Health and Wellbeing Boards – what are they all about?

The Health and Social Care Act (2012) not only involved a major restructure of NHS commissioning but also required a strengthening of ‘local accountability’ under the auspices of local Health and Wellbeing Boards (H&WBs).  H&WBs are expected to be the ‘glue’ between healthcare services and social care but what will they actually do, how much power will they have, and what does this mean for industry?

Section 194 of the Act required every local authority to establish a H&WB for its area.  The statutory functions of the Board are to:

·         Prepare a Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) between the CCG and local authority;

·         Encourage integrated working between health and social care on commissioning, pooled budgets, and integrated provision of services

·         Undertake any other functions, which may have an impact on public health, as delegated by the council.

According to all the rhetoric, members of the H&WBs will work together in partnership to reduce the variation in both the quality of life and the life expectancy of their local population. The JSNA and subsequent development of the JHWS will provide the main focus for the H&WB.  The JSNA will highlight health and wealth inequalities in each area, such as areas of deprivation and levels of obesity, cancer, and other long term conditions.  The board will identify the current services and support organisations that they have in place, and use this information to develop commissioning plans within the JHWS.
 

In January 2011 the Department of Health invited local authorities to become ‘early implementer’ sites for the development of H&WBs – 138 out of 152 applied, so these bodies have been developing and starting to operate in shadow form since March 2011.  The remaining local authorities had to be operational in shadow form from April 2012.  As of April 2013 all boards have had to take on their statutory functions.  This would suggest that, like CCGs, some H&WB are currently more established and have built stronger relationships than others – and Adelphi’s own research confirms this hypothesis.

All the boards have a “core” membership as defined by the guidance – but our own research would suggest that the more developed boards have also appointed additional members such as representatives from the Police, secondary care organisations and NHS England’s local area team.

Adelphi has also identified that some – but by no means, all - of the boards are already demonstrating their willingness to be innovative.   For example, one London board has introduced a ‘Dragon’s Den’ type approach to decide on its priorities and key areas of investment.  Another board has appointed an   independent Chair that isn’t employed by the council or NHS to bring an entirely fresh perspective.

Our findings also suggest that, at least to start with, H&WBs will have a more preventative focus.  They will aim to address their local population’s health and wellbeing needs before they happen and before they require extensive treatment and resource. 

There is also the big question of how H&WBs will work with NHS England, who are responsible for commissioning all local primary care, dentistry and pharmacy services as well as specialised services.  At Adelphi we expect that this relationship will develop over the next year with the boards and the local area teams inevitably wrestling over the balance of power at the outset.

So what does all this mean for the pharmaceutical industry?   For example, does your company have products or service offerings that can support the work of the H&WBs?   Are your reps aware of the priorities and timescales for action of the H&WBs within their territory?   Do you know if the H&WBs are actually willing to work in partnership with industry?   Do you know where the balance of power will lie and who to target?

At Adelphi we have already undertaken extensive research with members of NHS England and H&WBs to identify their needs, wants, and motivations.  We are working with pharma clients to help them review their brands’ value propositions to bring the two together.  Have you considered what your approach to these new boards will be and how you might be able to leverage their priorities and activities to expand your market within this new environment?