To consider proposals for a new model of working, (aligning the work of the Health and Wellbeing Board with the statutory requirements of the Health and Wellbeing Partnership).
To note proposed changes to the terms of reference for the Health and Wellbeing Board.
6.1 Siobhan Farmer, Director of Public Health, (Gloucestershire), outlined proposals relating to the proposed alignment of the membership and meeting arrangements of the Gloucestershire Health and Wellbeing Partnership (HWP) and the Health and Wellbeing Board (HWB).
6.2 The Health and Care Act 2022 introduced significant changes to the structures and governance of local NHS bodies, including changes to the way local Health bodies work with Local Government. As a consequence of the changes, the Gloucestershire NHS Integrated Care Board was formed on 1 July 2022, taking on the responsibilities and functions formerly held by the Gloucestershire Clinical Commissioning Group. It was noted that the Act did not impact on the statutory duties of Health and Wellbeing Boards, and that these must still be discharged. There remained, however, a potential overlap in the intended roles and responsibilities of Integrated Care Partnerships (ICP) and Health and Wellbeing Boards (HWB), for areas that are coterminous.
6.3 One change introduced by the Act was a requirement for each Integrated Care Board (ICB) and each upper tier or unitary Local Authority within its geographical area to establish a joint committee, (an Integrated Care Partnership). It was explained that, since Gloucestershire County Council and the ICB are coterminous, this resulted in the establishment of a single Integrated Care Partnership for the County. Each Integrated Care Partnership can determine its own procedures and methods of working.
6.4 Although at an advantage from Gloucestershire’s co-terminosity, the new arrangement also created the anomaly whereby the pre-existing Health and Wellbeing Board and the new Integrated Care Partnership covered the same geographical area. With the support of members from both the Health and Wellbeing Partnership and the Health and Wellbeing Board, consideration was given to how the two bodies might develop complementary roles in order to add value and streamline the delivery and improvement of local outcomes and services.
6.5 Making reference to the Health and Wellbeing Board - Guidance document published by the Department of Health and Social Care in November 2022, and the specific issue of coterminous areas, members were informed that: ‘In the few areas where the ICP and HWB are coterminous, (covering the same geographical boundaries), it may be appropriate for the HWB and the ICP to have the same members. This can be done, for example, by one part of the meeting formally being of the HWB, and the other part of the ICP. However, both have different statutory functions which each will be required to fulfil.”
6.6 Following publication of the guidance, comparisons were made between the existing membership of the HWB and HWP. As a result of the comparisons, it became apparent that the HWP had a significant number of core officer members in common with the HWB, plus additional representation from the Voluntary, Community and Social Enterprise (VCSE) sector and wider representation from health and care sectors. It also had several appointed members in common, including the Chair. However, the HWB included elected Cabinet portfolio leads from GCC, and the Deputy Police and Crime Commissioner.
6.7 When considering the arrangements for Gloucestershire, and given that the HWB maintains statutory responsibility for the Joint Health and Wellbeing Strategy (JHWS), as constituted by Pillar One of the Interim Integrated Care Strategy, (Making Gloucestershire a Better Place for the Future), it was suggested that the HWB continue to oversee delivery of this aspect of work, (for consideration at three meetings of the HWB per year). This allowed six meetings of the HWP from which to review progress of Pillars Two (Transforming What we Do) and Three (Improving Health and Care Services Today) of the Interim Integrated Care Strategy.
6.8 To achieve a more streamlined approach to the work of both committees, it was proposed that the membership of the HWB and HWP align, with the membership of the HWP attending HWP and HWB meetings. The benefits of establishing a dual membership would hopefully avoid the duplication of agenda items/reduce the repetition of work applicable to both groups, thus creating greater efficiencies in resource demands.
In order to achieve this outcome, the following proposals were made: -
a) The Terms of Reference for both the HWP and the HWB to be updated to reflect the proposed changes.
b) The membership of the aligned HWP/HWB to include elected representatives.
c) Continued oversight of the delivery of the JHWS, for which the Local Authority is accountable, would be via the HWB. Scrutiny of this aspect of work to remain with the Adults and Social Care Scrutiny Committee.
d) All other aspects of the HWB Terms of Reference to be maintained, including voting arrangements.
e) Meetings to be scheduled on the following basis: - the HWP to meet six times a year. Every other meeting of the HWP to include a reduced session for consideration of items specific to the HWP, whereby HWB members join part or all of the meeting. The HWP specific sessions to focus on Pillar 1 of the Interim Integrated Care Strategy.
f) Additional development sessions to be arranged periodically to review developments to the JHWS.
6.9 If agreed by the HWB and the HWP, virtual consultation of the proposals to be made prior to consideration by the Gloucestershire County Council’s Constitution Committee. Recommendations from the Constitution Committee to be presented to the County Council at its full council meeting in May 2023, seeking approval of the new arrangements.
6.10 Questioning why the new partnership arrangement could not be represented by a single ‘committee/board’ arrangement, (similar to that adopted by Somerset Council), it was explained that, due to the statutory functions of each committee, it was possible to align the membership of the HWB with the HWP, but important to maintain the individual identity of both committees in order to consider specific requirements.
6.11 The information was noted, with a request that the members of the HWP and the HWB submit any views to the Chair of the Board/Partnership for inclusion in the recommendations to the GCC Constitution Committee. The Constitution Committee to make recommendations to Full Council, seeking approval of the revised Terms of Reference.
6.12 Members supported the suggestion that any changes to the Terms of Reference, (for both the HWB and HWP), should be consulted upon virtually.
6.13 The proposed timings of meetings in 2023 were confirmed as:
Scheduled HWP Date: Proposed Date:
21 Mar (1.30pm) 28 Mar (1.30pm) HWB & HWP
09 May (1.30pm) 30 May (1.30pm) HWP
25 Jul (1.30pm) 25 Jul (1.30pm) HWB & HWP
19 Sep (1.30pm) 26 Sep (1.30pm) HWP
07 Nov (1.30pm) 28 Nov (1.30pm) HWB & HWP