The role of Health and Wellbeing Boards

Last Wednesday saw an update conference on Health and Social Care Integration in the splendid setting of Ickworth House’s Historic West Wing. The meeting was facilitated by Richard Humphreys of the Kings Fund, whom I have met on a number of occasions as Health and Wellbeing Boards were being formed and the thinking around them matured.

As I sat and listened to a wide range of speakers giving their views as to where we are at, it seems to me that we are some way off a joint vision for the spectrum of services and the mechanism to support the proper joint commissioning of those services, or in other words how we move money around the system.

As always the elephant in the room was the acute sector or more correctly how do we alter the system and close hospital beds without  a. the hospitals going bust b. MPs and the public chaining themselves to the hospital front doors and c. protests in the street about ‘Save our hospital’.

We all know that Big money is in hospital beds and we all know how protective people are of those beds, yet an admission to hospital must be seen and the system must be designed and funded to acknowledge that such an admission is a complete failure of the Health and social care system, yes we need beds and hospitals for when we are ill but far, far too many and in particular older people are going into hospital when that is precisely where they should not be, far too many people are in hospital who could, with the right primary and social care support, could be treated in their community and supported at home, far better outcomes for the resident and far less cost to the system.

One of the things that interests me most is the emerging picture from the United States health care system where major insurers who are not hung up on jobs and the beloved citadels of the system but on the actual costs of providing care. Once they have a person’s insurance contributions, they pump prime money into prevention health and social care programmes and this saves them significant sums of real money, further down the system in their hospital admissions. Just imagine if we took money out of the actues and put it into sports centres, a motion that would seem ridiculous but when you look at actual ways to save money in the long term perhaps not such a crazy idea at all. An analysis of the joint care pathway showing service interventions size, spend and an understanding of what will need to change and the impact of this demographically and financially is not an easy task but one we should be undertaking and its the local Health and Wellbeing Boards not Whitehall mandarins who are best placed to know their local area and what will work best.

Of course the first thing that would have to be tackled is the core stumbling block of payment by results funding mechanisms of the acute hospitals which is actually payment by activity, so less activity would mean less income and the current model would fail. The next stumbling block would be us residents who want the hospital there just in case and are deeply suspicious of any change because we simply do not believe that it’s about improving services but actually about cuts to our beloved NHS, however if waiting times were reduced then perhaps we might start to warm to the idea that we can increasingly be treated away from a hospital setting and more effectively.

One of the acid tests of this at the moment is the out of hours service, I don’t know a single person who if really worried for themselves or a loved one would trust the service rather than simply get the ill person in the car and drive to A&E, with the current performance of the ambulance service in the East of England we even worry about that turning up.

The scale of the challenge before the system and Health and Wellbeing boards is immense but so are the rewards to us as residents and the system as a whole that the difficult times ahead and are worth every effort to get this right. To some extent this is of course now not a new agenda but there is a new imperative to deliver the plan, cope with our ageing population and realise the savings that can be made at the same time as servicing residents needs better, now that’s something worth having the difficult discussions about.

About askcolinnoble
I'm a Conservative politician-lite, I dabble a bit in Party Politics with my main focus of working hard and being a strong voice for my community making sure local government delivers quality services and fellow residents get value for money for their hard earned money they pay in Council tax | Where this Gravatar appears and I am expressing my views or liking something I do so in a personal capacity and does not necessarily reflect the views or policies of Suffolk County Council, Forest Heath District Council, the Conservative Party or come to think of it anyone else | But having said the above at an election time and to stay legal anything I write is promoted by Kerry Buist on behalf of Colin Noble, both at West Suffolk Conservative Association, Unit 8, Swan Lane Business Park, Exning, Newmarket, Suffolk CB8 7FN

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