Will Health and Wellbeing Boards (HWBs) survive? There are divergent views. They still seem to be very popular in national policy circles, but more locally there are questions as to whether they are achieving very much. At a recent meeting with representatives across a region, it was a consistent story – they’re run like traditional council committees, they’re not strategic, they scrabble around for agenda items and they don’t take Healthwatch or the third sector very seriously.

Whether or not they’ll eventually be deemed to succeed, I don’t know (but I fear not and they’ll be abandoned for the next big thing, or reinvented with a new name). However, not knowing what they’re there for – which a number of people claim to be the problem – should not be a reason for giving up on them. I think there’s a very clear and powerful purpose. It’s just difficult to get right.

There’s no mystery about what that purpose is: it’s the key function set out in the 2012 Health and Social Care Act, namely to produce a Joint Health and Wellbeing Strategy (JHWS). That is powerful because it should drive the commissioning of the main public services in an area including the local NHS (the CCG and to some extent the Local Area Team) and the whole of the Council (as far as I can see, the Act doesn’t restrict it to social care commissioning: it is in relation to health and wellbeing, but that’s most of what the council is there for).

But getting a JHWS that can do that is hard. It’s not just a mechanical, technocratic exercise where you put the work in, turn the handle and get a result. It requires vision and creativity, and that’s hard to set up a procedure for. The Health and Wellbeing Board needs to come up with a picture which is simple enough to engage people but which sets a clear direction and is thoroughly evidence based. It must show what needs to be done differently. An extension of what is already being done (however valuable) will not be enough to meet the very real challenges ahead (such as funding and the ageing population).

Ideally you’d want to be able to show the essence of that on one page. That’s hard (I’ve tried), not just because it would have to be a very big page to get all the detail on, but because you need to view it from different perspectives, each of which needs its own page.

Some of those perspectives that it would be useful to show, even at a very high level are:
• the broad types of intervention to focus on that will make most difference. That might be things like: prevention, technology, service reconfiguration, social capital.
• How those break down into more detail. For instance, ‘prevention’ might be broadly broken down into: physical activity; diet and obesity; unhealthy behaviours (e.g. tobacco and alcohol); and social capital (e.g. socialisation, avoiding loneliness).
• What difference those interventions make to intermediate factors like levels of obesity, physical activity, functional families or efficiency
• How that affects the commissioning by a large number of different bodies, (from the various areas of council responsibility, to the CCGs, criminal justice and environmental bodies).
• The implications for various physical and mental conditions from cardiovascular disease and dementia to various forms of mental health problem.
• The way different interventions and results interrelate with each other, with feedback loops leading to non-linear change. It’s here that there is perhaps the biggest scope to make a difference.
• The different groups within the population you want to help (which can be divided up in lots of different ways – age, gender, socio-economic status, family type, living conditions etc. – so requiring even more pages)
• The net impact in terms of objectives such: as decreased premature inequality; lower inequality in healthy life expectancy; and reduced costs.

Having said you can’t show it all on one page, my attempt to do that is shown at the bottom of the page in a very simplified way. Maybe this just shows how difficult it is, but it’s a start.

Pulling it all together into something which will drive commissioning might require vision and creativity but it also requires an awful lot of hard work (and the vision might only come after familiarisation with a lot of the detail). So HWB’s don’t need to sit around waiting for inspiration to strike. They can get a broad picture of where the problems and opportunities are and start to drill down into them, bring in the experts from different fields (whether that’s a transport officer, a cardiac surgeon, a carer or a person with long term conditions) and start to delve into what the solutions might be. They can commission task and finish groups to work on detail. They can get out and about and talk to people. And they can have stakeholder groups where they start to bring it all together. That should make for some full, and worthwhile, agendas.

Producing a JHWS is a full time job for Health and Wellbeing Boards. And it needs to be done in partnership, involving people at all levels in the various organisations. This isn’t important for the survival of Health and Wellbeing Boards – who cares if a council committee survives? – it’s important because there is a real opportunity here to improve, and reduce inequalities in, people’s health and wellbeing, to really make a difference.

Health and Wellbeing Boards need some rocket boosters. But getting a man on the moon wasn’t just about the dramatic launch – it was also the years of co-ordinated hard work that led up to it. It’s time to make a similar commitment now, to saving and improving lives.