Introduction

Health and Wellbeing Boards (HWBs) emerged from debates about the Health and Social Care Bill (2011) as a key coordinating mechanism or steward for local health and social care systems (House of Commons Communities and Local Government Committee, 2013, 14). For many this is yet a further attempt to improve coordination between health and social care services which historically has been a mixed experience (Lewis, 2001; Glendinning and Means, 2004; see chapter 9). The rationale for HWBs, however, includes a broader coordinating function across local authority (LA) services with a role in addressing the wider social determinants of health such as housing, education and planning, as well as social care (see Chapter 10). This wider context of joint-working is generally unexplored despite the emergence in some areas of joint public health directors pre-dating the formal shift of Primary Care Trust public health responsibilities to local government in 2013 (Marks et al, 2011).

While partnerships are seen to be a prerequisite for tackling ‘wicked issues’ (issues so complex that their solution lies with a multi-agency response), historically they seem unable to break free from the ‘silobased’ structures which govern how many UK public services are organised and delivered (Coleman, 2014). Past initiatives to achieve joined up, well coordinated and jointly planned services have previously had limited success.

Various approaches to local authority and NHS partnerships have been introduced since the 1970s with varied success (Hunter and Perkins, 2014). Funding structures remained a key barrier partially addressed by the 1999 Health Act which introduced new ‘flexibilities’ allowing health bodies and LAs to

• • set up pooled budgets

• • delegate function, by nominating a lead commissioner or integrating provision, and

• • transfer funds between bodies.

The aim was that services should become far more coordinated, designed around users and potentially a cost saving. For example, keeping an elderly person in hospital can be more expensive than the more appropriate package of social care needed to allow the patient to be discharged. With pooled budgets, funds would no longer be tagged as belonging to health or social services, and managers would be able to take more sensible, holistic decisions; however, issues remained, such as non-compatibility of budgetary cycles, audit and governance arrangements and non-coterminous boundaries.