Health and Social Care Bill

My Lords, this group of amendments all relate to health and well-being boards and in particular their statutory minimum membership, responsibility for preparing both joint strategic needs assessments and joint health and well-being strategies, as well as their role in promoting integration. Amendments from the noble Lord, Lord Ramsbotham, and my noble friend Lord Shipley, relate to changes to the statutory membership of health and well-being boards, which I know we have previously debated. As noble Lords will be aware, we have consulted extensively on the membership of health and well-being boards and one of the consistent messages we have heard is that local people want a balance between the flexibility to add members alongside some consistency in representation from key players, such as elected representatives and clinical commissioning groups. The Future Forum looked at this and, following its report, we made a commitment that it will be for local authorities, or in some cases the leader or mayor, to determine the precise number of elected representatives on its board, although we have stipulated that there must be at least one. I would ask my noble friend Lord Shipley to note the words ““at least one””. We believe that it is right for local areas to be able to have the flexibility to determine the wider membership of their boards based on local need. I am of course happy, however, to engage with my noble friend in further discussions. The Bill allows local areas the flexibility to develop the arrangements that best work for them. It is important to be clear that the purpose of this policy is not primarily about setting up a committee but about stimulating effective joint working for and with local people and communities. The health and well-being board will be central to this joint working but must not represent its limit. We can be encouraged by what is now happening on the ground. We know that a large number of local areas are already working with all the relevant stakeholders to explore and agree how they can work together in the future to make the biggest difference to local people. For instance, from our work with shadow health and well-being boards, we have had lots of feedback to suggest that two-tier county councils are working closely with district councils through the boards in a range of creative and positive ways based on local need and circumstances. In fact, I understand that in many two-tier areas, shadow boards are already operating with more than one district council representative ranging from the leader, the chief executive or a senior officer. However, developing these relationships and understanding how best everyone, whether it be district councils, health professionals, local providers or the voluntary sector, can contribute in the most appropriate way, is something that we feel strongly is best left to these conversations rather than being prescribed on the face of the Bill. Amendments 238C, 238D and 238E, tabled in the names of the noble Lord, Lord Ramsbotham, and the noble Baroness, Lady Whitaker, relate to placing a particular emphasis on educational and children's services. They would make explicit reference to education and children's services in the Bill, in the context of the duty and powers of health and well-being boards, to encourage close working between the commissioners of health and social care services, with itself and with commissioners of health-related services in the area. I should like to take this opportunity to reiterate some of the points made during our previous debates on this topic. I fully agree that joining up health and social care services for children as well as for adults is crucial, but I believe that the existing provisions set out in the Bill are sufficient to ensure that the voices of children are heard. Indeed, I should like to remind noble Lords that in preparing the JSNA and joint health and well-being strategy, health and well-being boards will have a statutory duty to involve people who live or work in the area, and this will include within it young people. The director of children's services will be a statutory member of the health and well-being board to ensure that the needs of children are taken into account, and local healthwatch will also be able to use its membership on the boards to help ensure that the voices of the whole community, including those of young people, are fed in. In addition, the statutory guidance—I think this is a reassurance that the noble Lord, Lord Ramsbotham, wanted—we are producing on JSNAs and joint health and well-being strategies will emphasise the importance of understanding and addressing the needs of children and young people. We are also supporting the efforts of local partners by bringing together emerging health and well-being boards into a national learning network which is developing ways to engage effectively with local people, including a focus on effective joint working to improve services for children and families.