Item 6

Shadow Devon Health and Wellbeing Board

150 JanuaryNovember 20123

Report of the Devon Health and Wellbeing Board Secretariat

Ways of working and the future of the Devon Health and Wellbeing BoardPartnerships and Joint Working

Recommendations:

It is recommended that the Shadow Board:

i) Notes the Government’s intention to bring the new Regulations into effect from April 2013 which will strengthen and streamline the local authority health scrutiny function.

ii) Request the Secretariat, working in conjunction with the County Council’s Health and Wellbeing Overview and Scrutiny Committee to agree a short joint statement on roles and responsibilities based on section 1 of this report.1. That Devon County Council, on behalf of the Shadow Board, engages the Devon Audit Partnership over the period to April 2013 for risk management and assurance.

2. That a joint workshop be held in Spring 2013 for allleading members and representatives of the Devon, Plymouth and Torbay Shadow Health and Wellbeing Boards and each Council’s Health Scrutiny Committee.

3. Note that the Members’ development day, which will take place on the morning of Friday 8 February 2013, will include:

Guidance on the requirements and aims of the public sector equality duty.

The carrying out of a self assessment (using the LGA’s Development Tool) of readiness to become a statutory Board.

A briefing on Devon County Council’s operating and meeting procedures, code of conduct and standards in public life.

4. That the Secretariat prepares a report for consideration by the Heart of the South West Local Enterprise Partnership to enable an exploration of shared priorities and development of a strategy for health workplaces.

iii) That the Board notes the topics that will be covered at the members’ development workshop on Friday 8 February 2013.

iv) Ask the Secretariat to consult with a range of stakeholders to review existing structures and produce an options paper for integrated commissioning arrangements and engagement processes with health and social care providers and voluntary and community sector organisations.

1. Health and wellbeing: roles and responsibilities

1.1Background

At its meeting on 27 September 2012, the Board asked “that the Health and Wellbeing Secretariat consider how the Shadow Board might hold partners to account and also the role of Scrutiny and bring a report to a future meeting” (minute 14 refers). It was noted at the meeting on 15 November 2012 that Devon County Council’s Health and Wellbeing Scrutiny Committee receives regular updates on the work of the Board (minute 30 refers).

At their 27 November 2012, members of the County Council’s Health and Wellbeing Scrutiny Committee recognised the need for clarity about the relationship between the Board and the Committee.

1.2 Health and wellbeing scrutiny

The Health and Wellbeing Scrutiny Committee has responsibilities for:

  • Reviewing and scrutinising all matters relating to the planning, provision and operation of health services in Devon.
  • Making reports and recommendations to local NHS bodies and other local authorities on any matter reviewed or scrutinised.
  • Being consulted by NHS bodies on any proposal for a significant change in local health services and having the right to refer to the Secretary of State any instances where the Committee feels these to be inappropriate or not properly consulted upon.
  • Requiring NHS bodies to provide information for them and attend meetings.

The Committee’s remit is “To review the implementation of existing policies and to consider the scope for new policies for all aspects of the discharge of the Council’s functions relating to the health and wellbeing of the people of Devon including the activities of the Health & Wellbeing Board, when established [as a decision-making committee of the Council], and the development of commissioning strategies, strategic needs assessments and, generally, to discharge its functions in the scrutiny of health services. In addition, to make reports and recommendations as appropriate arising from this scrutiny to the County Council and to the Secretary of State for Health in accordance with the Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002.”

The Department of Health consulted, over the over the period 12 July to 7 September 2012, on proposals to make regulations to strengthen and streamline health scrutiny by local government. The proposals for the new arrangements for health scrutiny will build on the existing system by:

  • extending scrutiny to all providers of NHS care, whether they are from a hospital, a charity or an independent provider
  • requiring organisations proposing substantial service changes and the local authorities scrutinising those proposals to publish clear timescale for decision-making, so patients know when they can expect changes
  • requiring local authorities to take account of the financial and clinical sustainability of services when considering NHS reconfiguration proposals
  • seeking the help of the NHS Commissioning Board in liaising with local authorities and commissioners to secure local agreement on some service reconfigurations and ensuring that proposal for change meet the Secretary of State’s “four tests”

The Department of Health is developing regulations in the form of a new statutory instrument for health scrutiny. It is intended that these will be laid before Parliament early in 2013 and come into force in April 2013.

1.3Health and wellbeing board

From April this year, the statutory Devon Health and Wellbeing Board will be a committee of Devon County Council where key leaders from the health and care system work together to improve the health and wellbeing of the local population and reduce health inequalities. The Board will have statutory duties to:

  • Encourage integrated working between commissioners of NHS, public health and social care services for the advancement of the health and wellbeing of the local population.
  • Provide advice, assistance or other support in order to encourage partnership arrangements such as the developing of agreements to pool budgets or make lead commissioning arrangements under section 75 of the NHS Act.
  • Prepare a joint strategic needs assessment and a joint health and wellbeing strategy.

The principles which underpin the Devon Joint Health and Wellbeing Strategy, which was endorsed by the Board at its meeting on 15 November 2012 (minute 29 refers), are:

  • Focus on improving health and wellbeing for individuals and communities
  • Ensure services are efficient and effective
  • Promote healthy lifestyles and identifies illness and the need for support at an early stage
  • Support joint working where it makes sense to do so
  • Use evidence of what works, informed by people’s views, to guide its [the Board’s] work
  • Enable improvements and progress to be measured.

The roles of the Scrutiny Committee and the Board are different and distinct.

The Health and Wellbeing Scrutiny Committee’s work tends to focus on specific health and wellbeing issues such as

  • Falls and fracture prevention.
  • Strategic and operational changes at the Royal Devon and Exeter NHS Foundation Trust.
  • Future role of community hospitals and their contribution to patient care.
  • Health developments for armed forces veterans.

The Board’s role is strategic and its future work programme covers:

  • Transition of public health functions
  • Reports from the children and adult safeguarding boards
  • Authorisation of the clinical commissioning groups
  • Commissioning strategies

2. Development workshop for Board members on 8 February 2013

The development workshop (9.30am to 2.00pm) for Board members on Friday 8 February will include:

  • A self-assessment using the development tool produced by the Local Government Association and NHS Leadership Academy covering
  • Strategy, purpose, vision
  • Leadership, values, relationships, ways of working
  • Governance
  • Roles and contributions
  • Measures and accountabilities
  • A discussion of key priorities in the joint health and wellbeing strategy
  • Guidance on the requirements and aims of the public sector equality duty.
  • A briefing by the County Solicitor on the statutory regulations and Devon County Council’s operating and meeting procedures, code of conduct and standards in public life.

3. Engagement with stakeholders

Integrated commissioning arrangements and engagement with wider stakeholders will be important to the work of the Health and Wellbeing Board. As the local authority and clinical commissioning groups establish new ways of working it will be essential that the Board utilises these arrangements where appropriate rather than setting up duplicate processes.

The Cabinet of Devon County Council, in December 2011, recognised the importance of establishing a wider Health and Wellbeing network to engage the range of agencies, organisations and groups that influence the health and wellbeing of people in Devon (Devon County Council Cabinet minute 422 from 14 December 2011 refers). Existing commissioning arrangements include the following groups/networks:

  • Joint Commissioning Executive Group
  • Devon Provider Engagement Network
  • Devon Consortium of voluntary and community sectors bodies

The Shadow Board members acknowledged that at their May 2012 development workshop the importance of setting up communication processes with a range of provider organisations to help inform the work of the Board. Whilst having robust integrated commissioning arrangements will be important to the implementation and monitoring of the Joint Health and Wellbeing Strategy.

In establishing the new organisational structures and processes it will be important to ensure ownership by all partners and to avoid duplication, building on existing arrangements where effective.

To this end it is proposed that the Shadow Health and Wellbeing Board Secretariat is asked to work with commissioning bodies and wider stakeholder groups to produce an options paper that reflects efficient and effective approaches to be considered at the 7th March 2013 meeting.

Risk register and assurance

The Shadow Board has recognised the need to identify and manage the risks associated with its establishment and operation.

The Devon Audit Partnership, which provides assurance in areas such as risk management, has had informal preliminary discussions with the officers at Torbay Council, Plymouth City Council and Devon County Council who support the health and wellbeing boards.

The Audit Partnership has identified the factors which will determine Boards’ effectiveness as including:

Organisational complexity – engagement with district councils and several clinical commissioning groups. Boundaries with key stakeholders may not be co-terminous.

Boards’ success is interdependent with bodies outside local authority.

Large geographical areas covering urban and/or rural communities.

Resources not adequate to effectively support the Board.

Boards’ priorities are not clear or are not effectively communicated.

Board unable to effectively work in an environment of complex organisational change (within the NHS), unprecedented financial pressures and rising demand.

Environment of organisational change within the Council – political and officer, impacts on the effectiveness of the Board.

It is suggested that Devon County Council, on behalf of the Shadow Board, engages the Devon Audit Partnership over the period to April 2013 to support risk management.

Working with the Torbay and Plymouth Health and Wellbeing Boards

The University of Birmingham, Local Government Association and NHS Institute organised a south west regional event for health and wellbeing boards on 4th October 2012. Members and representatives of boards were invited to respond to a series of scenarios and challenges. Discussions between the members and representatives from the Devon, Torbay and Plymouth Shadow Health and Wellbeing Boards at that event recognised the potential for shared benefits through collaboration:

Agreement about the type of issues and matters that the three Boards will consider;

Coordination of response from each of the three Boards to proposals for changes to health, public health and social care services;

Shared approaches to consultation and engagement, particularly through local Healthwatch.

Relationship with the Health and Wellbeing Scrutiny Committee

Devon County Council’s Health and Wellbeing Scrutiny Committee receives regular updates on the work of this Board: it is a standing item for their meetings. The Centre for Public Scrutiny has published a guide which aims to help local leaders and others to understand the independent, but complementary, roles and responsibilities of health scrutiny and health and wellbeing boards. There is a link to that guide at

It is suggested that a network event/workshop is held in Spring 2013 for all members and representatives of the Devon, Plymouth and Torbay Health and Wellbeing Boards and Scrutiny Committees.

Update on progress and possible implications of secondary legislation

Shadow Board Members will recall that the health and wellbeing board is a local authority committee, specifically required to be established by the Health and Social Care Act 2012. The Shadow Board operates under the current Standing Orders and Financial Regulations of the County Council and its meetings are accessible to the public.

Shadow Board Members will also recall that the Government intends to enact secondary legislation governing:

Political proportionality requirements

Voting restrictions

Conflicts of interest

Appointment of sub-committees

Access to information provisions

It is understood that the Department of Health intends to publish details of the specific provisions in the current legislation that it intends to disapply, modify or retain in early November and an update on progress with the secondary legislation will be provided at the meeting.

The development day on the morning Friday 8th February 2013 for Shadow Board members will include a briefing session on the Council’s operating and meeting procedures, code of conduct and standards in public life.

Local Enterprise Partnership

The partnership mapping exercise which Shadow Board members undertook at their development day in June 2012 identified the private sector led Heart of the South West Local Enterprise Partnership (SWLEP), which covers all of Devon and Somerset, as a key stakeholder. The SWILEP has identified health and wellbeing as a priority so the opportunity exists to agree a joint approach. In terms of the Joint Health and Wellbeing Strategy the workplace is a key setting for promoting priority two: healthy lifestyle choices through a universal approach as well as targeted to returners to work following periods of sickness absence.

Therefore it is proposed thatnformal discussions with some of the LEP’s Board members have highlighted potential benefits from a :

A discussion with the Shadow Board about links between health & wellbeing and economic priorities.

Development of a jointshared strategic approach and set of priority actions for workplace health as part of the Government’s health at work network kis developed., chaired by Dame Carol Black.

Shadow Board Members may wish to ask the Secretariat to prepare a report for consideration by the LEP.

63. Equality Considerations
The needs of people and communities, particularly those most vulnerable or disadvantaged, will beare made explicit in the Devon Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy. Integrated Impact Aassessments will be undertaken on specific thematic, condition or population based health and wellbeing related strategies.

It will be important for the Health and Wellbeing Board to consider all individuals in shaping policy and have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations between different people when carrying out its activities.

74. Legal Considerations
The sSecondary legislation in relation to health scrutiny and in relation to the is due in January 2013 relating to the operation of the Health and Wellbeing Board is expected in early 2013.

85. Risk Management Considerations
The establishment of the Devon Health and Wellbeing Board will be subject to all necessary safeguards and action being to safeguard the Council's position. The corporate risk register will be updated as appropriate.

96. Options/Alternatives
The Health and Social Care Bill requires all upper tier authorities to establish a shadow Health and Wellbeing Board by April 2012 and a statutory Health and Wellbeing Board by April 2013.

107. Public Health Impact

The Shadow Devon Health and Wellbeing Board willis be central to overseeing the commissioning of services which address public health and other relevant health and wellbeing outcomes.

Dr Phil Norrey
CHIEF EXECUTIVE
DEVON COUNTY COUNCIL

Electoral Divisions: All
Cabinet Member for Health and Children: Councillor Andrea Davis
Contact for enquiries: Ian TearleRoland Pyle
Room No 255G60, County Hall, Topsham Road, Exeter. EX2 4QUD
Tel No: (01392) 36782913761

Background Papers
Nil