Treading the boards

Local health boards, while their size and cultures vary, share
with councils the vision to be responsive to the needs of their
communities and provide high-quality services.

Established two years ago, LHBs play the lead role in commissioning
local health services in conjunction with councils, voluntary
groups and the independent sector. Fulfilling a similar role to
that of primary care trusts in England, LHBs can commission
everything from GP services to rehabilitative care.

Councils and LHBs have a statutory duty to develop joint health,
social care and well being strategies and to work in partnership.
They share many common desires: to have greater freedom from
government and the burdensome regulation that dominates the NHS and
local government, and longer term and more transparent
funding.

Social care is at the heart of this unique arrangement. Major
opportunities exist for social services directors and politicians
to influence joint working and the commissioning of integrated
health and social care services – all directors and cabinet members
for social care sit on LHBs. Interestingly, this arrangement places
the council officer and member on an equal footing in terms of
role, status and decision-making.

Directors are also corporate leads for health improvement and
promoting the wider contribution of council functions to improve
health. This has helped local government to become more involved in
health, particularly public health and preventive programmes in
leisure, environment and education.

Directors of social care are often part of an extended management
team within the LHB and, for the first time, work alongside the NHS
on a range of strategic issues. There are regular meetings between
the chair of the LHB. In two councils, standing orders have been
changed to allow NHS professionals to jointly present reports
alongside council officers from the LHB.

In late 2004, the Welsh assembly first minister Rhodri Morgan said
he would accept applications to merge from some LHBs and hospital
trusts. Pembrokeshire, Carmarthenshire, Ceredigion and Powys are
likely to be the first to do this.

This signifies a willingness to move towards abolishing the
purchaser/provider split, and to extend the influence of directors
and elected members into direct management and commissioning of all
NHS services.

Will this overcome LHB frustrations over engaging NHS trusts and
reconnect the commissioning and delivery priorities that separate
the LHBs and the trusts? Will it also minimise some of the capacity
problems LHBs experience because of their size and capped
management budgets?

There is no doubt that if these new arrangements come to fruition,
we will be seeing a new model of commissioning and delivering
health care, several steps on from PCTs. Most importantly it would
extend local government’s influence into integrated public sector
services for defined communities.

• Beverlea Frowen is head of health, social care and well being
  at the Welsh Local Government Association.

Sharing and Caring
Joint working case studies involving local health
boards:

In Monmouthshire, joint working between health and social care,
over the past two years, has extended to joint commissioning posts
for continuing care. The cabinet member for social care occupies
the chair of the clinical governance sub-committee of the LHB and
joint management of several middle tier staff.

In the Vale of Glamorgan, LHB and council staff are co-located and
many operate joint posts. The leader of the council is a LHB board
member and has been a driving influence on the agreement of the
joint health, social care and well-being strategy. There are plans
for an integrated call centre serving the council and the
LHB.

In Powys, the cabinet member for social care is chair of the audit
and governance committee which oversees all governance arrangements
for commissioning and delivery of services in Powys and also
provides business support and finance services to all 22
LHBs.

In Anglesey, a research and health economics post is shared between
the LHB and the council. Council members are part of the LHB
management team, and elected members regularly meet with senior
commissioning staff to discuss social care and health improvement
issues.