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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.