Figure 4: What additional powers/responsibilities do you think
Health and Wellbeing Boards should take on?
of acute provision Commissioning of
primary care in
through a joint
vehicle with the CCG Right to scrutinise
primary care directly
The right to scrutinise contracts more closely was supported by a third of our
survey respondents (see figure 4), and was raised in some interviews as the
only way that HWBs would be able to truly influence primary commissioning
decisions. But the most popular responses by some way were to allow HWBs
to have strategic oversight of acute provision and to commission primary care
in a partnership. This would chime with Labour's proposals.103 In order for
HWBs to hold NHS England accountable for commissioning our 2013 report
'In Sickness and in Health' recommended that a body for HWBs should be
created to represent their interests within NHS England.104
Our conclusion is that if the sector wants to go for all-out integration, then it
should build on the spirit and intention of BCF and do it wholesale. This would
chime with our survey respondents who by an overwhelming margin (85 per
cent) were in favour of "increased financial incentives for closer integration e.g.
an expansion of the BCF"
Co-location of services, aimed at reducing unnecessary acute admissions - for
example, by putting GPs and social workers in hospitals full time - were seen
by several interviewees as a worthwhile investment. A case in point is Barnet,
where there are social care workers and more than 70 GPs and 60 nurses
providing 24-hour cover in three hospitals and one primary care centre.105 The
expansion of this gatekeeper role could play a critical part in supporting older
people outside of an acute setting.
But by the same token, pilots have shown that integrated, preventative care
outside hospitals can work, too. For example, Leeds has been chosen as one of
14 sites across the country to pioneer integrated care. Twelve health and social
care teams in Leeds coordinate the care for older people in a recovery centre.
This centre offers rehabilitative care to prevent otherwise avoidable hospital
admission, facilitate earlier discharge and promote independence. In its first
month of operation the centre reported a 50 per cent reduction in length of stay
at hospital.106 Smaller schemes can also have a large impact. An interviewee
told us that taking an acute cardiologist out of the local hospital and into the
community led to a 25 per cent reduction in hospital admissions.
103 HSJ "Burnham sets out
integration vision" (24
104 Localis, In sickness and in health
105 Barndoc Healthcare, About us
(accessed January 2015)
106 Department of Health,
"Integration pioneers leading the
way for health and care reform"
(1 November 2013)