My name is Lorna Shaw and over the past year, from January 2012 to March 2013, I have been
leading the Local Government Association’s Health and Well Being Board Leadership Programme,
with funding from the Department of Health.
Health and Well Being Boards were established by the 2012 Health and Social Care Act; they
are intended to provide system leadership and to achieve improved health and well being
outcomes for local people.
The programme has therefore been focusing on leadership development, and aimed at supporting
Health and Well Being board members with the leadership behaviours, skills and knowledge
to help them to operate effectively in a cross-organisational environment.
The programme comprises a menu of activities that health and well being boards are able
to access, these include, a development tool which enables health and wellbeing boards
to self-assess their overall effectiveness.
Regional Chairs’ networks, providing a safe forum for Chairs and Vice Chairs of Health
and Well Being Boards to work together on issues of common concern, exchange ideas and
share learning.
There is also bespoke support where we have pooled resources with the NHS Leadership Academy,
enabling more than 60 health and well being boards to have benefited from individually
tailored support to meet their specific needs.
This video focuses on the regional simulation events which were organised between September
and October 2012, these enabled Health and Well Being Board members to work together
on tackling a range of challenging yet realistic scenarios.
The events were commissioned and undertaken by the University of Birmingham.
Over to Deborah Davidson to tell you more about the regional events.
Hello my name is Deborah Davidson and I am a Senior Fellow at the Health Services Management
Centre at the University of Birmingham.
Together with colleagues at the Institute of Local Government Studies here, we have
been working closely with the Local Government Association to design and deliver a series
of regional ‘challenge’ events for Health and Well Being Boards.
The purpose of these events was to provide boards with a safe developmental space to
consider how to respond to real issues they will face, observe the way in which they worked
together on these challenges and identify their needs for development.
It also offered an opportunity to log where uncertainties and capacity issues existed.
To support board’s ongoing development, we have put together a short video of participants'
experiences of the events.
Our first board member Trevor, talks about the benefits of learning and what it helped
the board to think about in terms of its role and what it is there to do.
It’s been really, really good we have been a shadow board for some time and this gave
us a real opportunity to look at how we work together the scenarios were very realistic
and we have been looking at the value added contribution we can make as a board and what
is it that the board is going to do that is additional to all of the other governance
arrangements we’ve got in our respective organisations and I think what we think is
that we are need to be quite strategic and to ask some of the kind of key questions rather
than get into too much detail so quite high level because otherwise we are not going to
add anything to the existing arrangements.
We can see from our next participant that even when boards have prepared well the challenge
events have helped members to get to a better understanding of the work they have to do
with partners and to build better working relationships across health and local government.
I think it has been a very successful morning, actually we had a Health and Well Being Board
yesterday with a lot of discussion about the development of our joint strategic needs assessment
and the health and well being strategy and today I have understood better how they would
all fit together and how we would work from those documents for a more holistic approach
through integrated working with our CCG colleagues and the Local Authority.
I think there was some real learning for the boards today, I think as I said it’s a fairly
mature board so they have been through some learning and processes together they have
also spent quite a lot of time together learning which has been great and useful for them but
a lot of the things that came up today were around some big governance issues particularly
around how they relate to scrutiny committees, how they relate to cabinet decisions, this
is also a district level board based on the CCG outlines, so they also have the dynamics
with the county level board.
For me I think it was a chance to reflect on the work that has already been done, an
opportunity to meet with colleagues from all sectors and to really start to work on the
purpose of our role in the future and how we can really make changes happen for our
local population.
Well I think today has acted as a catalyst for relationships and understanding in the
board where we have been able to discuss some of the important issues for health and local
government in terms of making health and well being boards work.
It will be the system leader in the future and it is such an important relationship if
we are able to transform services in a way that actually benefits citizens in our local
communities.
I suppose the importance of being able to sit down with colleagues who are drawn from
different backgrounds who have got different expertise in order to clarify the priorities
of the Health and Wellbeing Board to make sure that it is delivering some short term
objectives and outcomes that benefit the population as well as some of the longer term strategies
so those really are quite important things about how to make sure we really deliver for
the future We know from partnership working in health and social care, that different
organisational culture and local politics can create real tensions.
The Challenge events have enabled some boards to recognise that these tensions exist and
need to be brought to the surface and worked with.
We are bringing together two different cultures really, er actually I think there is quite
a lot of mutual understanding and respect anyway but you know, there are issues about
political drivers versus clinical safety drivers and things like that which haven’t come
to a head yet but potentially could in the future so I think it has been useful to raise
those really.
I think some of the comments that stick in my mind and for going forward will be about
elected members and GPs actually have a lot in common in a sense that they are there to
care for the welfare of people they serve and going forward we really need to foster
that focus on what is really important but also to be able to challenge appropriately
when it is in the interest of people to do so.
Drawing on the expertise and leadership from all health and well being board members at
particular points in time or for particular tasks, is also an important capability that
boards need to develop.
I think learning about who might be best placed to defend difficult decisions really, you
know I think we had one issue where it was the possibility of closing much loved small
casualty, an ineffective casualty unit where you might want to put the GP’s up to explain
that, it’s much better to have a clinically safe A&E a bit further away than to have a
clinically unsafe A&E unit that is very close really whereas another issue was a kind of
process issue that had gone wrong with Health Watch and there you would be better to field
the local councillors to talk about that really and so kind of working out in advance who
might be involved in media relations and so on, really.
I was working with quite a small board and there was a real advantage in that because
they were quite a small group of people we could have a really in depth discussion about
some of the issues.
The downside was we also had to reflect on how a full board might work with those issues
if the full range of folk were present.
The group worked together really well they were very inclusive, very respectful, they
were very conscious of the progress that they had made to date but also of some of the big
challenges that lay ahead we also talked quite a lot about how they might handle issues of
conflict in future, at the moment they were very respectful, very polite, had a really
nice atmosphere and ethos, but we did debate, when we were reflecting what would happen
if there was a really contentious issue that cropped up if they had to discuss something
really difficult, if they had to really fundamentally disagree with each other and then come back
the next day and know each other well enough for things still to be o.k.
I think the most interesting thing for me was when the board started to discuss what
kind of paper it wanted to receive at what kind of stage.
Some of the issues they wanted to receive quite a detailed, analytical paper at a fairly
late stage in the process when it was all worked up.
For other kinds of issue the board wanted to receive something very early on when it
was still very exploratory and they could help to problem solve and to try and genuinely
understand the nature of the problem together and I guess the difficulty for the board its
Chair and for staff in participating organisations is knowing which kind of issue, is which kind
of issue, what kind of papers the board wants to receive when and how and that felt like
quite a communication and quite a cultural challenge for boards going forwards.
One of the things that struck me most is the importance of time and space away from a very
busy day job but the very real life scenarios helped to anchor the discussion in in reality
and in in front line practice.
But actually this was probably the most time that some of the board members have ever spent
together in one go and actually gave them real scope to explore some of the issues that
crop up in meetings in much greater depth than would be possible in the workplace.
I played back to the board some of the language they were using which was quite, quite belligerent,
I think somebody talked about being, er love bombing an area and somebody talked about
kneecapping the chair of scrutiny and we had a discussion about that kind of language in
the public arena and how that might come across even though, because they are quite informal
with each other they understand and they don’t take offence at that at all if you have got
new members of the board joining for example health watch you know, how they are going
to feel if there is that kind of language going on and if you are acting out in the
public arena you know how some of that language might play.
So I think just reflecting that back to them made them slightly think perhaps, they, because
there is such a strong nucleus working together perhaps they just need to be a bit more aware
of, in how they might be viewed by other people.
I think they really benefited from the exercise going round and talking to other areas about
how they were going to co-produce the health and well being strategy I think it was quite
clear that most boards for this time had done a very traditional kind of engagement you
know with consultation on example, issues that had already been agreed and they are
all very clear that they wanted to do something different next time so I think they are really
going to go away and try and do that and I think it reassured them aswell that they are
doing pretty well actually in terms of their board what they do want to go away and do
is to really iron out some of the governance issues and some of the issues around, you
know, perhaps the communication protocol who does what, who speaks on behalf of the board
and some of the issues perhaps around the health watch role and how much they sort of
support that.
So I think some definite learning points and some definite things they are going to take
away and develop over the next few months.
We have drawn on the learning and outcomes from all of the programme activities over
the last year to produce some legacy products, including case studies and a simulation resources
tool.
These can be found at the LGA website coming up at the end of this video.
Inevitably, as Health and Well Being Boards take on their statutory role from the 1st
April, new challenges are likely to be thrown up and the LGA is currently finalising the
scope and nature of support to be provided from April onwards.