Commeth the Moment, Commeth the Health & Wellbeing Boards
How services are shaped and where they are located geographically is one of the issues that is, to put it kindly, less well thought through in the new arrangements for the NHS. System-wide reconfigurations like North West London’s Shaping a Healthier Future are being led by the soon to be abolished Clusters. This is because the scale of the challenge is so large and because only the Clusters have the clout to tackle these issues.
In fact there are many commissioning challenges of differing scales that have estates configuration consequences but there is a real concern that the new Clinical Commissioning Groups will have too many other things to focus on without also having to address issues relating to the location of services. More worryingly, some providers may adopt a “this is what you are getting” approach because the challenge of reconfiguring their own estate to meet commissioniners’ requirements is equally difficult. It is unlikely that market mecahnisms alone will ensure that services are provided in the optimum geographical configuration for each area.
These issues remain outstanding at a time when NHS community and primary care estates resources are seriously depleted and when the plans for the new PropCo (Property Company) are not yet fully developed.
So, who in the system has a great interest in where services are located and has the opportunity to influence these issues? Local Authorities have always had a much greater focus on how their services are located across their territories and their elected representatives genuinely know every street in their patch. The only other agencies with a similar geographical interest and focus are Public Health Departments, now to be located inside local authorities.
I therefore think that Health and Wellbeing Boards can bring a real geographical focus to the configuration of service provision and the reduction of health inequalities by their leadership on developing the Joint Strategic Needs Assessments and their co-ordinating responsibilities to the actions of the CCGs and the local authorities.
Hopefully CCGs will see the benefits of HWB engagement and leadership on this issue as they are likely to share similar objectives of increasing access to health care and reducing health inequalities.