Published by David Prior on 4 December 2014
- Our Work
- The Reformer Blog
27 March 2015
By common consent, the 2012 Health and Social Care Act is one of the worst pieces of legislation passed in the history of the NHS. Disowned by Downing Street and described by the highly respected King’s Fund as damaging and distracting, it was the last thing our health service needed when hit by growing pressures and an unprecedented funding squeeze.
Ironically, the one piece of the legislation that did get general support – the creation of health and wellbeing boards (HWBs) may lay the foundations for a much more integrated health and social care system where services are built round individual needs. Made up of representatives from councils and the NHS, the HWBs are tasked with assessing the health needs of their local population, promoting greater integration of services through joint commissioning and pooled budgets. They have made a steady rather than spectacular start.
Recent King’s Fund analysis describes the impact of the HWBs to date as variable and limited, with little sign that they provide the collective leadership needed to tackle pressing issues. This isn’t altogether surprising. The current health and social care system is almost designed to put obstacles in the way of effective local leadership and integration of services. A series of different agencies, funding streams and conflicting targets makes working together much harder.
And yet, we know that this has to change. 12 years ago, Derek Wanless’s health review warned that unless we took prevention seriously, the UK would be faced with sharp rises in the burden of avoidable illness. How right he was. That is why our proposals for whole person care are so important. They aim for real integration with joint ownership, budgetary alignment, and accountability through the HWB Board, alongside a much stronger emphasis on helping to improve people’s health.
By asking HWBs to lead local commissioning and by bringing together services to work around people, we will finally be able to link health policy with all the other local level policies that have a bearing on health. Most notably, housing, planning, education, employment, skills and leisure, which by combining forces could do so much more to build up more resilient individuals and communities.
In addition, we shouldn’t ignore the potential link between the work of HWBs and the local economy. As Rose Gilroy and Mark Tewdwr-Jones of Newcastle University have recently pointed out, there is a critical relationship between health and the economy. Indeed, the 2010 Marmo Review identified both a strong case for reducing health inequalities and a compelling economic case. Health inequalities are estimated at more than £30 billion a year in lost productivity and welfare and health costs.
Revitalised HWBs could be crucial in sharpening up commissioning, providing local health and care leadership as well as helping to enhance the local economy.Rt Hon Lord Hunt PC OBE, Shadow Spokesperson for Health @LordPhilofBrum