Wellbeing Boards Research Articles

Lifestyle medicine: a cultural shift in medicine that can drive integration of care

Our traditional medical mindset and healthcare culture are being severely challenged. In the face of novel infectious diseases, such as Coronavirus 2019 (COVID-19), along with rising levels of chronic diseases, such as obesity, type 2 diabetes mellitus, psychiatric illness, cardiovascular disease and cancer, many argue that current healthcare practices are failing to meet our needs. Energy and vision for a new way of practicing medicine are colliding, from both top-down, driven by policy, and bottom-up, driven by clinicians and patients. Policy makers have laid out the need for integration of healthcare delivery to address the complex chronic disease burden; creating integrated care partnerships, health and wellbeing boards and primary care networks to bring together 'at the place level' primary and secondary care, mental and public health services, social care and the voluntary sector. In practice, this is starting to build lasting working relationships between previously siloed services, to address the complex environmental, social, cultural, lifestyle and biopsychosocial drivers of ill health rather than simply providing access to hospitals, doctors and medication. Similarly, out of frustration with our traditional pharmaceutically driven medical model, grass-roots clinicians have built a new vision for their role in this better integrated health system, with the discipline of lifestyle medicine.

Recent Advances in HIV Diagnosis (Orasure and Oraquick)

Acquired Immunodeficiency syndrome(AIDS) is an infection caused by the Human ImmunodeficiencyVirus(HIV). The infection straight forwardly influences the cells of the insusceptible framework, especiallythe T lymphocytes, bringing about various sharp contaminations prompting the terminal condition AIDS.Since no antibodies are accessible for this shocking illness, HIV disease is a danger and can without muchof a stretch be named as a revile upon mankind. The Centers for Disease Control and Prevention (CDC)and numerous general wellbeing boards of trustees advocate for the fast HIV test that is accessible. Teststhat can distinguish HIV contamination biomarkers inside 30days of disease, when beginning safe reactionsare mounted. The OraQuick ADVANCE Rapid HIV - 1/2 Antibody test is sensitive– utilizing subjectiveimmunoassay to distinguish the antibodies of HIV-1 and HIV-2 out of an oral liquid. Orasure Technologiesis enabling the worldwide network to improve wellbeing and health by giving access to precise fundamentaldata. OraQuick and Orasure determination are rapid, flexible, accurate, simple and patient preferred toperceive antibodies to all HIV-1 subtypes, especially in making nations.

Partnership or insanity: why do health partnerships do the same thing over and over again and expect a different result?

Objectives The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health. Methods We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB. Results HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes. Conclusions Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact.

Enhancing democratic accountability in health and social care: The role of reform and performance information in Health and Wellbeing Boards

AbstractThe UK government passed the Health and Social Care Act in 2012, and a key element of this legislation was the introduction of Health and Wellbeing Boards (HWBs) in local government. HWBs were argued to have the potential to both improve democratic accountability and give greater autonomy to health and social care leaders to strengthen local health outcomes. This paper explores how members of HWBs construct and discharge accountability for better health outcomes to a local population. We find that there are multiple types of accountability present and that democratic accountability can be complemented by and compete with other types of accountability.

What is good general practice? Recollected.

‘How to move from managing sick individuals to creating healthy communities’ , the editorial earnestly intoned.1 Luke Allen et al went on to argue the case for reorienting the NHS towards prevention, upon which less than 5% of the health budget is currently spent. Social determinants, after all, account for up to 90% of health outcomes. They suggested, among other things, that practices should work alongside public health teams proactively to engage with local communities in furtherance of health promotion. So far, so comprehensible. In the opinion of many readers, I suspect, they then departed Planet Earth: ‘We need a greater focus on fundamentally changing the physical and socio-political structure of society … ’ Really? There are several reasons why their call will go unheeded, notwithstanding a long tradition of public health in general practice (or, for that matter, strong arguments for changing the structure of our society). Few have ever embraced the role of Tudor Hart’s community physician.2 In part, this is because Allen et al ’s vision is essentially ideological. Public health inclines to centralisation and is largely ‘left wing’. GPs, on the other hand, are politically heterogeneous. Closet ‘Corbynistas’, they are often working in inner cities, rubbing shoulders with more reactionary colleagues from the shires. Vulgar caricatures, of course, but GPs are understandably suspicious of grand plans. The utilitarian values underpinning population-oriented care and budget-holding are sometimes at odds with the individualistic nature of the doctor–patient relationship. Then there is the ever-present problem of time. Allen et al suggest that GPs engage with Health and Wellbeing Boards, Joint Strategic Needs Assessments, and Better Care Fund activity. Even without spare …

A Qualitative Study of the Views of Health and Social Care Decision-Makers on the Role of Wellbeing in Resource Allocation Decisions in the UK

There has been growing international interest in the role that wellbeing measures could play within policy making in health and social care. This project explored the opinions of a sample of UK decision-makers on the relevance of wellbeing and subjective wellbeing (by which we mean good and bad feelings or overall evaluations of life, such as life satisfaction) for resource allocation decisions within health and social care. Through these discussions we draw out the perceived advantages and the potential concerns that decision-makers have about broadening out to wellbeing and subjective wellbeing rather than just measuring health. Three focus groups were conducted: with members of the National Institute for Health and Care Excellence (NICE) Citizen’s Council, with a Health and Wellbeing Board at a Local Authority and with Public Health England. In addition, eleven semi-structured interviews were held with staff from NHS England and members of a range of NICE committees. We identified a range of opinions about the role of wellbeing and a broadly held view that there was a need for improved consideration of broader quality of life outcomes. We also identified considerable caution in relation to the use of subjective wellbeing.

Partnership in action: forging a new approach

Purpose Professional partnerships between housing and health are not impossible, but they take time, commitment and dedicated strategic leadership. The language and culture of the two sectors are sometimes complex and do not always match. There can be issues understanding each other’s motivation, ethics and terminology which can cause a barrier when working together. The purpose of this paper is to share the journey of how Wakefield District Housing (WDH) is working with the care and health sector to create sustainable partnerships that benefit both parties, getting to a stage where they could successfully integrate with healthcare providers in the Wakefield district. Design/methodology/approach The paper offers the reader an overview of how WDH’s membership of the Wakefield Health and Wellbeing Board enabled improved partnership working with NHS and other members, including the establishment of a Housing, Health and Social Care Partnership, the employment of dedicated senior staff, co-located multi-disciplinary teams and joint design of new services. Findings WDH has demonstrated that the organisation understands the challenges facing NHS colleagues, has acknowledged the complexities of the system that their partners work in and looked for solutions alongside them. The opportunities within partnership working are boundless and, if successful, the outcomes for tenants and the wider Wakefield population could be in excess of those envisaged in planning the project. Partnerships will almost inevitably encounter challenges along the way but if all partners keep their own and shared visions in mind, further success is within reach and all parties will get there faster by not going alone. Practical implications The paper offers useful guidance and ideas for other housing organisations aiming to improve their contribution to local integrated healthcare. Originality/value This paper provides an original perspective from inside the programme, offering practical, comprehensive and deliverable initiatives to improve health outcomes for local communities.

Enhancing Democratic Accountability in Health and Social Care:Health and Wellbeing Boards in England

The Health and Social Care Act (2012) required the creation of Health and Wellbeing Boards (HWBs) to provide strategic leadership for health outcomes for localities across England. It was suggested...

Is end-of-life care a priority for policymakers? Qualitative documentary analysis of health care strategies

Background: Prioritisation of end-of-life care by policymakers has been the subject of extensive rhetoric, but little scrutiny. In England, responsibility for improving health and care lies with 152 regional Health and Wellbeing Boards. Aim: To understand the extent to which Health and Wellbeing Boards have identified and prioritised end-of-life care needs and their plans for improvement. Design: Qualitative documentary analysis of Health and Wellbeing Strategies. Summative content analysis to quantify key concepts and identify themes. Data sources: Strategies were identified from Local Authority web pages and systematically searched to identify relevant content. Results: In total, 150 strategies were identified. End-of-life care was mentioned in 78 (52.0%) and prioritised in 6 (4.0%). Four themes emerged: (1) clinical context – in 43/78 strategies end-of-life care was mentioned within a specific clinical context, most often ageing and dementia; (2) aims and aspirations – 31 strategies identified local needs and/or quantifiable aims, most related to the place of death; (3) narrative thread – the connection between need, aim and planned intervention was disjointed, just six strategies included all three components; and (4) focus of evidence – where cited, evidence related to evidence of need, not evidence for effective interventions. Conclusion: Half of Health and Wellbeing Strategies mention end-of-life care, few prioritise it and none cite evidence for effective interventions. The absence of connection between need, aim and intervention is concerning. Future research should explore whether and how strategies have impacted on local populations.

Securing systems leadership by local government through health and wellbeing strategies

The aim of this study was to strengthen Health and Wellbeing Strategies (HWSs) by identifying potential areas for system leadership across local authorities in relation to specific aspects of health/illness, wider determinants of health and transformational change management. The work involved a document analysis of strengths of the first 12 HWSs produced in the North East of England applying principles of appreciative inquiry (AI), followed by a knowledge-to-action group approach with stakeholders. A summative event resulted in Health and Wellbeing Board (HWB) members identifying potential areas for collaboration. The study identified diverse examples of good practice, and considerable consensus in terms of key priorities, both wider determinants such as employment, transport and housing, and subject areas such as lifestyle issues and children having the best start in life. There was agreement in principle to work across local authority boundaries, with academic partners. Consideration of HWSs as part of a complex adaptive system was welcomed by HWB Members. Collaborative working across HWBs could strengthen the effectiveness of HWSs in relation to inequalities in health, place-shaping and wider determinants of wellbeing. The co-production of identified areas to work toward health improvement was successful.

What constitutes successful commissioning of transition from children’s to adults’ services for young people with long-term conditions and what are the challenges? An interview study

ObjectiveWe explored what constitutes successful commissioning for transition and what challenges are associated with this. We aimed: (1) to identify explicit and implicit organisational structures, processes and relationships that drive...

Off the Radar? Addressing housing disrepair to improve health in later life

Purpose The purpose of this paper is to highlight the pivotal role of initiatives that address housing disrepair, home improvements and adaptations as a way of improving health, independence and quality of life in older age. Design/methodology/approach The author uses data from housing and health, combined with the author’s experience of policy formulation as well as working with older people and developing practical services, particularly those which address private sector housing stock condition. Findings As well as its massive economic impact, housing greatly affects people’s health and wellbeing, not only in later life but across the life course. In England, there is a long history of systematic, government backed action to improve and maintain housing stock condition. There are significant economic and social gains from a coherent national response to addressing private sector housing disrepair, including creation of employment opportunities, economic stimulus through enabling best use of assets, as well as health and social care gains. In addition to increasing housing supply through building much needed new homes, existing housing stock disrepair needs once again to be “on the radar” of policy makers operating across health, social care and housing. Concerted action to make homes safe, healthy places to live in later life, whatever an older person’s tenure, requires vision and innovation and is an essential element in the integration of health, social care – and housing. With significant funding constraints in local authorities, especially for adult social care, and in the context of growing pressures on the NHS, sustaining good health in later life is more important than ever. There is a compelling case for cross-sector action to reduce health hazards in ordinary, private housing, given that 79 per cent of older people who live in non-decent homes are owner occupiers. This is an opportune moment for Health and Wellbeing Boards to take a lead on this issue at a local level, as well as time to put housing stock condition back “On the Radar” of national government policy. Social implications There is a need to embed practical housing services in the emerging integrated health and care systems in order to extend healthy later life for the majority of older people who live in mainstream housing. Originality/value The author draws on over 30 years’ experience of innovation, development and evaluation of older people’s housing, services and policy development to provide a vision for greater integration across health, care and housing.

Developing a local antimicrobial resistance action plan: the Cornwall One Health Antimicrobial Resistance Group.

The UK Five Year Antimicrobial Resistance (AMR) Strategy was published in September 2013 and recommended a One Health approach emphasizing the importance of collaboration to tackle AMR. We describe the inauguration of what we believe to be the first regional One Health group established in the UK. The purpose of the group was to ensure the implementation of a coordinated Cornwall-wide response to the UK AMR Strategy and we describe the outputs of the group to date. The Cornwall Antimicrobial Resistance Group was set up as a sub-group of the Health & Wellbeing Board's Health Protection Committee. Stakeholders reviewed the key objectives set out within the Five Year AMR strategy, identified local priorities and existing work streams within Cornwall, and completed a gap analysis. The annual work plan was developed from the gap analysis and provided a foundation for improved coordination of One Health antimicrobial stewardship (AMS) activity in Cornwall. To date, outputs from the group can be arranged under the following themes: education and engagement with the public; education and engagement with healthcare workers and veterinarians; and a comprehensive AMS programme for all sectors. The group continues to grow in size with wider stakeholder engagement and increased variety of work streams. This unique group facilitates discussions across sectors, which has enabled the sharing of knowledge, ideas and resources, stimulated local AMS initiatives, and ensured a platform for the development of future AMR and AMS work.

Health, cities and planning: using universities to achieve place innovation.

UK cities face a number of diverse issues affecting their future, with high levels of health inequality requiring local action to improve communities. In this article, Mark Tewdwr-Jones from Newcastle University outlines the case for utilising the skills of universities to overcome institutional fragmentation.[Image omitted: See PDF.]Cities in the United Kingdom and overseas are struggling to manage the diverse issues affecting their future. Changing demographics, economic uncertainty, climate change and threats of terrorism are all putting pressure on governments to deal with more immediate concerns, set against a backdrop of political upheaval, and changing governance frames. The challenge of addressing any of these is made particularly acute by a fragmented and volatile institutional restructuring process. This often militates against the need for a synoptic and long-term look at the drivers of change unique to individual places.[1] Increasing appetite for enhanced democracy raises pressures for innovative ways for the state to engage with citizens and businesses. It is often difficult to require institutions and professionals to move beyond their current form of engagement.[2] Public health is not immune from this turmoil.National, regional and local action to combat health inequalities is widely accepted as critical to creating improved communities. The Marmot Review[3] claimed a strong social justice and compelling economic case for reducing health inequalities. It is estimated that health inequalities cost over £30bn a year in lost productivity, welfare and health costs, leading Government to call for local areas to work together to address population health needs.[4],[5]There is a case for communities in our cities to benefit from more joined up (cross-boundary) planning and investment in health and social care.[6] Cross-sectoral benefits are contextualised by the extent to which local areas are able to make the most of healthcare procurement and employment policies and whether new institutions and agencies (such as devolved Combined Authorities, Local Enterprise Partnerships, and Health and Wellbeing Boards) can work effectively together across traditional boundaries, especially when many of the critical joining-up agencies are under pressure.This article reflects on the critical relationship between health, cities and planning, and makes the case for utilising the skills and anchoring role of universities in each city to overcome institutional fragmentation. Fiscal restraint has narrowed the debate to one of achieving healthcare in cities through innovative joint working with agencies beyond the National Health Service (NHS). This article seeks to rebalance the discourse through consideration of several interrelated issues:What opportunities for holistic action are delivered by the shift in managerial responsibilities for public health within cities?What is the role of health care in addressing wider societal and urban problems?What is the impact of the shifting governance of cities within which healthcare systems play an integral part?The new governance and new economic landscape for our largest cities requires more reliable forms of health intelligence, research evidence, and public engagement processes addressing the needs of different cities as unique places. It is not easy to coordinate intelligence needs and the potential of joint working across sectors. The critical question is whether universities - as one set of institutions rooted in distinct places - could play a central role by developing collaborative working models between sectors.The Interface Between Health, Cities and PlanningInteraction and linkages between health and cities are the basis for identifying the potential role of spatial coordination in supporting health and social care outcomes. Good health involves a combination of physical, mental and social wellbeing,[7] commonly referred to as the Health Triangle. …

Health and wellbeing boards: public health decision making bodies or political pawns?

ObjectivesHealth and Wellbeing boards in England are uniquely constituted; embedded in the local authorities with membership drawn from a range of stakeholders and partner organizations. This raises the question of how decision making functions of the boards reflects wider public health decision making, if criteria are applied to decision making, and what prioritization processes, if any, are used. MethodsQualitative research methods were employed and five local boards were approached, interview dyads were conducted with the boards Chair and Director of Public Health across four of these (n = 4). Three questions were addressed: how are decisions made? What are the criteria applied to decision making? And how are criteria then prioritized? A thematic approach was used to analyse data identifying codes and extracting key themes. ResultsEquity, effectiveness and consistency with strategies of board and partners were most consistently identified by participants as criteria influencing decisions. Prioritization was described as an engaged and collaborative process, but criteria were not explicitly referenced in the decision making of the boards which instead made unstructured prioritization of population sub-groups or interventions agreed by consensus. ConclusionsCriteria identified are broadly consistent with those used in wider public health practice but additionally incorporated criteria which recognizes the political siting of the boards. The study explored the variety in different board's approaches to prioritization and identified a lack of clarity and rigour in the identification and use of criteria in prioritization processes. Decision making may benefit from the explicit inclusion of criteria in the prioritization process.

Self-assessment toolkit.

A new health and integration toolkit has been launched by NHS Clinical Commissioners, in partnership with the Local Government Association, NHS Confederation and the Association of Directors of Adult Services. The self-assessment tool is designed to help local health and care leaders, through health and well-being boards, to assess their ambition, capability, capacity and readiness to integrate local health and social care services.

Affordable warmth: housing strategies for older people

Purpose – The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach – The authors consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through “desktop analysis”. The authors support this with qualitative data from Health and Wellbeing Boards (HWBs), health inequalities and environmental health from research comprising four longitudinal case studies in the Midlands and North of England over 18 months and semi-structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of HWB meetings observed. Findings – There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However, there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value – Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move towards sustainable, evidence based affordable warmth strategies for older people to protect and improve health.

Promoting Mental Health and Preventing Mental Illness in General Practice.

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert ‘Think Tank’ convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your ‘cluster’ of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

What next for environmental health?

The aim of the wider research was to explore Health and Wellbeing Boards (HWBs) during their early development stages, with a focus on health inequalities and the role of environmental health (EH). This article presents empirical findings relating to challenges facing the EH profession in the new English public health (PH) system and offers new practical suggestions as to how they might be overcome in relation to educating and training the new generation of EH practitioners (EHPs). Four case study HWBs in the Midlands and North of England were followed for 18 months from early 2012. In addition, EHPs and managers from each English region were interviewed. In total, 50 semi-structured interviews were carried out, around 55 h of HWB meetings were observed, and documents associated with HWBs such as strategies and minutes of meetings were collected. Data were analysed thematically, both inductively and deductively, using Atlas.ti. EH is largely invisible in the new PH system due to a variety of internal and external factors, including existing skill sets and practices. There is a new imperative to move away from reliance on statutory functions for funding and to engage with wider PH issues and colleagues, requiring new skills of evaluation and a change in perception from being 'doers' to include a greater role as 'thinkers'. This is being recognised by EHPs and managers, who are seeking ways to adapt to these new expectations. Recent changes to the English PH system have led to a period of reflection and the beginnings of adaptation in EH to overcome new challenges. Linked to this is a need for graduate training to prepare new practitioners to think critically, to thrive and become high-level managers of the future, while being technically competent. We suggest a new, enhanced role for Chartered Institute of Environmental Health (CIEH)-accredited universities in securing the future of the profession by supporting new graduates. Specifically, a mentoring scheme could be introduced for the practical training element for new practitioners. This would help to embed criticality and evaluation in practice, provide consistency in training, and overcome the disconnect between academia and practice.

The return of public health to local government in England: changing the parameters of the public health prioritization debate?

ObjectivesTo explore the influence of values and context in public health priority-setting in local government in England. Study designQualitative interview study. MethodsDecision-makers' views were identified through semi-structured interviews and prioritization tools relevant for public health were reviewed. Interviews (29) were carried out with Health and Wellbeing Board members and other key stakeholders across three local authorities in England, following an introductory workshop. ResultsThere were four main influences on priorities for public health investment in our case study sites: an organizational context where health was less likely to be associated with health care and where accountability was to a local electorate; a commissioning and priority-setting context (plan, do, study, act) located within broader local authority priority-setting processes; different views of what counts as evidence and, in particular, the role of local knowledge; and debates over what constitutes a public health intervention, triggered by the transfer of a public health budget from the NHS to local authorities in England. ConclusionsThe relocation of public health into local authorities exposes questions over prioritizing public health investment, including the balance across lifestyle interventions and broader action on social determinants of health and the extent to which the public health evidence base influences local democratic decision-making. Action on wider social determinants reinforces not only the art and science but also the values and politics of public health.