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.

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