Letters NHS reforms

Health and wellbeing boards are at risk in fury over NHS reforms

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e876 (Published 07 February 2012) Cite this as: BMJ 2012;344:e876
  1. David Colin-Thomé, professor and independent healthcare consultant1
  2. On behalf of Amit Bhargava (national co-lead, NHS Alliance Clinical Commissioning Federation), Donna Kinnair (member of council, College of Medicine), Brian Fisher (patient and public involvement lead, NHS Alliance), Michael Dixon (chair NHS Alliance; chair of council, College of Medicine), Aidan Halligan (vice president, College of Medicine), Chris Drinkwater (president and public health lead, NHS Alliance), David Peters (member of council, College of Medicine), George Lewith (vice chair, College of Medicine), Cyril Chanter (member of advisory council, College of Medicine), and Graeme Catto (president, College of Medicine)
  1. 1Morpeth, Northumberland NE65 9FD, UK
  1. david{at}dctconsultingltd.co.uk

The fury over the NHS reforms risks missing the opportunity offered by health and wellbeing boards (HWBs).1 Marmot identified two priorities to make our health services sustainable2:

  • • Creating an enabling society that maximises individual and community potential

  • • Ensuring social justice, health, and sustainability at the heart of all policies.

HWBs, through their responsibility for the joint strategic needs assessment and the local health strategy, provide the opportunity for local partners to collaborate in achieving these goals.

We believe that the current central command and control structures have failed to deal with these priorities. We must enhance local social capital and community solidarity through enabling the development of individuals and communities and creating a sustainable bottom-up Big Society. HWBs have enormous potential to link health, social care, and the wider agenda of the environment and employment. They will fail if they become a centrally controlled talking shop for the great and the good. They should facilitate, challenge, and listen to community and front line voices to develop action on agreed local priorities. Local authorities will need a board chair able to foster an environment of effective and innovative local partnership, in which people and organisations are prepared to give as well as receive. The board will need to identify and ensure that local assets are developed and used cost effectively, with minimum interference, bureaucracy, and duplication.

Our current political and policy approach cannot deliver community health and wellbeing. We need to co-create the vision of self empowerment through community action. We believe this is the only way for our society to manage our increasing health needs, obligations, and responsibilities. We must develop local systems that maximise individual and community potential and ensure that social justice, health, and sustainability are at the heart of all that we do.


Cite this as: BMJ 2012;344:e876


  • Competing interests: None declared.


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