Health and Social Care Bill

It will almost certainly be the local outpost that will have direct responsibility for those matters. A number of amendments would introduce specific requirements in relation to the JSNA, but before I move on to that I have been informed of something that I think I probably implied, if not stated. It would be up to the board to decide who would be most appropriate to attend at a particular health and well-being board meeting. I agree that the JSNA must be a full analysis that covers the current and future health and social care needs of the local population. It will be a framework to examine inequalities and the factors that impact on health and well-being. This could include aspects such as deprivation. Its scope will naturally include health and social care needs that are related to a wide range of areas, such as alcohol harm, disability or older people. In preparing the JSNA and joint health and well-being strategies, local authorities and CCGs will be under a duty, which the health and well-being boards will discharge, to involve people who live or work in the area. In practice this could include allied health professionals, as proposed in the amendments of the noble Baroness, Lady Finlay, Amendments 327A and 328A. A number of noble Lords, in particular the noble Baroness, Lady Wilkins, my noble friend Lady Benjamin and the noble Lord, Lord Warner, raised concerns about how health and well-being boards will operate in relation to children’s services. I fully agree that joining up health and social care services for children as well as adults is crucial. That is why the director of children’s services is a mandatory member of the board. It is also why the scope of the JSNA and joint strategy covers children’s services across health and social care. The duties to involve local people in the preparation of the JSNA and joint strategy do not distinguish between adults and children, so we expect the voice of children to be heard. Section 10(1) of the Children Act 2004 places a duty on ““relevant partners”” to co-operate with the local authority. Relevant partners include maintained schools, including academy schools, and local health bodies such as the CCGs when they are formed. As I have said, directors of children’s services will be statutory members on the health and well-being boards. They will be well placed to promote the interests of children as they relate to education services. My noble friend Lady Jolly raised the issue of district council involvement, as did other noble Lords. District councils have a crucial role to play in offering local insight and expertise. Health and well-being boards will have the flexibility to include district council representatives in their membership, where the district council is not the local authority that is required to establish the boards. There will also be duties on them to involve district councils in preparing the joint strategic needs assessment. We know that a large number of local areas are already working with stakeholders to explore and agree how they can work together in the future to make the biggest difference to local people, so that everyone, whether they are district councils, clinicians, local providers or members of the voluntary sector, can contribute in the most appropriate way. The joint health and well-being strategy will be a shared, overarching response addressing the health and social care needs of an area identified through the JSNA. A number of amendments highlight the desirability of integrated services. In the joint strategy, the board will be able to consider how the commissioning of wider health-related services could be more closely integrated with health and social care commissioning. For example, the board could consider whether and how housing or local authority leisure services affect health, and if they do, how commissioning could be more closely integrated with commissioning of health or social care services. However, I would say to the noble Baroness, Lady Massey, in particular, that this is not something that we wish to be prescriptive about in the Bill. Instead, we are leaving these decisions to be taken locally; we believe that that is right. In response to a point made by the noble Baroness about the joining up of children’s services being in some way optional for health and well-being boards, that is certainly not right. The board’s duties cover both adults and children; it would not be open to a board to do nothing with respect to children’s services. The noble Baroness and I would agree that integration across health and social care is applicable in many situations and is to be regarded quite often as best practice. However, I suggest that as such it is much more the province of statutory guidance. The noble Baroness, Lady Greengross, asked a number of highly relevant questions about how we ensure that integration happens on the ground. That is why we have asked the Future Forum to report on this topic. I can confirm that we will be responding to their latest work in January, so perhaps I can speak with the noble Baroness at that point. We have also included in the Bill a duty for key health and social care commissioners to have regard to both the JSNA and the joint health and well-being strategy when exercising their functions. If their commissioning plans vary significantly from them, they will have to be able to justify why, or consider changing their plans. However, I want to state my firm view that it is right that health and well-being boards do not have a right of veto over plans, as that would undermine commissioners’ autonomy and introduce additional complexity and uncertainty into a relationship that should in essence be built on trust and partnership working. It would also give health and well-being boards the ability to make commissioning decisions that could affect expenditure from the NHS, without them having to take responsibility for that expenditure. That would not be appropriate. We must not forget that this policy is not primarily about setting up a board; it is about joining up the commissioning process at a local level by bringing key partners together in a strategic and coherent way. Those partners can then consider the total resource available and come to a joint understanding as to how the resources can be best invested to secure better health and well-being outcomes for their whole population. Clause 192 supports that objective by placing a duty on health and well-being boards to encourage integrated working between commissioners of health and social care services, which is exactly what noble Lords have been urging. Alongside the integration duties throughout the Bill, health and well-being boards must also consider the use of partnership arrangements, such as lead commissioning and pooled budgets, when preparing the joint health and well-being strategy. Amendment 336A, from the noble Lord, Lord Beecham, would place an additional function on health and well-being boards and give them powers to make referrals for investigation. In doing so it raises an important issue, which I know is of concern to the Government as well as the Committee, and on which we had a good debate in an earlier session on 22 November. However, this amendment is unnecessary, as it would establish a referral process that would in many respects duplicate existing roles and responsibilities within the system, such as those of the Care Quality Commission and local healthwatch organisations, which will of course be able to make recommendations for service improvements and investigations. The noble Lord, Lord Beecham, asked about cross-government working. Government departments already enjoy close working relationships on health issues. These will continue, including through the Cabinet Committee that we now have on public health. The noble Lord also referred to community place-based budgets. We want to ensure that GPs and councils have the flexibility to pool and align funds locally where that will improve outcomes for people. The health and well-being boards provide the ideal forum for local application of community budgets, and we intend to explore any barriers to that happening. Finally, the noble Baroness, Lady Donaghy, referred—very aptly I thought—to the health team. The Government, and the Bill, place a great deal of faith in professionals. We think that that is right, and we want the NHS of the future to be led by clinicians and professionals across the health service, so I hope I can reassure her that we are at one on the value of the whole health team, as she put it. I hope I have reassured noble Lords of our good intentions in this area, and that I have answered the questions put to me. I hope, too, that noble Lords will feel able not to press their amendments as a result.