Pause for thought on the Health and Social Care Bill: a good idea?

Posted on Wednesday 6th April 2011

Taking the time to reflect before acting is rarely a bad idea. Too often governments confuse haste with decisiveness. There can certainly be no harm in further thinking about the planned radical changes to the health service.

Many of the proposed changes carry a high risk of unintended consequences; GP commissioners will be on a steep learning curve and some are bound to overspend. If they commission too much from the private sector, short terms savings may be outweighed by longer term costs – both financial and political – if valued local NHS services become unsustainable because too much of the business has gone elsewhere. If the Coalition gets these changes wrong the press and public will be unforgiving, especially as reform was not in either of the Coalition’s manifestos and because management and commissioning arrangements don't matter much to patients and the public.

One of the proposed changes – the creation of Health and Wellbeing Boards to ‘hold the ring’ between adult social care, public health and GP commissioners – has been broadly welcomed.  About 90% of upper tier authorities have signed up to be ‘early implementers’. Most are just getting on with meeting their GP commissioners, drafting their Board’s terms of reference, agreeing membership and thinking about how they are going to work together to deliver better outcomes in their areas. If the government gives up on Health and Wellbeing Boards now they will waste all the energy and commitment which has gone into making so much progress, in such a short time and at a time when local authorities have had so many other challenges to face. They will lose a great deal of goodwill and may find it hard to generate enthusiasm for another set of arrangements.

Concerns have been expressed about the lack of democratic accountability of GP commissioners. Increased local democratic accountability for health services is certainly to be welcomed and would fit with the localism agenda. Local authorities know more than anyone about the needs of their areas. However, having token Members on the boards of GP commissioning consortia is not the best way to achieve that. In large cities they would be spread very thinly across a number of consortia boards and it would be difficult to ensure sufficient expert officer support or consistency of decision making. From where would they derive their authority to influence GP’s commissioning decisions? The planned Health and Wellbeing Boards will give Members real authority and a clear role. They will be committees of the council, chaired by the Leader or a nominated Member, involving all the senior officers with vital specialist knowledge as well as representatives of patients and users. Boards will provide a framework for a new kind of local partnership to ensure better integration of public health, adult social care and acute services with more focus on prevention and early intervention and longer term investment in better outcomes.

Health and Wellbeing Boards have great potential.  They could achieve even more if they had some powers to go with their duties. There’s an old saying ‘if it ain't broke, don't fix it’. In the case of Health and Wellbeing Boards -  ‘if it’s going well, don't mess about with it.