Local Authorities (local government)

Local Authorities (local government)

The 152 ‘top tier’ Local Authorities (LAs) took on responsibility for commissioning the majority of public health services from 1st April 2013; county councils and unitary authorities are classed as ‘top tier’ authorities.

Each LA has a Health and Wellbeing Board (HWB) which has a wide remit across the new health and care system, providing strategic oversight and bringing together all the local commissioners. HWBs do not commission services; that is undertaken by the LA.

LAs and CCGs have equal and joint responsibility for producing the Joint Strategic Needs Assessment (JSNA), through the HWB.  The JSNA and the Joint health and Wellbeing Strategy (JHWS) will inform the preparation of the Pharmaceutical Needs Assessment (PNA) which will be used by NHS England to determine some applications for pharmacy market entry.

Health and Wellbeing Boards (HWB)

The ambition behind the introduction of HWBs was to build strong and effective partnerships, which improve the commissioning and delivery of services across the NHS and local government, leading in turn to improved health and wellbeing for local people. The Health and Social Care Act 2012 created a common flexible framework, by requiring the establishment of an HWB for every upper tier local authority from April 2013.

The 2012 Act prescribes a core statutory membership of:

  • at least one elected representative, nominated by either the Leader of the council, the Mayor, or in some cases by the local authority;
  • a representative from each CCG whose area falls within or coincides with, the local authority area;
  • the local authority directors of adult social services, children’s services, and public health; and
  • a representative from the local Healthwatch organisation.

NHS England must appoint a representative for the purpose of participating in the preparation of JSNAs and the JHWS and to join the HWB when it is considering a matter relating to the exercise, or proposed exercise, of NHS England’s commissioning functions.

Local authorities or HWBs can add members, to the board beyond that set out in the legislation. This could include representatives from other groups or stakeholders who can bring in particular skills or perspectives, or have key statutory responsibilities which can support the work of boards.

Health and wellbeing boards assess the current and future health and social care needs of the local community through Joint Strategic Needs Assessments (JSNAs). JSNAs are based on a principle of analysing the available evidence on the local community’s health and social care needs. This includes engaging and working with a wide range of local stakeholders such as patient groups, voluntary organisations and the public. Using the JSNA, health and wellbeing boards will then jointly agreed strategic priorities for local health and social care services in Joint Health and Wellbeing Strategies (JHWSs). Taken together, JSNAs and JHWSs are intended to form the basis of commissioning plans, across local health and care services, (including public health and children’s services) for CCGs, NHS England and local authorities. 

Overview and Scrutiny Committees

Councils are run by elected members (councillors), with a small number of them forming the cabinet (or executive) which takes strategic decisions and sets priorities for the council. The rest of the councillors are involved in the scrutiny function. This mirrors the distinction in Parliament between MPs in the Government, and those who serve on Select Committees.

Each relevant council has a health overview and scrutiny committee (OSC) dedicated to scrutinising local NHS policy, planning, and impact against local needs and inequalities. This committee is made up of councillors  and thereby has democratic legitimacy. It may also include co-opted members.

The health OSC devises a work programme which may call for reports on any aspect of local NHS activity so that it can hold both commissioners and providers to account. The health OSC also must be consulted on any proposed substantial service changes. It may make recommendations to and require a response from any healthcare provider or commissioner on any aspect of activity that it has scrutinised. 

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