Wellbeing Boards Research Articles

How useful are child death reviews: a local area’s perspective

BackgroundChild Death Overview Panels (CDOP) provide a multidisciplinary and confidential forum to learn from and reduce deaths in those under 18 years. How well they perform and how to improve their effectiveness is a question posed at both local and national levels in England. With this in mind, this study looked at the child death review process in two London boroughs with a joint CDOP.FindingsData on cases reviewed from April 2008 to January 2011 were analysed focusing on cause of death and modifiable factors. Key stakeholders involved in the child death review process were interviewed regarding the effectiveness of the local death review process with responses analysed thematically.105 (50.5%) of all notified deaths were reviewed to completion by CDOP of which 26.7% had modifiable factors. Neonates were the largest group of deaths (42.8%). Stakeholders found reviews time consuming, required significant administration and better integration with related processes e.g. hospital mortality meetings. Too much time was spent analysing cases of limited modifiability such as neonates. Implementation of recommendations needed strengthening and inclusion into the wider health and social care economy including joint strategic needs assessments and commissioning processes. Delayed reporting of information on cases contributed to a backlog.ConclusionsThe current process is bureaucratic, should better address neonatal deaths and needs more focus on implementing recommendations. Solutions include simpler forms, neonates-only subgroups, and linking recommendations to strategic initiatives such as Health and Wellbeing Boards.

Public health and health and wellbeing boards: antecedents, theory and development

The 2012 Health and Social Care Act transfers responsibility for public health in England from primary care trusts to local authorities. This article traces the theoretical and policy antecedents of the proposals and highlights some key changes since their original conception in the 2010 public health white paper. It suggests that the development of health and well-being boards and their objectives can best be understood by viewing them through the theoretical prism of public value or new public service theory and concludes with some recommendations for their implementation and development.

The environmental health practitioner: new evidence-based roles in housing, public health and well-being

Since the Victorian public health acts, the now named environmental health practitioner (EHP) (previously public health inspector or environmental health officer) has been pivotal in providing healthier housing through a range of policy initiatives and legislative requirements. The role of the practitioner has changed substantially in the past decade, particularly as the public health and well-being agendas have brought focus to the socio-economic determinants of health, including housing, with a renewed vision of tackling the most acute health inequalities through evidence-based practice and taking a population-based approach. The now established Housing Health and Safety Rating System has enabled a far greater focus on evidence than previously. However, for many households on low incomes living in owner-occupied and privately rented housing the situation is inequitable and, for many, has negative health effects. The private-sector housing renewal budget has been discontinued and the allied housing and social care resource has been cut. As a result, EHPs and colleagues need to promote the importance of their work at every opportunity as Public Health England came into being in 2013 and public health has been transferred from the National Health Service to local authorities. This presents both opportunities and challenges in demonstrating the effectiveness of housing strategies and interventions by fine-tuning arguments for securing greater resources through joint strategic needs assessments presented to health and well-being boards.

What can health and wellbeing boards do for us?

The relaunch of London Journal of Primary Care (LJPC) with a new website continues the theme of integration and collaboration in community settings. The argument for local integration is well-rehearsed – quality elderly care cannot be provided unless there is interagency teamworking in community settings; addressing intractable problems like addiction, child abuse and family breakdown requires joint working and innovation in community settings; chronic diseases such as diabetes and cancer require shared care between specialists and generalists in community settings. The question is, HOW do we do it? This issue of LJPC explores this question, starting with five papers that describe the infrastructure needed. Colin-Thome and Fisher explain that policy must be bold: If Health and Wellbeing Boards are to make a real and lasting impact on the health and resilience of the populations they serve, they must revitalise the principles of community-oriented primary care. Chandok et al remind us that communities for health require trusted relationships: One important ingredient of trust-building is the size of area in which activity happens. 50 000 population – 10–20 general practices – is small enough to feel you belong and large enough to have political clout. Unadkat et al describe a model of shared care for long-term conditions (diabetes): … team-working across disciplinary and organisational boundaries that avoids duplication, synchronises efforts, quickly accesses specialist knowledge and helps patients to help themselves. Dhillon and Godfrey describe ways that routinely gathered data can evaluate complex community-embedded interventions: Feedback of data needs to be regular to see overall trends, and used as ‘food for thought’ rather than claiming a higher ‘proof.’ Stange and Gullett compare multi-agency working with high-quality cooking: … the secret is to taste it. LJPC invites you to continue this theme through online discussion and case studies of integrated care. In particular we want to explore: what the role of primary care is in the 21st century what infrastructure it needs to be effective.

Health and Wellbeing Boards for a new public health.

We remind readers of the evidence that community empowerment is a cost-effective way to improve health, and also that the conditions now exist to develop this approach in the UK, by facilitating collaboration between clusters of general practices and multiple other organisations. We argue that it is the role of Health and Wellbeing Boards to make sure that this huge potential is realised.

Duncan Selbie: the new face of public health in England

Duncan Selbie: the new face of public health in England

Commissioning vocational rehabilitation after stroke: Can the Cinderella services get to the ball? A qualitative study.

To understand the barriers and enablers to commissioning vocational rehabilitation (VR) after stroke. Interviews with health and social care commissioners responsible for stroke services across three counties were conducted to explore their views on the barriers and enablers to commissioning VR. Transcripts were subjected to thematic analysis, and validity checked with members of the research team. The findings indicate that health commissioners have had to focus on demand-led and expensive acute stroke services, leaving little resource for community services. Though the benefits of VR to patient health are acknowledged, any cost savings would not be realized within the health budget. Social care commissioners, in times of budget restriction, focus on the most vulnerable, aiming to maintain independence and reduce care home admission. In the absence of evidence, there is a perception that the need for VR after stroke is relatively minor. Factors which might facilitate commissioning of a VR service include adapting the service to align with commissioners' requirements, making VR a targeted outcome of community stroke services, utilizing emerging opportunities for joint health and social care commissioning such as Health and Wellbeing Boards, and closer working with researchers to improve the evidence-base.

Health for all

From April 1, public health will become the responsibility of local government. Here, experts explain how this shift--overseen by the new health and wellbeing boards--could ease bottlenecks in health services and change how nurses work.

BJSM social media contributes to health policy rethink: a physical activity success story in Hertfordshire

Strategies to modernise the National Health Service (NHS) in England have brought about the development of local organisations called Health and Wellbeing (H&WB) boards through the Health and Social Care...

Making health and wellbeing boards a success: engaging providers

PurposeThe aim of this paper is to bring attention to the current level of engagement of care service provider organisations with shadow health and wellbeing boards. The paper argues that full engagement of provider organisations will improve the effective working of the future health and wellbeing boards; both in the creation of good commissioning strategies and in their subsequent implementation.Design/methodology/approachA survey of Voluntary Organisations Disability Group (VODG) members was undertaken, and analysed alongside other reports of progress in implementation.FindingsCurrently there is a very low level of engagement of provider organisations. A notable exception is in Coventry which is an exemplar for good engagement: a case study is provided.Originality/valueThis is new knowledge. Also, a connection is made between emerging government policy on market facilitation in social care and its implications for health and wellbeing boards.

Global population explosion: economic and health meltdown

A new hard-hitting film: ‘mother: caring for 7 billion’ suggests that the world's exponentially increasing population is the major cause of poverty, over-consumption, food poverty, riots, wars, de-forestation, ill health, major crises, conflict climate change and catastrophic failure of economies.1 As doctors, we could act as advocates for change, yet we work best treating just one patient at a time, never judging and rarely crossing boundaries into mass prevention or health improvement. Humans, as the most successful species ever, have now outgrown their resources.2 World population has doubled in just the last 40 years, since Ehrlich's prophesy of a ‘Population bomb’, and now stands at 7,000,000,000.3 And it keeps inexorably rising.2 The world's population is increasing unsustainably because the topic is seen as too sensitive. There is an urgent need to tackle the issue. The burden of the lowered standard of living that results from population growth and from the decline of resources, falls most heavily on the poor.4 Unemployment has a higher five-year mortality than many cancers.5 Being born into the most deprived postcodes or areas has a devastating effect on health.5 Half the world's population is under 28.1 Forty percent of pregnancies in the USA are unintended.1 One-third of maternal deaths in Ethiopia are due to unsafe abortions.1 Two hundred and fifteen million women have no access to contraception.1 It is possible to change what is perceived as normal. In Ethiopia, radio soap operas have been used to change cultural norms, for example the public can empathize with a woman refusing an under-age arranged marriage.1 There has been a reported increase in spousal communication by allowing discussion of taboo subjects.1 In Bangladesh, there are fines for arranging such a marriage. Perhaps we also need a different economic paradigm? Countries see growth in gross domestic product (GDP) as a marker of success, yet this encourages consumption of scarce resources and GDP includes burgeoning healthcare industries. Would sustainability be better than growth? Even water is in short supply. The US economy requires 150,000 more jobs each month to cope with 1% population growth; one economist describes economic planning as a giant Ponzi scheme: that we are all paying with money that will never be repaid.1 There is no easy answer, but some good results with micro-finance initiatives that empower women.1,6 In England, there are fledgling ‘Health and Well-Being boards’ taking shape at county council level to put public health and preventive measures at the heart of decision-making on healthcare. Melinda Gates is directing their charitable funding towards accessible contraception.7 Why are we too embarrassed to discuss this? A large number of women in the world have no control over their own fertility. Modern long-term reversible contraception moves some decision-making away from the moment of sexual intercourse. Has the fight against Aids made things worse? If condoms are promoted as the means of preventing disease with a bonus of reducing unwanted pregnancies, has this reduced the potential for long-term reversible contraception to be offered to large numbers of eligible women of all ages? Perhaps now is the time to separate the two? How large a part has religion played in keeping contraception a taboo? We need to give women all over the world the same choices that we take for granted. We can delay having children until we are confident, grown-up and established enough to return to work economically independent. Girls who stay in education have better health, have children later and have fewer children, who in turn have better health, ‘the girl effect’.6 But cultural change and education needs to include everyone in society. As healthcare professionals, we are stuck in the paradigm of allowing patient choice and treating each individual patient. We should, perhaps, be using our advocacy role to demand change across societies. If we open up discussion of this taboo with policy-makers and the public we may improve health for billions in the future.

Health Care Commissioning: The UK Health Policy Reforms

In 2013/14, the first year of the UK’s reformed health service, area health authorities known as Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) who were largely responsible for the determination of local health challenges and priorities and for the design and delivery of strategies to tackle these challenges, will be abolished from April 2013, and service improvements will be driven by a clinically-led local commissioning system. In this new system, groups of geographically aligned primary care practitioners will come together to create new statutory organisations known as Clinical Commissioning Groups (CCGs) who will take on the responsibility for the direct commissioning of the majority of NHS services with oversight from an umbrella body at the national level, the NHS Commissioning Board (NHSCB) responsible for the effective and economical running of the NHS [7]. The public health function will be transferred from the PCTs to the local governments under the auspicious of Health and Wellbeing Boards (HWBs). The new structure builds on the centrality of practicebased commissioning, taking it a great deal further in primary care with a greater local control of decision-making to improve patient care and outcomes. One school of thought was that the new structure in place would bring ‘patient empowerment, local professional judgement and greater provider dynamisms’ [6].

Cherry picking: health and wellbeing boards

Cherry picking: health and wellbeing boards

Health and Social Care Bill: health and wellbeing boards

Health and Social Care Bill: health and wellbeing boards

The need for all services to be psychologically informed

PurposeThis paper seeks to offer a commentary on Psychologically Informed Services: A Good Practice Guide, a recently published operational guidance document on developing psychologically informed environments (PIEs) in services for homeless people.Design/methodology/approachThe paper is an invited opinion piece and comment, based on the specialist experience and viewpoint of the authors in education on mental health issues in primary care.FindingsThe new operational guidance is welcomed, with some provisos. Psychologically informed environments are needed not just in homelessness resettlement, but in all areas where services are commissioned; and all commissioned services should take particular care to collect suitable data on the outcomes they aim for and intend to achieve.Originality/valueThere is a great opportunity with GP commissioning to commission services that are psychologically informed and holistic, although it may be hard to ensure services remain user‐focused and not disjointed if split up for tendering. Public health leadership on the new Health and Wellbeing Boards will be crucial to integrate services so the new system will not make things worse. Given the need, hopefully a similar drive for PIEs everywhere – the criminal justice system, care homes and community wellbeing – will follow.

Joined at the Hip? Joint Strategic Needs Assessments, the Voluntary and Community Sector and Lessons in Partnership Working

Andrew Kaye and Tara Melton from Royal National Institute of Blind People look at what Joint Strategic Needs Assessments mean for public health Why have not-for-profit organizations turned to one another to share tips on the most practical routes for influencing Joint Strategic Needs Assessments (JSNA)? Are we beginning to see a growing public interest in JSNA, or at least their potential to highlight and address the diverse health needs of whole populations? Based on recent evidence, that could be the case; the question then is what does this mean for shaping public health? Original guidance on JSNA stated that engagement is an essential element of JSNA...the process, will in itself, have a positive impact on health and wellbeing.1 Unfortunately, four years later effective engagement with the voluntary and community sector remains an aspiration in many areas.2 It is also unclear whether voluntary organizations have the tool sets and resources to engage with JSNA joint health and wellbeing strategies (JHWS) and shadow health and wellbeing boards. Last November the Royal Society for Public Health (RSPH) and Royal National Institute of Blind People (RNIB) came together to host a workshop on influencing JSNA in collaboration with the public health NGO Forum.3 Colleagues from organizations as diverse as Age UK, Action for Blind People, Action on Smoking and Health and the Royal Society for the Prevention of Accidents all took part. What became immediately obvious were the varying levels of confidence in and preparation for engaging with JSNA. The value of JSNA JSNA were originally designed to lead to stronger partnerships between communities, local government and the NHS. Now they have an enhanced role; a critical function of JSNA is building a unique picture of place. A JSNA must make links between determinants of health, through telling a story about a community; its people; its assets; and the health challenges that still exist. Only when a JSNA does all these things can it help inform a decent JHWS and focus on the wider determinants of health. JSNA is not in and of itself a tool for tackling health inequalities or improving health outcomes. Groups that were once neglected but now seek a higher profile for their health and wellbeing priorities nonetheless view JSNA as a useful stepping-stone. JSNA represents an effective vehicle for raising awareness of various groups' health and wellbeing needs. Lessons from the sight loss sector RNIB together with its partners on the UK Vision Strategy4 have positioned ourselves as sector leaders and have started to dedicate more resource to engaging with JSNA. Early results are very promising in terms of increased recognition of eye health and eye care within many local JSNA. However, bringing the needs of people at risk of, and living with sight loss to the attention of JSNA leads, not to mention seeing this data used to then guide investment decisions, was certainly not straightforward. Undoubtedly one of the most useful things RNIB did from the outset was to commission research on the future costs and prevalence of sight loss. It was very well convincing ourselves that tackling avoidable sight loss was a moral imperative, but unless the economics stacked up, it was going to be difficult bridging the voluntary-statutory sector divide. …

Will neurology ever move higher up the policy agenda?

The party conference season is over and one of the highlights for Neurological Commissioning Support (NCS) was being able to wave the flag for neurology in a fringe meeting at all three party conferences. The meetings included politicians who gave response to the ask of the NCS policy: ■Neurology networks should be established in the same way that the cancer networks have been, to support service planning and delivery ■Neurology must be represented on all commissioning structures—every clinical senate, incorporated into Joint Strategic Needs Assessments, and considered thoroughly by Health and Wellbeing Boards ■There must be a neurology advisory panel to advise the NHS Commissioning Board on how best to commission for neurology. Reshuffling the deck—time to deal a better hand for neurology (NCS, 2011a; 2011b; 2011c) spelt out that neurology still has a low public profile despite the number of people living with a neurological condition being far greater than those living with cancer. There are 10 million people in the UK living with a neurological condition, compared with 2 million people living with cancer (Maddamns et al, 2008; National Cancer Intelligence Network, 2010). Of those 10 million, one million people are disabled by their condition; 350 000 require help with most of their daily activities, 850 000 are carers. These people also account for 20% of acute hospital admissions and are the third most common reason for individuals visiting their GP (Neurological Alliance, 2003). The numbers of people dying with a neurological condition are also under-rated because it is rare that a persons’ neurological condition will be cited as their cause of death and as a result, statistics on mortality are limited and can be misleading (South West Public Health Observatory, 2010) (Table 1). Every day in the UK, 75 people are diagnosed with epilepsy and there are nearly half a million people with epilepsy who are taking medication in England alone. It has been estimated that the avoidable cost of providing the current poor NHS services to people with epilepsy costs the economy £189 million annually (All Party Parliamentary Group on Epilepsy, 2007). Approximately 1 000 people each year die from epilepsy and around 40% of all deaths in adults and 59% in children are avoidable. A number of reports and recommendations have been made to improve epilepsy management yet despite these, new research shows that epilepsy mortality is actually rising. Deaths from epilepsy rose by 31% in males and 39% in females between 1995 and 2005 (Ridsdale et al, 2011) at a time when survival rates for cancers are improving.

The quiet revolution: health service reform and its impact on drug and alcohol services in England

PurposeThe purpose of this paper is to examine the implications for drug and alcohol treatment of radical policy changes being implemented by the government, particularly the proposed transition of responsibility for treatment from the National Treatment Agency to a new public health service from 2013.Design/methodology/approachIt is argued that this is a critical moment in the development of substance misuse services in England, particularly given the impact of health service reform. Concerns are raised about the lack of reference to drug and alcohol treatment in key policy documents, such as the Department of Health's White Paper Healthy Lives, Healthy People. The removal of the “ring fence” from the pooled treatment budget may result in national disinvestment at a time when public spending cuts are likely to reduce local authority spending on drug and alcohol treatment. It will be challenging to deliver on the vision of recovery in the “Drug strategy 2010”.FindingsThe new public health structures and the commitment to recovery create new opportunities to improve services too – for example, the potential for joint working through Health and Wellbeing Boards. It is also positive that Healthy Lives, Healthy People stated that the NHS Constitution will apply to the public health service.Originality/valueWhile these changes could provide a platform for improving outcomes, there is a genuine risk that substantial disinvestment in drug and alcohol services will be witnessed.

Health and wellbeing boards

PurposeThis paper seeks to look at proposals in the Health and Social Care Bill for the establishment of health and wellbeing boards.Design/methodology/approachThe paper looks at one part of the Health and Social Care Bill, the provisions in Chapter 2 of Part 5 relating to the establishment and functions of health and wellbeing boards.FindingsThe paper considers the functions of health and wellbeing boards, particularly in relation to encouraging integrated working, and suggests that the proposed legislation does not yet clearly spell out what steps the boards should take to encourage integrated working or how commissioners of services should be encouraged to work more closely together.Originality/valueThis paper offers a legal perspective on the possible establishment of health and wellbeing boards.

Health and Wellbeing Boards

![Graphic][1]</img>One of the major innovations proposed in the Coalition’s Health and Social Care Bill, currently going through parliament in the face of mounting public and professional resistance, is that the public health activities of PCTs should be transferred to Health and Wellbeing Boards, under the aegis of local authorities. This proposal is so uncontroversial that, as the PCTs are being dismantled, the vast majority of top-tier councils are already moving to establish new bodies in which senior council officials — and at least one elected councillor — take on an influential strategic role in the administration of local health services.1 Friends and enemies … [1]: /embed/inline-graphic-1.gif