Coventry and Warwickshire’s health and wellbeing boards (HWB) had been meeting jointly for a number of years; Partners in Care and Health (PCH) brought in amid concern this partnership work was duplicating the move towards integrated care systems; focus of the HWBs and integrated care partnerships sharpened thanks to fresh perspective and challenging questions posed by PCH peers.
The challenge and approach
Coventry and Warwickshire councils have a long history of working together. Their two health and wellbeing boards (HWBs) have been meeting jointly for development sessions in various guises since 2017 and their public health departments work together on a range of topics from suicide prevention to tobacco control.
The two HWBs have remained on separate statutory footings, however, with the joint development sessions acting as an important forum for the two areas to discuss partnership working and collaboration on campaigns, such as the Year of Wellbeing.
Over time the creation of sustainability and transformation partnerships and then the move to integrated care systems, which were both done on a Coventry and Warwickshire basis, meant the role of the joint HWB development sessions began to overlap with the new Coventry and Warwickshire Integrated Care Partnership.
‘Everything in flux’
Gemma McKinnon, Warwickshire’s Public Health Service Manager for Strategic Partnerships, said: “I think we had got to the point, particularly recently with our integrated care partnership (ICP), where the joint HWB development sessions were struggling to identify their specific role in the emerging ICS governance – they were covering similar issues and it felt like there was a lot of duplication and they were covering the same ground. We decided we wanted to review what their role and remit was, but wanted to get some outside input to do that.”
The two councils turned to PCH for support. Two PCH peers, one a former director of public health and the other a former senior NHS officer, were brought in. The peers spent time talking to the two councils and members of each partnership group before holding a workshop for all the members of the groups.
“It was really valuable to have their input,” said Gemma. “We did feel a bit uneasy as everything seemed to be in flux across the system and we didn’t want to seem that we hadn’t got it figured out. But straight away they stressed that many areas were grappling with the same issues and we should be candid about it. During the workshop we split into groups and discussed the differences between the ICP, the joint HWB, individual HWBs and the care collaboratives.
“The peers were really good – challenging us and asking the difficult questions. That’s the value of getting people in from outside. They have a fresh perspective and are able to bring in ideas from other areas. In the end we decided the two HWBs would no longer meet together – we felt that it would be better for them to retain a more local focus while the ICP covered the whole Coventry and Warwickshire footprint.”
‘Thinking clearly’
Following the workshop, two working groups were established. One focussed on the governance and remit of the ICP and HWBs and the second was set up to strengthen citizen engagement involving the local Healthwatch groups and Directors of Public Health.
Gemma said: “The latter was something that came up at the workshop. We felt we needed to review who we were working with – and whether there were gaps and parts of the community we were not engaging with.”
The citizen involvement workstream is still in the process of getting set up. But work is already under way on governance and remit of the ICP and HWBs, said Gemma. “We have sought to define what the role of HWBs and ICPs are. There is still some overlap – and that is quite right – but we have tried to be clearer in our focus on what each should be doing.
Coventry City Council Public Health Consultant, Valerie de Souza said: “We have come to the position that HWBs should be looking at place-based preventative activity across the wider determinants of health – housing, transport and education for example – whereas the ICP should focus on the longer-term strategy across the Coventry and Warwickshire footprint.
“To establish what this looks like we have been taking test cases through the proposed ICS structure – we have done this for the work and health strategy and are about to do it for the mental health concordat work.
“What has become clear is that you cannot have a one-size fits all. It needs to be done on a case-by-case basis so we are now setting up a system that will triage what goes where before it gets to either the HWBs or ICP.
“There is still lots of work to do – but we feel we are in a much stronger position and have a much better idea of how we should be using the HWBs and ICP to push ahead with integration. The PCH support helped us with renewed focus and think clearly about the best way to organise ourselves.”