Health and wellbeing boards could provide a way for leaders of different services to work together to push through real transformation of public services, says Anita Higham
Shared visionary leadership is urgently needed in local communities – and now may be a good opportunity to achieve it. At the moment, there is no formal means by which leaders of all local community services – schools, social care, children's centres and the police – can work together. While the leaders of health and social care are being encouraged to work more closely, there would be even greater benefits if they were joined by those running education.
New statutory health and wellbeing boards could provide a way for leaders of different services to work together to push through real transformation of local communities and public services.
For the first time, there is now an opportunity for productive co-operation between the worlds of health, social care and education that could establish a solid base for a social infrastructure, and one that is in tune with the government's push towards greater local decision-making and the drive to pass more responsibility to frontline professionals and those who use public services.
But how can public managers seize this opportunity? Part of the planned changes to the NHS demand that GPs should work closely with local authorities in commissioning social care. But many GPs do not see themselves as agents of change in their community. They see themselves as primarily accountable to their individual patients, rather than to a whole community. They are predominantly self-employed, running their practices as small businesses and contracting independently with various parts of the NHS or private providers. Most have little insight into, or understanding of, their local schools or the social care provided by councils, and do not yet appear to see the relevance of co-operating with leaders of other services to improve the wellbeing of their communities through integrated planning in health, social care and education.
Traditionally, the NHS and local government have different cultures and styles in assessing needs and commissioning services. A culture of client involvement tends to prevail within local government, but clinicians and NHS managers do not instinctively engage with members of the community as their "clients" before deciding how best to meet health needs. Most schools, meanwhile, have limited experience, or any real understanding, of commissioning.
There is little crossover. Healthcare leaders have limited insight into the culture of community-based schools, or of how they operate to serve their local population, and lack confidence in knowing how to engage with schools – and vice versa.
Community-focused needs assessment – where local groups are consulted before taxpayers' money is allocated – should offer all these services a way potentially to serve their communities. But, at the moment, the divide between the NHS and councils is frighteningly wide. The NHS and GPs in commissioning clusters are ranged on one side while those who receive their services – families, young people, children, older people and other adults – are firmly on the other side.
The health and wellbeing boards must bridge that gap, if they are to strengthen communities and provide a means by which those running social care and educational services can engage with their GPs and commissioning consortia.
Do public leaders have the courage for this revolution in local services?
• Anita Higham is a member of the NHS Alliance patient and public engagement steering group.