Partnership or insanity: why do health partnerships do the same thing over and over again and expect a different result?

Abstract

Objectives The paper reports on an empirical study of Health and Wellbeing Boards (HWBs) in England. Established by the Health and Social Care Act 2012, HWBs act as place-based hubs for leaders in health, social care, local government and other sectors to come together to address health improvement and the wider determinants of health. Methods We conducted a three-year study of HWBs (2015–2017) in five localities across England. This involved collecting qualitative data from semi-structured interviews with key actors in the HWBs at strategic and operational levels, and focus group sessions with voluntary-sector participants at each HWB. Results HWBs have largely followed the path of previous partnerships in terms of a lack of clear aims and objectives, lack of ownership and accountability by partners, and an absence of any significant impact on health outcomes. Conclusions Many of the features of unsuccessful partnership working were largely displayed by HWBs. Boards require more executive power and ownership from the bottom up if they are to have any real impact.

Health and wellbeing boards as theatres of accountability: a dramaturgical analysis

“…The NHS Long-Term Plan makes passing mention of HWBs in stating that 'ICSs and Health and Wellbeing Boards will also work closely together' (NHS England 2019, p.30), but it is not clear what this will mean in practice or how their roles will complement one another. Instead there remains a risk of partnership overload, with HWBs in danger of being eclipsed if they do not take efforts to refresh or reinvent themselves (Perkins et al 2020). Our findings highlight a potential unfulfilled role for HWBs, in line with widespread calls for greater public engagement in contemporary governance (Boswell, Settle, and Dugdale 2015).…”

Designing tools for ‘joined up’ homelessness prevention: Insights from one case study

“…Service integration is one strategy to tackle complex challenges facing the broader health and policy sectors (Gosling et al, 2019). Service integration is defined as 'joint working' (QCOSS, 2016, p. 4) or the 'structures and processes' (Jones, Phillips, & Milligan, 2007, p.…”

Partnership and accountability in the era of integrated care: a tale from England

“…As health and social care became more complicated and fragmented in the wake of the Health and Social Care Act, joint working became all the more difficult. Despite being 'the one place where the system can come together', 6 Health and Wellbeing Boards seemed in the main to be little more than talking shops, unable to coordinate the action that might fulfil strategic promise.…”

“…Perkins et al.’s study of five Health and Wellbeing Boards in England provides insight into their evolution, 6 adding to a relatively slim knowledge base on their role and function. Their findings are gloomily familiar for those acquainted with the literature on partnership in health and social care: in the main, Health and Wellbeing Boards appear to have been hindered by conflicting priorities, weak accountability arrangements and mistrust across organizations.…”

“…14 Perkins et al.’s findings suggest that for several reasons, Health and Wellbeing Boards are finding it difficult to take up this strategic mantle. 6 Developments in the integration agenda since then have made the need for such leadership more pressing. If challenges around responsibility, accountability and influence can be addressed, Health and Wellbeing Boards might yet become system leaders, rather than vestigial appendixes.…”