 2. an advocacy service (or signposting to same) for those improvement to the overall health system wishing to make an NHS complaint RELATIONSHIP ISSUES LHW has seat on HWB as a statutory member, and its own • Much will depend on the ability of the LHW to assemble good powers of referral to scrutiny and to Healthwatch England. evidence and on the credibility of its HWB representative • The LHW member is likely to play a key part in forming the Date for establishment put back to April 2013. Extra national consultation and engagement strategy for the HWB, and to help funding for set up costs of £3.5m. National funding will be it to look outwards to the local community £27m carried forward from LINks and an extra £11.5m in • Councils and CCGs will be keen for the LHW to work within an 2013/4 to reflect the additional duties of Local HealthWatch. agreed and synchronised engagement strategy rather than duplicating or cutting across council or CCG consultation 15 of the Healthwatch pathfinders are London boroughs. programmes • LHWs will participate in HWB decision-making and share A number of London Boroughs are planning to commission collective responsibility, but will also be contracted and Healthwatch services from provider bodies spanning more performance managed by the local authority. than one borough. • LHWs can refer contentious commissioning issues to health overview and scrutiny. This may create tensions at times HWB RELATIONSHIP WITH LOCAL STRATEGIC PARTNERSHIP

LSP HWB

From 2004 to 2010 London Boroughs developed relatively UNDERSTANDING THE RELATIONSHIP standardised LSP arrangements, to oversee and manage • there is no requirement for HWBs to maintain any link or Local Area Agreements (2004-10). relationship between their HWB and the Borough‟s LSP or over-arching partnership body In most boroughs this involved setting up some form of health • this will be a matter for local choice and will depend on the and care/wellbeing partnership. Neither these nor LSPs had history of partnership working in individual boroughs statutory status. • in London and elsewhere, a number of local authorities have changed their partnership arrangements to make the shadow Since the demise of LAAs, a majority of Boroughs have HWB the main body dealing with the „people‟ agenda, with a retained some form of over-arching partnership body. But in separate partnership dealing with „place‟ issues (regeneration, a significant minority, the LSP has been wound up or has economic development, transport, infrastructure). The LSP will ceased to meet. have been wound up as part of this process

Slightly under half the Boroughs have retained a structure RELATIONSHIP ISSUES with a shadow HWB positioned as a thematic sub-group of The relationship between the HWB and any LSP will be their version of a LSP. In others, the shadow HWB has determined by the local context. Where there is an active LSP been set up as wholly new body and is already positioned as this may be useful to the HWB in several respects: part of the council‟s committee system. • As a means of promoting HWB activities to a wider range of partners, including the business community, police, DWP From April, councils will need to reconstitute their HWBs as • As a route for involvement in wider consultation exercises of statutory committees. Normal local government rules on local campaigns mounted by the LSP e.g. behavioural transparency and public access to meetings will apply. change or citizen responsibilities • As a means of enlisting a wider range of local politicians and In many respects, HWBs may continue to operate as a decision-makers on a health or wellbeing issue partnership body, with a relationship to a continuing LSP and • As a route to escalating issues to parts of government other to other partnerships (e.g. community safety, economic than DH (e.g. DfE, DWP, CLG) development).

HWB RELATIONSHIP WITH HEALTH SCRUTINY

Health Scrutiny HWB UNDERSTANDING THE RELATIONSHIP • There has been over a decade of development of the health Health Scrutiny powers were first introduced in 2001, and scrutiny function undertaken by local authorities have been amended in several subsequent pieces of legislation. • Earlier relationship issues between health scrutiny and NHS bodies have largely settled down (e.g. summoning of One of the aims of the 2010 White Paper was to strengthen officials, access to reports, and consultation on reconfigurations) local accountability and scrutiny of health services. HCSA 2012 provides for this strengthening, and DH intend to have • Council scrutiny can help to ensure credible and workable regulations in place by April 2013. JSNAs and JHSWs

The Centre for Public Scrutiny distinguishes between RELATIONSHIP ISSUES • overview – a strategic view of the risks faced by • S190 of HSCA 2012 expands the scope of health scrutiny by communities and of their health and social care needs applying it to “health service providers” as well as “NHS bodies”, • scrutiny – focused on the operational aspects of providing hence the range of bodies scrutinised will widen health and social care • The new relationships being formed between the NHS and DH proposes that in future health scrutiny functions should local authorities, as reflected through HWBs, is likely to change be conferred on the local authority (rather than direct to the the nature of health scrutiny. Previously this has tended to focus Overview and Scrutiny Committee. This is on the basis that on holding NHS bodies to account this gives councils more flexibility as to how to discharge these functions. It would allow e.g. for a single scrutiny • There may in future be more emphasis in addressing gaps in body overseeing health, social care, and wider wellbeing. the overall health and care system, and identifying areas where integration could be strengthened The Centre for Public Scrutiny is unhappy with this proposal, arguing that it weakens the independence of scrutiny.

HWB RELATIONSHIP WITH DIRECTOR OF PUBLIC HEALTH

UNDERSTANDING THE RELATIONSHIP DPH HWB • Local government has welcomed the return of public health functions (responsibility was transferred to the NHS in 1974) • This is seen as an opportunity to embed health improvement The Director of Public Health is responsible for: across the full range of local authority services • health improvement, leading on investment for • The transfer is not absolute. The DPH role has a split or dual improving and protecting the health of the population locally accountability built into it, to NHS CB/Public Health England • health protection, working with PHE and NHS in and to the local council responding to outbreaks and emergencies • Of £5.2bn national public health funding (2012/13) around • health services, giving public health expertise, advice £2.2bn will go to local authorities and £2.2bn to the NHS CB, and analysis to CCGs, HWB and London-wide bodies. with the rest to DH and Public Health England • The Public health grant will be ringfenced for the foreseeable future The Director of Public Health will be: RELATIONSHIP ISSUES • the principal adviser on health to elected members and • Allocation of public health budgets, both between London and officials the rest of England and across boroughs, has been a live issue • the officer charged with delivering key new public health • Several Boroughs have raised concerns that their PH grant functions will not cover their statutory duties, including demand-led • a statutory member of the health and wellbeing board services such as sexual health. Final allocations for 2013/4 • the author of an independent annual report on the health may improve the situation of the population • When resources are tight, it will always be uphill work to secure funding for long-term preventive work, including health Local authority functions after April 2013 will include: education and behaviour change amongst the public • Childhood obesity • Pressure will come on DPHs to meet measures and outcomes • Sexual health in the national Public Health Outcomes Framework. These • Drug and alcohol treatment outcomes may not always coincide with the HWB view of local • NHS health check programme priorities • Advice and information to the NHS • The relationship between DPH and the council is that of In several instances DPH posts are being shared across employer/employee as well as independent adviser. Unlike the boroughs. Recruitment has proved a challenge in London DAS and DCS, the DPH has the third potential tension of and it could be that even by April 2013 only around 50% of working to PHE and the NHS CB the anticipated 25 DPH posts across 33 boroughs will be filled.

HWB RELATIONSHIP WITH BOROUGH COUNCIL

UNDERSTANDING THE RELATIONSHIP • HWBs will be a council committee, yet unlike any other that Council HWB currently exists • The LGA has stated that „while councils have a clear leadership role it would be inaccurate, and highly counter-productive, to view boards as council-owned committees – and councils As from April 2013, each Borough will need to reconstitute its themselves are very aware of this danger HWB as a statutory committee of the local authority. It will be • HWBs needs to be both a decision-making body, and a forum important for all HWB members to be clear how the Board for reconciling views and reaching a consensus between local then relates to other parts of the council, e.g. the full council, authority, CCG, and other members the executive (cabinet) and overview and scrutiny (see later slide) • The way that HWBs operate may often be closer to the non-statutory partnership bodies that have supported Local The 2012 HCSA makes clear that HWBs will not operate in the Strategic Partnerships over the past decade (see separate same way as other council committees. DH have published a slide on HWB relationship with LSPs) note on the expected content of regulations which will amend • Boards (and councils) will need to agree what position to take or disapply several parts of local government legislation in on governance issues where there will be local choice – such order to enable Boards to function as intended. as voting rights of HWB members and inclusion of minority party councillors These regulations (coupled with the HSCA 2012 will make clear that: - RELATIONSHIP ISSUES • councils can add members to the HWB over and above those • Leading councillors and backbench members will need to accept representatives fixed by the HSCA 2012 that the HWB view on an issue may not always reflect the • non-councillors will be able to vote alongside councillors, with policy of the full council or even the cabinet (this scenario is councils having some choice as to who votes already emerging on London hospital configurations) • normal local government rules requiring political • Other HWB members will be learning to work within a context proportionality on committees will not apply to HWBs in which strategic political leadership should be viewed as a plus • normal local government rules on public access to meetings, and not a minus agendas and minutes, standards, and declarations of interest • The Board will be reviewing council commissioning plans (adult will be retained and childrens‟ services) as well as those of the CCG. Parity of • HWBs will be able to take on other executive functions of the challenge and of evidence-based decision-making, will be local authority as and when delegated to them important

HWB RELATIONSHIP WITH DAS and DCS

DAS and UNDERSTANDING THE RELATIONSHIP DCS HWB • Councils are familiar with the idea that the DCS and DAS posts in local government differ from those of other chief officers, in that there is a statutory requirement for their appointment and Government issues guidance on their role Directors of Adult Services (DAS) and Director of Childrens • Councils take very seriously the advice given by these officers, Services(DCS) along with the DPH, are members of the HWB and generally respect their independent professional judgement by virtue of statute. In many Boroughs, the DAS will have led • It will be a new experience for councillors to have senior officers on implementing the NHS reforms within their council. sitting alongside them at a council committee

The DAS and DCS posts in local government are already RELATIONSHIP ISSUES „statutory‟ in the sense that councils are required to appoint • Assuming DH Regulations leave it to local discretion to decide to such posts. voting arrangements at HWBs, some councils may choose that voting is not extended to officers DH guidance sets out an intended role for the DAS, as does • In the mid 2012 Knowledge Share exercise, 22 of the London DfE guidance for the DCS post. DfE are currently updating, HWBs reported their decision-making processes as „consensual‟. theirs, but neither set yet covers the role on HWBs. Five use a majority voting system, while the rest are not known • This issue does not seem to have caused problems on shadow Unlike the DPH, these postholders remain wholly bodies, but will surface as HWBs become involved in more accountable to the local authority and its elected members hard-edged decisions on resource allocation and commissioning and not to any part of central government. • Councils may also need to review their protocols on member/ officer relations to reflect the specific DAS, DCS and DPH role The NHS has long experience of executive directors sitting on HWBs and on the need for these post holders to be able to alongside appointed non-execs on PCT boards, on „equal‟ take a professional stance that may differ from the council‟s terms. But this is novel for local government. • The DAS and DCS roles will provide important communication routes in and out of the HWB. Their respective pan-London At present, it appears likely that DH will allow councils/HWBs associations (ADASS and ALDCS) are well-established forums, to make their own choices on which members have voting influential in terms of professional thought leadership and rights at statutory HWBs after 2013. of lobbying

PARTNER BODY OR ACCOUNTABILITY KEY DUTIES AND RESOURCES RELATIVE INFLUENCE KEY ISSUES (CAN BE EDITED FOR AGENCY RESPONSIBILITIES CONTROLLED ON HWB ACTIONS BOROUGH CONTEXT)

NATIONAL LEVEL

NHS National To SoS for Health Statutory duty to Approx £80bn of NHS Very significant, via Relationships will be through Commissioning Board manage all NHS spend, commissioned oversight of CCG London Area Team commissioning direct and via CCGs and GP commissioning Public Health Exec agency of DH, Statutory duty to Around £830m spent Will be looking to PHE will operate to a single England accountable to SoS provide a public jointly by PHE and DH ensure that PHOF Operating Model. What scope ro and Perm Sec. health service to the at present measures delivered respond to varying London needs? NHS CB Healthwatch Statutory committee Statutory duties of Budget will be part of Support to Local HWB might need to engage with England of CQC, with own advice and escalation CQC grant from DH Healthwatch and HWE in event of concerns over identity of local concerns handles escalated performance of Local HealthWatch issues Care Quality Statutory NDPB of Statutory regulator of £163m budget for Could intervene on Commission Dept of Health health and social registration and any specific service care inspection NICE Becomes a NDPB of New roles in Source of advice NICE guidance on public health DH following in April guidance on social and guidance likely to be influential 2013 care and PH, in addition to current responsibility Health Education SHA in shadow Responsible for MPET allocation HWB relationships Workforce training, and availability England form. Becomes an workforce education nationally is £4.9bn for likely to be through of key professional; staff will be an executive NDPB of and training education and training LTEBs issue for HWBs DH in April 2013 Monitor Independent Statutory duty to Degree of Need for HWB relationship with regulator directly regulate the health intervention in Monitor could be significant in accountable to market and health market yet to event of local service failure and Parliament competition become clear continuity issue PAN-LONDON AND SUB-REGIONAL

NHS CB London Local To NHS CB Statutory duty to Approx £4bn for direct Statutory Level of autonomy of London Area Area Team oversee all NHS commissioning responsibility of Team from NHS CB not yet clear. commissioning HWB for JSNA and JHWS input PARTNER BODY OR ACCOUNTABILITY KEY DUTIES AND RESOURCES RELATIVE INFLUENCE KEY ISSUES (TO BE EDITED FOR AGENCY RESPONSIBILITIES CONTROLLED ON HWB ACTIONS BOROUGH CONTEXT) NHS Providers and To their To deliver health As per funds paid Source of ideas for How to engage and whether to Trusts commissioning body and care services by commissioning innovation and new include on HWB bodies forms of delivery Public Health To Public Health Oversight of public PHOF outcomes will Some form of intervention from England (London) England health delivery be tracked PHE will follow if borough falls below PHOF aspirations London Health Dual accountability Improving London‟s Up to £2m provided Forum to progress Now to be non-statutory. Improvement Board to London Mayor health by NHS this year. London-wide work Funding dependent on Borough and Boroughs Less for 2013/14 programme agreement to contribute. Mayor and GLA London electorate Health inequalities Growing interest in HWBs will need to identify public health scope for London-wide PH campaigns London Independent after 3 Providing support Income from Will impact on CCG Relationship with HWBs yet to Commissioning year hosting by NHS and commissioning support services effectiveness emerge. More important for Support Units CB expertise to CCGs delivered CCGs London AHSCs and Licensed and funded Research and Not known at Source of advice and HWBs will want to see research AHSNs by NHS CB innovation present expertise budgets appliedto health priorities London Clinical Hosted by and Expert source of None directly Source of advice and Senate accountable to NHS clinical advice expertise CB London Local To Health Education Responsible for £1.2bn for 2012/13 HWBs may work in Impact of LTEB decisions on Education and England (HEE) workforce to be reduced in sub-regions to future London workforce in Training Boards education and future years influence LETB health and care. (LETBs) training LOCAL LEVEL

Clinical To NHS CB, to GP Statutory, to CCG budget Very significant as Differing cultures of GPs and Commissioning practice members, commission care (national average drivers of local LAs seen as significant area for Group) and to local people for whole £290m) commissioning HWBs to address. population. NHS providers and To Trust and to NHS To provide health As per funds paid Usually not on HWB. Whether to include on HWB or Trusts and SoS care for commissioned Important to engage engage through other means services PARTNER BODY OR ACCOUNTABILITY KEY DUTIES AND RESOURCES RELATIVE INFLUENCE KEY ISSUES (CAN BE EDITED FOR AGENCY RESPONSIBILITIES CONTROLLED ON HWB ACTIONS BOROUGH CONTEXT) Local HealthWatch Independent and Statutory duties of DH funding to Depends on How the relationship between accountable to local advice, info and Boroughs to strength/credibility of HWB and HealthWatch will people and advocacy commission LHW Local HealthWatch develop Healthwatch England

Health Scrutiny To local electorate Statutory duty to None Depends on local Local political balance on and to full council scrutinise NHS relationship of .council likely to have a and social care scrutiny/executive significant impact. services

LSP or main No direct Non statutory, no None. Previously Variable between HWB becoming key Partnership body accountability. duties. Role in steered use of LAA boroughs, depending partnership body in some Council usually takes overseeing multi- spend. on status/role of LSP boroughs, effectively replacing leadership role agency working. former LSP Council executive To local electorate Statutory body, Borough budget Very significant, via HWBs need to address long- and full council responsible for Leader/Mayor or term issues. Politicians look to wellbeing of area executive councillor short-term political cycle as chair. Directors of Adult To the local council To meet care and Sizeable local Major role in Should statutory place on HWB and Childrens and local electorate, other needs of authority budget developing JSNA and also carry voting rights? A new Services within DH/DEd adults and children JHSW for scenario for council cttees. guidance Director of Public Dual accountability To improve and Ring-fenced PH Major role in As above and DPH needs Health to PHE and council protect health grant developing JSNA and independence on critical public JHSWA health issues

Key to colours Accountability local and/or democratic

Accountable to NHS and DH

Depth of colour indicates relative level of importance as a HWB relationship – deeper equals higher importance