Tuesday, 26 June 2012

Lancashire’s Health and Wellbeing Board – fit for purpose or a political vehicle?

Lancashire’s Health and Wellbeing Board looks politically skewed and one has to question whether it can make the best judgements for the health and well being of Lancastrians given it’s unrepresentative nature.

It is not just politically biased but geographically leaving it less accountable. Hyndburn is completely unrepresented.

There are six politicians on the new Board: five Tories and one Labour – a new member, giving the Tories a huge majority voice. The question of direction and policy mirrors the problems with the Government’s NHS reforms – healthcare becomes partisan and decisions potentially not made based on absolute need but relative need.

In the case of Lancashire we have a Health and Wellbeing Board which is mainly comprised of Conservative County and District Councillors, all of whom represent more loosely populated rural areas. Aside from the new member Julie Cooper in Burnley, none of the old industrial and mill towns are represented – despite the fact that they have greater need.

This isn’t some tea and biscuits committee. They will have a budget of £70million for the purpose of primary care in Lancashire.

The House of Commons Library advised that levels of child poverty are the best measure of deprivation. The national average at local authority ward level is 21.8%, but in the wards of those on the Health and Wellbeing Board the level is much lower.

· Valerie Wilson (Garstang) – 7%
· Mike Calvert (Pendle East) -13%
· Susie Charles (Lancaster Rural East) – 7%
· Cheryl Little (Fairhaven) – 8.2%
· Bridget Hilton (Waddington and West Bradford) – 3.6%

Compare that to some of the wards in Hyndburn. In Church child poverty stands at 39.6%, in Central Accrington it’s 37.3%, in Barnfield it is 35.1% and in Peel it is 32.2%. These are shocking levels, well above the national average and more than 3 times as high as they are in the wards represented on the Health and Wellbeing Board.

This is not to make the case that need exists across the county, but that those people living in seriously tough conditions in these wards represent a concentration of need, one that is not represented by the political decision makers on the Board.

The evidence is overwhelming; poorer areas have lower life expectancies and suffer with more non-communicable diseases like cancer and diabetes.

There is serious risk that deprivation slips off the agenda as an indicator of healthcare need. That there risks being a lack of understanding of the issues, the people, the neighbourhoods and the problems they face. Mistakes from the past may be repeated and relative need may skew priorities. How can individuals with more affluent communities claim political exclusivity as it was with last years to board on the answers to communities they do not represent.

Introducing unbalanced and unrepresentative political representation into healthcare is not right. It cannot be left to GP’s be to vanguard of the poor because for all their medical knowledge, issues around prevention require a broader approach. District Council’s provide leisure facilities, planning and development controls and lead on regeneration and the local economy. All critical factors in determining life chances. The County Council provides education and social services and the NHS primary care facilities. The third sector providers support for a whole manner of charitable social aims.

Relying solely on the local knowledge of GP’s is flawed. Their wider partnership approach has historically been minimal and their experiences and interaction with other decision makers limited. GPs clearly are a cornerstone in this process. However a total reliance on GP’s assumes that GP’s are in a position to allocate time and experience to these matters but a quick glance at the East Lancashire PCT scorecards for GPs in Hyndburn, show that the majority of Hyndburn’s GPs fall in the bottom 50% of the PCT’s development score measure. The inclusion of medical practioners on the proposed board has no geographical element.

I have expressed deep concerns about civil servants sitting on decision making bodies. They do not have to be accountable and it will inevitably be in receipt of question or challenge undermining their credibility and authority.

In a place like Hyndburn it is important we get this right. Balanced and experienced political representation is important as is a broad umbrella of bodies who can shape health outcomes. Providing space for children to play, adults to exercise, better recreational facilities and services. Promoting healthy eating through planning and development and encouraging an active lifestyle all require the input of the District Council, The County Council, the third sector, the private sector and the NHS.

The new Health and Wellbeing Board risks being a group of political decision makers who know little of the areas of greatest need and who don’t represent the areas of greatest need with a finger in the air that the unaccountable medical practioners can get it right.

The members of the shadow Health and Wellbeing Board are:

1.       CCllr Valerie Wilson (Chair) - LCC
2.       CCllr Mike Calvert - LCC
3.       CCllr Susie Charles - LCC
4.       Richard Jones - LCC
5.       Helen Denton - LCC

The upper tier local authority portfolio holders for health, adult social care and children's services, as well as the Executive Directors for Adult Social Services and Children and Young People are to be core members of the statutory Health and Wellbeing Board

6.       Lancashire Director of Public Health (post currently being
recruited to)

The Director of Public Health is also to be a core member of the statutory health and wellbeing Board. Frank Atherton(Lead DPH for the
Transition) attended the Board until he left at the beginning of May.
Aislinn O'Dwyer is now working with us  as an independent Public Health consultant until the substantive DPH  takes up post and will attend the Board. In addition, Maggi Morris (DPH for NHS Central Lancashire) is also a member of the Board until the substantive DPH takes up post.

7.       Cllr Cheryl Little - Fylde District Council (representing the
Fylde coast districts)

8.       Cllr Bridget Hilton - Ribble Valley District Council
(representing the central districts)

9.       Cllr Julie Cooper - Burnley District Council (representing the
east Lancs districts)

The District Council members were nominated to represent districts in the different parts of the county, by the Lancashire Leaders Group.

10.   Peter Kenyon - Chair of NHS Lancashire (the PCT cluster)

11.   Janet Soo Chung - Chief Executive of NHS Lancashire

NHS Lancashire is overseeing the health service transition and will be setting up the local office of the National Commissioning Board, which according to the Act is to be a core member of the Health and Wellbeing Board.

12.   Dr David Wrigley - NHS Lancashire North CCG

13.   Dr Tony Naughton  - NHS Fylde and Wyre CCG

14.   Dr John Caine- NHS West Lancashire CCG

15.    Dr Ann Bowman - NHS Greater Preston CCG

16.   Dr Robert Pennett - NHS Chorley and South Ribble CCG

17.   Dr Peter Williams - NHS East Lancashire CCG

The shadow Board agreed at its first meeting that all 6 CCGs should be invited to attend if the Board is to be as effective as possible in influencing CCG plans

18.    Lorraine Norris, Chief Exec Preston City Council, representing
the District council Chief Execs

The Lancashire Chief Executives group agreed to nominate one of their number to lead on health and wellbeing.

19.   Walter D Park, Chair of Lancashire Link 

With the national delay to the implementation of HealthWatch the Board agreed that it would be appropriate for the LINk chair to attend to increase representation of the patient and public voice in the Board

20.   Canon Mike Wedgeworth, Third Sector Lancashire