Agenda item

(1)               The Health and Social Care Act 2012 outlined a new role for local authorities for the co-ordination, commissioning and oversight of health, social care (adults and children’s) public health and health improvement.

(2)               Kent is the largest two tier area to have to implement the Health and Social care act 2012; some of the provisions of the Act are not designed for this scale and Kent faces unique challenges in implementing a successful Health and Wellbeing Board (HWB).

(3)               The report before the Board focused on the development of the sub-architecture for Health and Wellbeing Board functions, based on the initial year of operation in Shadow form, and the development of the Dover and Shepway Shadow Health and Wellbeing Board. The provisions for Health and Wellbeing Boards in the Health and Social Care Act do not give any formal role or responsibilities to District Councils. However, Kent County Council recognises the role of District Councils in the agenda and wants to engage proactively with them in developing the Health and Wellbeing Board and its sub architecture.

(4)               S194 (11) states that “A Health and Wellbeing Board is a committee of the local authority which established it and, for the purposes of any enactment, is to  be treated as if it were a committee appointed by that authority under section 102 of the  local Government Act 1972” Amongst other things this also means it can establish sub committees.

(5)               The Shadow Health and Wellbeing Board noted that whilst the County Council will retain the legal duty to establish a Health and Wellbeing Board; it has become clear, both through the establishment of the Dover and Shepway HWB and the development of this Board, that any sub committee will need to focus on a number of key areas to add value. These areas are:

(a)               Clinical Commissioning  Groups (CCGs) level  Integrated Commissioning Strategy and Plan;

(b)               Ensure effective local engagement;

(c)               Local monitoring of outcomes

(6)               It was also noted by the Board that the focus of any sub-architecture will need to be the integration of commissioning at a local level for both adults and children, feeding into the county-level Joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment and other operational arrangements. In Kent, there are three options to consider:

(a)               Option 1: Sub Committees based on CCG boundaries

(b)               Option 2: Sub Committees based on District Council boundaries

(c)               Option3:   Locality Boards

(7)               The Shadow Board noted that there was wide-spread support for the development of CCG level Health and Wellbeing Boards.

(8)               Paul Carter whilst supportive of the general thrust of the report had some concerns over the re-configuration of Public Health. He was concerned that if the Board was not careful there would be another layer of meetings. He was keen to see a rationalisation of bodies to ensure that what was created were not just another opportunity to talk about issues but were contributing to the health and wellbeing of the local population.

(9)               Mr Watkins raised a concern that the report was silent about the issue of financial subsidiary.

(10)          Dr Pinnock agreed that there should be Local Health and Wellbeing Boards and its membership should include representatives of Public Health, Children’s’ Centres, and the voluntary sector etc. He asked what functions will be – what actually will these proposed local Health and Wellbeing Boards be doing, How will issues such as “minding the gap” or equity be dealt with by these Local Boards. He concluded that for the CCG he represented to have a Local Health and Wellbeing Board was fine as the CCG boundaries were co-terminous with that of the Borough Council except foe one village out and one village in, and the same could be said for Thanet. However, if you looked at West Kent the picture was very different.

(11)          Dr Chaudhuri said the local Health and Wellbeing Boards were not accountable bodies  Dover and Shepway they had gone ahead and created a local health and wellbeing Board, Just because the law had not caught up his view was that there was the agreement in principle to move ahead in an informal way and  drive forward practical integration.

(12)          Paul Carter said in his view the Board should develop a model of what good looks like. Roger Pinnock added that he felt that Ashford Borough Council who might reasonably be expected to be on the Board and what functions would be devolved to them.

(13)          Meradin Peachey advised the Board that it would be important for the local Health and Wellbeing Boards to look at the Inequalities Gap particularly in looking at different parts of Public Health. She added the importance of building the Children’s’ Trust and said that the National Commissioning Board should not be overlooked.

(14)          RESOLVED that the Kent Health and Wellbeing Board and Kent County Council working in partnership with the District Councils and clinical Commissioning Groups develop a sub-architecture based on CCG boundaries.