HealthWatch England

The document proposes to strengthen the collective patient voice through arrangements with local authorities and at a national level, through a ‘powerful new consumer champion’ - HealthWatch England. At a national level HealthWatch England will be a statutory part of CQC and at a local level the current LINks organisation will become local HealthWatch.

Local HealthWatch will be given additional functions and funding, over and above that of LINks, such as a signposting function to the range of organisations that exist, NHS complaints advocacy services and supporting patients to exercise choice. They will also continue to have an interest in the NHS Constitution and will also retain the rights to visit provider services. The local HealthWatch will be commissioned by Local Authorities (LA) and will be held to account by LAs for delivering services that are effective and value for money.

Local HealthWatch will be able to report concerns about the quality of service provision to HealthWatch England.

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Local Authorities

Local Authorities (LAs) will take the lead in improving local public health. Their new roles will be:

1. To lead the Joint Strategic Needs Assessment
2. To support local voice and the exercising of patient choice
3. To promote the joined-up commissioning of local NHS services, social care and health improvement
4. To lead on local health improvement and prevention activity

This will provide the opportunity to link and integrate health and social care and wider services including disability services, housing and tackling crime and disorder.

The existing responsibility and funding for health improvement activity such as smoking, alcohol diet and physical exercise, will transfer from PCTs to LAs. LAs will be responsible for the commissioning of smoking cessation services, with GP consortia being responsible for ongoing healthcare issues coming from that patient’s smoking, such as treatment for impaired lung function.

LAs working with the Public Health Service

A new National Public Health Service (PHS) will be created to secure the delivery of public health services that need to be undertaken at a national level. In order to manage public health emergencies, the PHS will have powers in relation to the NHS, matched by corresponding duties for NHS resilience.

LAs will play an important role in PHS campaigns of national importance, which aim to protect public health or provide population screening. It will also have a role in national health improvement campaigns, tailoring programmes to meet the needs of local populations.

Local Directors of Public Health will be jointly appointed by LAs and the PHS. They will have a ring-fenced budget for health improvement, allocated by the PHS. They will be able to use this budget to deliver local and national campaigns.

The Secretary of State, through the PHS, will agree with LAs the local application of national health improvement outcomes. It will be for local authorities to determine how best to secure these outcomes and this may include commissioning services.

Health improvement functions will transfer to LAs in 2012, depending upon the passage of legislation. The Government will support moves to set up shadow arrangements in 2011. Supporting legislation will be included in the Health Bill, expected to be published in autumn 2010.

LAs and Health and Wellbeing Boards:

An option suggested in this consultation is that LAs will set up Health and Wellbeing Boards.

The Health and Wellbeing Boards would comprise of representatives from: elected members of the local authority, directors for social care, public health and children’s services, GP consortia, HealthWatch and the NHS Commissioning Board. Additionally, representatives of the voluntary sector and providers may be invited to participate. Providers will be engaged in a manner that ensures equality and transparency. There would be a statutory obligation for the LA and commissioners to participate as members of the board and act in partnership on these functions.

Health and Wellbeing Boards would have four main functions:

1. To assess the needs of the local population and lead the JSNA
2. To promote integration and partnership across areas
3. To support joint commissioning and polled budget arrangements
4. To undertake a scrutiny role in relation to major service redesign (the statutory function of overview and scrutiny committees would transfer to the health and wellbeing board)

The role of place-based budgets will be left to individual Health and Wellbeing Boards to determine.

If an issue develops around quality of care being provided, the boards should try to resolve it locally and external expertise may be employed to help resolve any ongoing issues. The board would have the power to refer a commissioning decision to the NHS Commissioning Board and will be able to refer any dispute between the Board and the NHS Commissioning Board, to the Secretary of State.

LAs and GP consortia:

GP consortia will be free to decide commissioning priorities to reflect local needs, consistent with the public sector equality duties and supported by the national framework of quality standards, tariffs and national model contracts established by the NHS Commissioning Board.

GP consortia will also have a duty to involve the public in planning services and considering any proposed changes in how those services are provided. The Health and Wellbeing Board will have an important role in enabling the NHS Commissioning Board to assure itself that GP consortia are fulfilling their duties in ways that are responsive to patients and the public.

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Points of issue

• Clarity is required  on how LAs and GP consortia work together, especially around the ability of LAs to compel consortia to work in a joined-up manner
• The JSNA needs to include the PNA and consortia should be required to commission services outlined in the JSNA, taking into account ability to provide and financial capacity.
• The geographical boundaries of GP consortia will not necessarily be co-terminus with local authority boundaries and there is a potential requirement for consortia to provide two differing standards of service – or even a completely different set of services – within the community a particular consortium serves. 
• Health and Wellbeing Boards will engage periodically with providers, in a transparent manner, but consortium members are likely to be providers themselves and play a full role on the board, potentially representing their own interests. 
• It is not clear where the ‘control of entry’ for pharmacy contracts sits –it appears likely it will sit with the Health and Wellbeing Boards
• Pharmacy profession needs to engage with LAs at a local level and LGA (and PHS in the future) at a national level
• Huge opportunity for pharmacists to be involved in health improvement agenda
• Pharmacists should be members of the Health and Wellbeing Boards

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