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HWBs should not take on full responsibilities for health budgets, say CCGs

Health and wellbeing boards (HWBs), run by councils and health representatives, have a unique role in joining up health and care commissioning – but are not the appropriate bodies to take on the full responsibilities for health budgets.

That is the verdict of NHS Clinical Commissioners (NHSCC), which represents clinical commissioning groups (CCGs) in England and argues that the cultural differences between the NHS and local government will take time to “meet in the middle”. 

It adds that the political nature of HWB structures – which sit within local government organisationally – mean that they cannot be the bodies to take on the totality of health and social care spend. 

Therefore, a partnership with the NHS and local government is critical to ensure local populations are benefiting from pooled expertise that is balanced with an apolitical view on population need. 

The point was raised in a new report ‘A Shared Agenda – creating an equal partnership with CCGs in health and wellbeing boards’ where it is argued that the clinical expertise that CCGs bring play a “critical” and “central” role on HWBs, and one that is vital if integrating health and social care across the NHS and local government is going to become a reality. 

Dr Amanda Doyle, co-chair of NHSCC and chief clinical officer of NHS Blackpool CCG, said “Clinical commissioners are part of the fabric of their local communities. To HWBs we bring a practical, day-to-day health commissioning perspective. 

“As GPs we have considerable knowledge of the communities we service and can also tap into the breadth of patient knowledge from within our own membership.” 

‘A Shared Agenda’ is an attempt to highlight some of the barriers that are holding HWBs back and to learn from the areas where it is working well to ensure there is an equal partnership that delivers for patients. 

It was stated that several challenges currently stand in the way of HWBs fulfilling their potential and hinder CCGs from making a fully effective contribution to them. 

For instance, retaining HWBs within the structure of local government can compromise their independence and lead to an imbalance of power between the CCG and the council. 

CCG leaders say successful multi-agency working calls for mutual trust, respect and effective communication. It also demands a shared vision, direction and understanding of problems, as well as a commitment to acting jointly and a sense of interdependency. “It is difficult to foster these qualities in unequal partnerships,” they add. 

It was also stated that operating the Better Care Fund from 2015 will test how well CCGs and local authorities can cooperate and share resources. NHSCC stated that as a centrally devised programme it has highlighted some of the challenges and opportunities for joint working. 

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