MPs fire warning over health and wellbeing boards and accountability

There appears to be “real confusion” over how, and for what, health and wellbeing boards (HWBs) are to be held accountable, the Communities and Local Government Committee has warned.

In its report, The role of local authorities in health issues, the committee said: “Given the health and wellbeing board's pivotal role in the new local health system, as the forum for local government, the NHS, the public and providers, each board must be held accountable for its work.

“But it is unclear whether HWBs will be held responsible for health outcomes in an area. We have heard differing accounts from Communities and Local Government and Health Ministers as to how or, indeed, whether they will be.”

The MPs added that accountability could not take place just through the election of the board's local councillors, “and this seems to be an area of real confusion”.

The report said: “The questions are, what are HWBs to be accountable for, given their lack of powers; and, what sort of accountability is appropriate: democratic, procedural or financial?”

The CLG committee said it was concerned also by the suggestion that the Director of Public Health, a member of the board, would inform the scrutiny committee if the board were performing poorly.

“This would place Directors of Public Health in an invidious position, and we therefore do not consider this to be a satisfactory or robust mechanism to hold boards to account,” the report added.

The MPs urged the Government to clarify the procedures for holding HWBs to account, including the role it expects local overview and scrutiny committees to play and the role of the Director of Public Health, given their position as a board member.

“Directors of Public Health should also report directly to the local authority's chief executive, and we urge the Government to reassert its understanding of this point, too,” the report said.

The CLG committee suggested that the NHS Commissioning Board, which is at the top of the pyramid, lacked local accountability and its status in relation to HWBs was unclear. 

Nor was it clear to whom clinical commissioning groups (CCGs), the bodies that commission local services, were to be held accountable. The MPs said they were not persuaded by ministers’ arguments for not allowing councillors to sit on them. Who should sit on a local CCG was a local matter that should be left to local resolution, the report added.

The CLG committee  called on the Government to set out in detail what a HWB can do if the NHS Commissioning Board or CCGs fail to commission services consistent with its strategies.

Committee chair Clive Betts MP said: “Under the reformed system, considerable power is to be invested in a range of new bodies. With such power must come accountability. 

“The purpose of localism is not only to devolve decision making to a local level, but to make it accountable to local people. With these changes it is clear that there is a shift of power and money from the Whitehall to local government and I welcome that. But the new arrangements are complex and responsibilities are shared across several bodies. The result is that lines of local accountability are fragmented and blurred.”

Overall, however, the committee welcomed the return to local government of the responsibility to improve the health and wellbeing of local people.

It said: “The successful operation of health and wellbeing boards is crucial to the new arrangements. Boards should aim to be creative by including where possible those individuals with responsibility for the social determinants of health, including those working in education, planning and economic development.

“The obvious danger with the new boards, however, is that the initial optimism surrounding their establishment and first year or two in operation will falter and go the way of previous attempts at partnership working that failed and became no more than expensive talking shops.”

The committee added that, to succeed, HWBs would need to work on the basis of relationships and influence, and this would depend on both people and structures.

The report also commented that:

• It was still not clear who would be in charge in the event of a regional or national outbreak. The Government therefore needed to set out clearly and unambiguously the lines of responsibility in the event of health emergencies. 
• Current information-sharing arrangements were inadequate and needed to be improved. The Government must involve the Information Commissioner in clarifying what data local authorities and the NHS can share. 
• The Government should work to clarify the funding formula for 2015-16 with a view to removing ring-fencing and moving to community budgets. 
• The Government should put in place a timetable for publishing and consulting on the 2015-16 allocations and finalise them by October 2014. This would provide those commissioning services and providers with at least six months in which to plan.

The CLG committee meanwhile noted the perverse incentive of basing funding on health outcomes, as councils that improve the health of local people will have their funding cut. The Government should ensure the Advisory Committee on Resource Allocation reviews the allocation formula, it said.

Clive Betts said: “An overarching strategy needs an overarching budget. Community budgets, which allow all providers of public services to share budgets, are being piloted and in the medium term they may provide this, ensuring that money is directed at people and places, rather than organisations.”

A copy of the report can be viewed here.