In a climate of financial uncertainty, it is tempting to reduce collaboration for fear of losing control over resources but, as John Wilderspin argues, health and wellbeing boards must work creatively and collaboratively to avoid these pitfalls.
News is dominated by the Eurozone crisis and the implications for this country. How public services will cope with an uncertain and constrained financial future is an issue that is directly relevant to health and wellbeing boards who will have to work smarter than pre-existing structures to continue to achieve better outcomes for their local populations. Boards will need to make the best use of collective resources across the NHS and local government. But how can they ensure this happens when instinctively, people may feel the need to be more cautious and protective about money than ever?
Most health and wellbeing boards are currently refreshing their Joint Strategic Needs Assessments (JSNAs) as a precursor to agreeing first draft Joint Health and Wellbeing Strategies (JHWSs). Quite rightly, they are talking about their aspirations for what they might do differently and better for local people.
But board members are realistic people, and they know that these aspirations won’t be achieved just through strategies and plans; they will also need actions and behaviours to be different. Easy to say, but hard to do as I know from personal experience of trying to live up to my espoused values! At the heart of this will be the absolute requirement to make better use of the resources we have at our disposal; money, people, buildings, information, and all our other assets.
In the case of the NHS, this links to QIPP and the need for the NHS to make up to £20 billion of efficiency savings by 2014/15. In local government it means managing within reduced budgets of up to 28% over the next four years. At the same time we are responding to demographic pressures, and the expectations of a public who have experienced real gains in service quality and availability over the last few years, and quite understandably don’t want to lose those gains. To describe this as an ‘unprecedented challenge’ is a significant under-statement.
One of the obvious ways to deal with this challenge is to share resources and make sure they are channelled into supporting carefully selected joint priorities, without duplication or waste. But our behaviours aren’t just shaped by reason; they are deeply affected by our emotions, by our culture, and by our history. And one reaction to these straightened times is actually to reduce the amount of collaboration, for fear of losing control over scarce resources, and because of an underlying lack of trust in our partners. I have already seen examples of this happening, in both the NHS and local government.
With all the pressures on NHS and local government leaders, it takes courage to ‘hold the faith’ when pooling budgets and sharing resources. Fortunately, there are plenty of places where people are doing just that, within health and wellbeing boards, and across their local systems. They are considering how overheads can be shared, how people can access a range of services from one, integrated team, and how more and more services can be jointly commissioned. Some boards came together to form a learning set to look at how best this can be done in future. The product of their work together is available in draft form on the Knowledge Hub and final versions will be published shortly. I hope these publications will support local organisations and help stimulate further sharing of ideas about how we tackle this ‘unprecedented challenge’ together.
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The draft products, and many other resources, can be accessed via the National Learning Network for health and wellbeing boards’ community on the Knowledge Hub (registration is required).
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