Health and Wellbeing Boards Research objectives Under the Health and Social Care Act 2012 The aim of this research study was to explore the each top tier and unitary authority in England extent to which local authorities and Health and had to establish a Health and Wellbeing Board Wellbeing Boards across England recognise and in order to improve health and wellbeing and prioritise the Care Act’s understanding of prevention. reduce inequalities. As a minimum, they are made up of one local elected representative, a local Specifically, we wanted to answer the following Healthwatch representative, a representative of questions: each local clinical commissioning group, the local authority director for adult social services, the local > Is pr evention a key consideration in local decision authority director for children’s services and the making, including commissioning? director of public health. One of their core responsibilities is to carry out a > And if so, does the understanding of ‘pr evention’ joint strategic needs assessment and develop a encompass all three tiers (primary, secondary joint health and wellbeing strategy that meets the and tertiary), including support services for needs identified in that assessment. Both should people with lower-level needs? ‘sit at the heart of local commissioning decisions, > Since the Car e Act came into force in April underpinning improved health, social care and 2015, has there been an improvement in the 24 prioritisation and understanding of prevention? public health outcomes for the whole community.’ > How do local authorities and Health and The Care Act’s statutory guidance reiterates the Wellbeing Boards plan to put prevention into importance of these strategies, noting that they action? ‘should be informed and emphasise preventative services that encourage independence and > How well do local authorities’ local appr oaches wellbeing, delaying or preventing the need for acute to prevention and their commissioning strategies 25 reflect the Care Act’s guidance on preventing, interventions.’ reducing and delaying needs? Health and Wellbeing Boards have also played a key role in the development of Better Care Fund We have undertaken a review of joint health and plans. The £5.3 billion Better Care Fund (previously wellbeing strategies two years in a row. Both called the Integration Transformation Fund) created times we concluded that the term ‘prevention’ is a local, single-pooled NHS and local authority understood differently across the country. In both budget to encourage health and social care 2013/14 and 2014/15 many strategies understood integration. The Chancellor committed an extra prevention only as minimising the risk of people £1.5 billion to the Better Care Fund by 2019-20 developing care and support needs in the first place as part of its ‘radical, local-led plan to create an (primary prevention) or as targeting people at high 26 integrated health and social care system by 2020’ risk of developing needs (secondary prevention). during his 2015 Spending Review. With this in mind, we also wanted to explore the Leaders of the social care sector are concerned following question: about the time-frame of this funding, noting that > Has ther e been an improvement in Health and it does not reach ‘levels of any significance until towards the end of this parliament.’ They also warn Wellbeing Boards’ understanding of prevention this puts ‘the delivery of the NHS Five Year Forward in light of the Care Act’s triple definition of 27 prevention? View and the Care Act at risk.’ Others have reiterated the importance of this being ‘new money’ 28 and ‘spent on adult social care.’ 24. Department of Health (2011), Joint strategic needs assessment and joint health and wellbeing strategies explained: gov.uk/government/uploads/system/uploads/attachment_data/file/215261/ dh_131733.pdf 25. Department of Health (October 2014), Care and Support Statutory Guidance, Chapter 4 (4.53) 26. HM Treasury (25 November 2015), Spending review and autumn statement 2015: gov.uk/government/publications/spending-review-and-autumn-statement-2015-documents/spending-review-and- autumn-statement-2015#a-sustainable-health-and-social-care-system-1 27. Joint letter for the Chancellor and Secretaries of State, from Care and Support Alliance, Association of Directors of Adult Social Services, Care Provider Alliance, NHS Confederation (December 2015): careandsupportalliance.com/social-care-sector-response-to-the-spending-review/#sthash.eS0VEpiv.dpuf 28. Lord Porter, Chairman of the Local Government Association (25 November): local.gov.uk/spending-review/-/journal_content/56/10180/7586753/NEWS British Red Cross Prevention in action [email protected] 10 l l