NHS Future Forum calls for beefed-up powers for health and wellbeing boards

The government should strengthen the role and influence of health and wellbeing boards as part of its reforms, the NHS Future Forum has recommended.

The Forum – an independent group set up by the government to “pause, listen and reflect” on the Health and Social Care Bill – argued that the boards should be given stronger powers to require commissioners of both local NHS and social care services to account if their commissioning plans are not in line with the joint health and wellbeing strategy.

Its report said: “Local government and NHS staff see huge potential in health and wellbeing boards becoming the generators of health and social care integration and in ensuring the needs of local populations and vulnerable people are met.”

The Forum also suggested that better integration of commissioning across health and social care should be the ambition for all local areas. “To support the system to make progress towards this, the boundaries of local commissioning consortia should not normally cross those of local authorities, with any departure needing to be clearly justified,” it said.

Other key recommendations include:

• The pace of the proposed changes should be varied so that the NHS implements them only where it is ready to do so
• There should be a comprehensive system of commissioning consortia but they should only take on their full range of responsibilities when they can demonstrate they have the right skills, capacity and capability to do so
• Nurses, specialist doctors and other clinicians must be involved in making local decisions about the commissioning of care – not just GPs – but in doing this the NHS should avoid tokenism, or the creation of a new bureaucracy
• Competition should be used as a tool for supporting choice, promoting integration and improving quality and must never be pursued as an end in itself. Monitor’s duty to ‘promote’ competition should be removed and the Bill should be amended to require Monitor to support choice, collaboration and integration
• Private providers should not be allowed to ‘cherry pick’ patients and the government should not seek to increase the role of the private sector as an end in itself. “Additional safeguards should be brought forward”
• The duties placed on the Secretary of State, the NHS Commissioning Board and commissioning consortia to reduce health inequalities are welcome but they need to be translated into practical action
• Improving the public’s health is “everyone’s business” but should be supported by independent, expert public health advice at every level of the system. “In order to ensure a coherent system-wide approach to improving and protecting the public’s health, all local authorities, health and social care bodies (including NHS funded providers) must cooperate"
• All organisations involved in NHS care and spending NHS money should be subject to the same high standards of public openness and accountability.

The recommendations will now be considered and responded to by the Government.

Forum Chairman Professor Steve Field, a practising GP from Birmingham, said: “There is no doubt that the NHS needs to change. The principles underlying the Bill – devolving control to clinicians, giving patients real choices and control, and focusing on outcomes – are well supported.

“However, during our listening we heard genuine and deep-seated concerns from NHS staff, patients and the public that must be addressed if the reforms are to be progressed. If the substantial changes we propose are accepted by Government, then I think the resulting framework will place the NHS in a strong position to meet this objective and tackle the pressing challenges in the years ahead.”

The Forum’s reports can be downloaded here.

Philip Hoult