Monday, 5 November 2012

Lancashire's Health & Wellbeing Board - Urgent need of reform

Lancashire’s new Health and Wellbeing Board has been set up stuffed with top Tories and health professionals. It is not surprising then that their list of priorities for the Board is both inward looking and based on self interest that will not serve Lancashire well and will waste public money. The board has become simply 'a crutch for the NHS' and hasn't the ability to recognise and tackle the bigger issues.

I have written previously about my concerns.

Labour must challenge both the make up of the Board and following next May's local elections radically reform the Board's structure and priorities.

Filling the majority of the positions with health professionals has produced a list of clinical priorities. Inward spending within the scope of services provided by Board members. Out of Touch Tories representing affluent areas cannot expect to be engaged with the day to day challenges facing ordinary people in some of the less economically active areas. Health professionals too busy with their day to day clinical work are far removed from the complexities of life and health care, or more significantly, promoting a health lifestyle that will improve all the outcomes far more.

What is missing from this list is housing, recreation and broader issues that play deep into the life chances of individuals. Why these priorities won't succeed collectively, though some may have individual success is that they are priorities for the few, not priorities for the many. A list that could only be drawn up by people who are unable or unwilling to see the bigger picture. It does nothing to tackle wider health inequalities and sadly Lancashire's Health and Wellbeing Board is letting down the majority of people in Lancashire.

When was the last time this group of people contacted their local authority to assess the provision of available, affordable recreation? Or contacted them about sub standard housing? Or contacted them about early intervention scheme (LA's run Sure Start Centre's)? I know Miles Parkinson, Labour leader of Hyndburn has never been contacted.

I am staggered the Board have arrived at this list without ever considering looking outwards. Health inequalities have been the subject of many governments reports.

The Black report was a 1980 document published by the Department of Health and Social Security (now the Department of Health). It also found that the main cause of health inequalities was economic inequality.Identical conclusions were drawn in subsequent government reports; the Whitehead Report published in 1987 came to the same conclusions as the Black report, as did the Acheson Report later in 1998, and the Marmot Review in 2010.

The Acheson Report contains 39 policy suggestions in areas ranging from taxation to agriculture, for ameliorating health disparities. It had some influence on the 1998 government green paper Our Healthier Nation: A Contract for Health which had a stated aim of reducing health inequalities; and the 1999 white paper Saving Lives: Our Healthier Nation.

The final report of the Marmot Review, 'Fair Society Healthy Lives', was published in February 2010, and concluded that reducing health inequalities would require action on six policy objectives:

1. Give every child the best start in life
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure a healthy standard of living for all
5. Create and develop healthy and sustainable places and communities
6. Strengthen the role and impact of ill-health prevention.

Contrast these ambitious to those of Lancashire's Health and Wellbeing Board;

1. Smoking in pregnancy
2. Loneliness in older people
3. Affordable warmth
4. Early response to domestic violence
5. Support for carers
6. Alcohol Liaison Nurses
7. Identify those at risk of admission to hospital and provide appropriate intervention
8. Self-care - – encouraging people to take control of their own health and wellbeing.
9. Healthy weight – environmental measures
10. Joined up support for vulnerable families

The Board are now out and about getting approval for their priorities (as opposed to the people's priorities), all important in their own small way. However many should be part of a basic NHS service. Many are not preventative only providing care after the fact - failing to challenge the underlying problems that lead to health inequalities.Nearly all are health care led priorities seeing to transfer funding to ease NHS burdens.

I doubt very much whether their consultation "will be your opportunity to, not only find out more about the Board’s strategy, but to share ideas and discuss how you can help influence and achieve the aims of the strategy". Or to change fundamentally the Board should work. The idea that "In particular, you will be given the chance to provide specific recommendations on how the ten Health and Wellbeing Strategy interventions (detailed below) can be effectively delivered" does not lay bare the issues at hand but seeks to ameliorate the public towards a policy that has already been decided.

The Tories are letting Lancashire down by 1) making the political representation on the board all Tory; and 2) by not recognising the health inequalities within Lancashire. Your opportunity to change the way this Board works comes next May at the local elections for it is a vote for Labour and a democratic will that will bring the much needed and greatest reform to Lancashire's Health and Wellbeing Board.