HEALTHWATCH AND HEALTH AND WELLBEING BOARDS INTRODUCTION In April 2013 local Healthwatch organisations came into being. The national body, Healthwatch England, with clear responsibilities and powers, was also established. One of the roles of Healthwatch England is to provide support to the 152 local Healthwatch around England. Each health and wellbeing board will include a representative from the local Healthwatch as a full and equal member. Every top tier and unitary local authority in England must have had a health and wellbeing board by 1 April although many will have had a shadow board already in place. The inclusion of local Healthwatch membership of the health and wellbeing board is intended to give the formal patient, user and public representation to the process of strategic commissioning for a local population. It is important that local Healthwatch use this place effectively and appropriately and for the benefit of their local population. HEALTH AND WELLBEING BOARD PRINCIPLES The principles behind health and wellbeing boards include:- 1 - Shared strategic leadership and ownership within a local area for the identification of health and wellbeing issues for the population - Transparency and openness in how it works - Engagement with patient, user and public representation on an equal footing. The Health and Social Care Act 2012 outlined these general principles but left flexibility for local authorities and their partners to operate their health and wellbeing board structure in the way which best suits local needs. Engagement with the local community, in a complementary but different way from that of the elected member(s), is achieved through the local Healthwatch representative of the health and wellbeing board. HEALTH AND WELLBEING BOARD FUNCTIONS The Boards have a number of statutory functions, which are set out in Appendix 1.
These include:- - Producing a Joint Strategic Needs Assessment (JSNA) which outlines the health and wellbeing needs of the community, and a Joint Health and Wellbeing Strategy (JHWS) which identifies priorities and sets out how services will be commissioned or provided to meet these needs. - Promoting integrated working across health and social care commissioning and with other local services such as education and housing. Local authorities may delegate other public health issues to health and wellbeing boards. All players are encouraged to consider wider issues which impact on the health and wellbeing of their populations, such as social deprivation, access to and use of leisure facilities, housing and environmental issues and so on. MEMBERSHIP The Health and Social Care Act 2012 creates health and wellbeing boards within the local authority committee structures and membership must include: 2 - At least one councillor - The Director of Public Health - The Director of Adult Social Care - The Director of Children s Services - At least one representative from each relevant (ie local based practices) Clinical Commissioning Group (although a single person may represent more than one CCG) - At least one representative of the local Healthwatch. The council may also appoint other members as it sees fit. NHS England will identify a representative, usually from the Area Team, to attend as and when necessary, on the invitation of the health and wellbeing board. NHS England must be involved in the preparation of the Joint Strategic Needs Assessment and the Joint Health and Wellbeing Strategy. Local authorities will need to manage the size of the health and wellbeing boards. Two tier areas may want to devise mechanisms to ensure the voice of district council members is heard, as well as representatives from leisure, housing, crime and community safety. AGENDA The agenda must not be too extensive to allow sufficient debate. During 2012 a number of regional workshops, facilitated by the Local Government Association (LGA), stressed the need for health and wellbeing boards to focus the agenda on fewer items and do them effectively. A model could be for the health and
wellbeing board to meet every two or three months with an information workshop between meetings to explore specific issues more widely and include other partners. No formal health and wellbeing board decisions could be taken at these workshops DEPUTIES Each health and wellbeing board, in conjunction with their local authority, will agree a policy on the use of deputies. It would be useful for a health and wellbeing board to allow voting deputies for the statutory members including the local Healthwatch nominee. This should be clarified at an early meeting. The local Healthwatch deputy could also start to attend meetings as a meme of the public to help understand the issues. VOTING All the core members of the health and wellbeing board will have the right to vote which is unique for a local authority committee. It is more common within the NHS where directors have had voting rights at Hospital Trust Board meetings. However, the local authority, in conjunction with the health and wellbeing board, has the power to limit voting rights. The issue of how, when and if the local Healthwatch representative should vote in health and wellbeing board debates is discussed below. HEALTH AND WELLBEING COMMITTEES AND SUB GROUPS Health and wellbeing boards can establish sub committees, specific task and finish groups or some other system of working on a particular issue for presentation to the full health and wellbeing board. This is acceptable so long the health and wellbeing board s statutory duties relating to the development of the JSNA and the JHWS are met. This approach is used frequently in both local authorities and the NHS. This may have implications for local Healthwatch. Where most of the preparatory work is carried out in sub committees or in advance of the health and wellbeing board, opportunities for input at the full meeting may appear limited. However, the principle nothing about me without me should still be followed. Every local Healthwatch will need to ensure widespread engagement with the local community including the voluntary and community sector whether as users or providers or both in relation to the JSNA and the JHWS. Local Healthwatch will be key to ensuring that such participation is as widespread as possible using all available mechanisms including electronically based ones. Local Healthwatch can involve the harder to reach users of NHS and social care services especially as local Healthwatch can be flexible by, for example, working outside normal working hours and going to where people are (ie younger people, care homes, day centres). 3
The strength and credibility of Healthwatch relies on reaching out to all sectors of the community. Many LINk organisations had well developed arrangements with third sector organisations either on a generic basis or for specific interests such as mental health, older people and cancer sufferers. Where these are inclusive it will add credibility to the local Healthwatch and the health and wellbeing board. Access and understanding of data and information will be crucial to local Healthwatch understanding the needs of the community and informing the joint strategic needs analysis and joint health and wellbeing strategy. CODES OF CONDUCT Members of health and wellbeing boards are bound by the codes of conduct applicable to local authority committees. Details of these will be available from the local authority and published on their website. Members of a health and wellbeing board will need to declare any personal or pecuniary interests on appointment and this declaration should be repeated if there is a relevant agenda item. For example, a local Healthwatch member who is an employee, member, or trustee of a local voluntary or community organisation which was a provider or potential provider of a service commissioned by the local authority or the CCG. If deputising arrangements have been made the deputy may represent local Healthwatch at that particular meeting. Adherence to the Code of Conduct is a legal requirement. Behind the code of conduct are the seven Nolan principles of public office which local Healthwatch should be aware of and integral to all their work. These can be found here (add link) These principles should operate throughout the work of local Healthwatch including the work of the local Healthwatch representative on the health and wellbeing board. TRANSPARENCY AND OPENNESS Meetings of the health and wellbeing board should be held in public with relevant papers made publicly available no less than five days prior to the meeting. The meetings should also be accessible to the public and advertised at the offices of the local authority and other appropriate location such as the offices of the CCG and the local Healthwatch. Certain issues may be discussed in private where these may be prejudicial to the public interest. These relate to issues where an individual may be named or where there is a particularly sensitive matter or commercial relevance, although this facility should not be used to discuss matters which might prove uncomfortable to one or other of the partners around the health and wellbeing board, including local Healthwatch. A motion on the agenda, moved, seconded and agreed, will be necessary to make the item private. The agenda must note the subject topic although it can keep this vague to protect anonymity. 4
Within an induction programmes for their board members, local champions, members and staff, local Healthwatch should outline the role of the health and wellbeing board and perhaps encourage attendance at one meeting. ENGAGEMENT WITH THE LOCAL COMMUNITY The joint strategic needs assessment and joint health and wellbeing strategy will require participation and many local authorities have established effective mechanisms for such activity. Some health and wellbeing boards operate part of some of their meetings as a participatory exercise by focussing on a particular subject, or range of issues, and inviting interested parties to take part. In these cases the local Healthwatch is in an excellent position to facilitate some of that process. APPOINTMENT OF THE LOCAL HEATHWATCH REPRESENTATIVE Selecting the local Healthwatch representative for the health and wellbeing board may be a challenge. Most of the members of the health and wellbeing board will have a professional background and there is a tendency for the use of jargon and acronyms making accessibility a challenge. However it is important that this is challenged and the person feels comfortable doing so. In addition the person must have credibility with both the health and wellbeing board members and the local Healthwatch board members, staff and volunteers. Each local Healthwatch must decide who is best suited to act on their behalf in some cases this may be seen as being the chair or the chief officer or someone else. It will vary depending on local circumstances. SUPPORT AND FEEDBACK The local Healthwatch representative on the health and wellbeing board will need the full support of the organisation. Where there are interest or geographically focussed sub structures in the local Healthwatch, these will need to have an opportunity of feeding into the health and wellbeing board process. For example, the LINk in Leicestershire used a system whereby the chair of the key interest groups met with their representative on the shadow health and wellbeing board two or three days prior to the health and wellbeing board meeting. Everyone had access to the papers and they are able to discuss the issues and brief the representative. The health and wellbeing board representative also needs to feed back to fellow board members, staff and volunteers. This could be a simple report as an agenda item on the local Healthwatch Board meeting or by email or telephone reports, published on the local Healthwatch website. The local Healthwatch must decide 5
which format is best for them but the individual concerned must never be put in a position of simply representing their own views. If a deputising arrangement has been agreed then the deputy should be involved in pre-meeting discussions. THE FRANCIS REPORT The key messages focus on transparency and openness alongside a duty of candour. As the public representative, the local Healthwatch nominee is at the forefront of ensuring issues are discussed openly and properly. The Francis report was particularly critical of hospital trust board members who appeared to take a back seat and accept what they were told by officers without question. Local Healthwatch members of health and wellbeing boards need to be aware of this and the impact it may have on their performance as one of the, if not the only independent board member. CONFLICTS Declarations of interest and identification where an individual may have a conflict of interest is discussed above. There are a number of other issues under the heading of conflict. Firstly, of course, is the fact that local Healthwatch is commissioned and funded by the local authority. This should not impinge on local Healthwatch s responsibility to represent the views and experiences of patients, users, their carers and the general public providing local Healthwatch has good evidence of these. Where there are genuine differences of opinion within the local Healthwatch, the local Healthwatch representative may put forward arguments or points which he or she does not necessarily support. Whatever argument or view is being put forward needs to be firmly based on what local Healthwatch has as clear evidence. There may be times when the local Healthwatch representative must decide if to vote on an issue. Other people are formally responsible for commissioning services and will have various duties around this placed upon them. The local Healthwatch representative may be thought to be allying itself with those it is supposed to be monitoring. However each local Healthwatch must determine its own appropriate approach. Appendix 1: Health and Wellbeing Boards have the following duties which MUST be undertaken: 6
(The duties apply to the Health and Wellbeing Board as a whole, except where indicated that the duty applies to a specific member of the HWB, e.g. CCG). 1. A duty to prepare assessment of needs (Joint Strategic Needs Assessment) in relation to local authority area and have regard to guidance from Secretary of State. 2. A duty to prepare joint health and wellbeing strategy for meeting needs included in joint strategic needs assessment in relation to local authority area and to have regard to guidance from Secretary of State. 3. A duty to publish joint strategic needs assessment and joint health and wellbeing strategy. 4. A duty to involve health and wellbeing boards in preparing or significantly revising the CCG commissioning plan including consulting it on whether the plan has taken proper account of the relevant joint health and wellbeing strategy (this legal duty applies to the CCG to involve the health and wellbeing board). 5. A duty to provide opinion on whether the commissioning plan has taken proper account of joint health and wellbeing strategy. 6. A duty to include a statement of the final opinion of the relevant health and wellbeing board in the published commissioning plan (this is legally a duty of the CCG to include the health and wellbeing board statement in their published commissioning plan). 7. A duty to review how far the CCG has contributed to the delivery of any joint health and wellbeing strategy to which it was required to have regard and to consult health and wellbeing board on this. 8. A duty in conducting the performance assessment, to assess how well CCG has discharged duty to have regard to joint strategic needs assessment and joint health and wellbeing strategy and to consult health and wellbeing board on its view on CCGs contribution to delivery of any joint health and wellbeing strategy to which it was required to have regard (when conducting its annual performance assessment of the CCG). 9. A duty to involve third parties in preparation of joint strategic needs assessment: Local Healthwatch people living or working in the area for county councils each relevant district council. 7
10. A duty to involve third parties in preparation of the joint health and wellbeing strategy: 8 Local Healthwatch people living or working in the area. 11. A duty to have regard to the NHS England mandate in developing the joint strategic needs assessment: and joint health and wellbeing strategy. 12. A duty to consider flexibilities under NHS Act 2006 when developing joint health and wellbeing strategy. 13. A Health and Wellbeing Board must, for the purpose of advancing the health and wellbeing of the people in its area, encourage persons who arrange for the provision of any health or social care services to work in an integrated manner. Health and wellbeing boards have the following powers, which they can choose to exercise as they see fit: 1. The health and wellbeing board has the power to give its opinion to the local authority which established it on whether the authority is discharging its duty to have regard to relevant joint strategic needs assessment and joint health and wellbeing strategy. 2. The health and wellbeing board has the power to provide NHS England with opinion on whether a published commissioning plan has taken proper account of the joint health and wellbeing strategy (copy must also be supplied to the relevant CCG). 3. The health and wellbeing board has the power to appoint additional members to the board as deemed appropriate. 4. Health and wellbeing boards have the power for two or more HWBs to exercise their functions jointly. 5. The health and wellbeing board has the power to request information for the purposes of enabling or assisting performing its functions from: the local authority certain members or those they represent with a duty to provide (this includes local Healthwatch and local CCG) 6. The health and wellbeing board has the power to consult any persons it thinks appropriate in preparation of JSNAs. 7. The health and wellbeing board has the power to include in joint health and wellbeing strategy, a statement of views on how the commissioning of health and
social care services, and wider health-related services, could be more closely integrated. 8. The Local Authority has the power to delegate any local authority function (except scrutiny) to the health and wellbeing board. 9. The health and wellbeing board has the power to encourage close working (in relation to wider determinants of health): between itself and commissioners of health related services between commissioners of health services or social care services and commissioners of health-related services 10. A Health and Wellbeing Board may encourage persons who arrange for the provision of any health-related services in its area to work closely with the Health and Wellbeing Board. 11. A Health and Wellbeing Board may encourage organisations that arrange for and organisations that provide any health or social care services to work closely together. 9