Governance

Effective governance of health and care has to be locally appropriate including, by local agreement by all partners and through health and wellbeing boards, take account of other governance such as combined authorities, devolved arrangements or NHS planning requirements.


Councils

Under the Local Government 2000 Act, councils can organise their executive as a mayoral, cabinet or committee structure. Councils have a wide range of statutory duties in relation to health and care, including scrutiny of local services.

Data.gov.uk: statutory duties placed on local government

Department of Health: local authority health scrutiny

Health and Wellbeing Boards

Health and wellbeing boards (HWBs) are statutory bodies created under the Health and Care Act 2012. They are committees of the council, and have a number of statutory duties including to improve the health and wellbeing of their population, and to promote integration.

Department of Health: The general duties and powers relating to health and wellbeing boards

Combined authorities

Under the Local Democracy, Economic Development and Construction Act 2009, as amended by the Cities and Local Government Devolution Act 2016, combined authorities are a group of two or more councils to collaborate and take collective decisions across council boundaries.

Clinical commissioning groups

Clinical Commissioning Groups (CCGs) were created following the Health and Social Care Act in 2012, and replaced Primary Care Trusts in 2013. CCGs are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area. They have many statutory responsibilities including to improve their population's health and to promote integration.

NHS Commissioning Board: the range of core CCG functions as set out in legislation

NHS trusts

Hospitals and NHS services are organised and governed as either trusts, created under the National Health Service and Community Care Act 1990, or foundation trusts, created under the Health and Social Care (Community Health and Standards) Act 2003; the latter has greater operational freedoms. Both are governed by boards of directors, and are statutorily responsible for providing safe and effective services. They do not have a duty to improve population health.

Monitor: Your duties: a brief guide for NHS

NHS Choices: authorities and trusts

Sustainability and Transformation Plans (STPs)

An NHS-led planning framework for local health and care systems for accelerating the implementation of the NHS's Five Year Forward View. There are 44 footprints covering England. STP governance will often include a programme board, stakeholder group and other reference groups.

Frequently asked questions

What partnership models respect organisational sovereignty yet enable collective decision making?

  • The health and wellbeing board provides a forum that brings together clinical, political and managerial leaders, although few yet have delegated powers or responsibilities
  • Many integration programmes create partnership boards as a strategic forum, with some moving to more formally merged arrangements over time
  • Some areas concentrate on integrating or aligning commissioning functions, while others are integrated providers such as federations or networks (see Integrated Commissioning and Provision section.
  • Devolution arrangements also provide a model to bring together health and care, with appropriate democratic involvement and decision-making devolved to the lowest level.

How can partners work across multiple footprints?

  • Key to navigating across multiple footprints is a consistent focus on ‘place', that is the needs and wishes of the local population
  • STPs effectively create another tier of governance across the NHS and local government. As they are without statutory basis, they sit outside individual partner's statutory obligations. Many footprints are creating or adapting partnership arrangements to provide a basis for effective decision-making, although it is as yet proving challenging to ensure adequate accountability to communities as well as other constituents such as provider boards or lay members. Some partners are aligning their governance to STP footprints, such as creating a single HWB, CCG federation or provider network for the STP footprint .
  • Overlapping governance areas can create multiple arrangements for different purposes. The key is ensuring decision-making is with the right people and in the right place: the more local and lower down the chain the better.
  • Another key issue in developing appropriate governance arrangements is supporting local leaders to develop trusting and collaborative relationships. See System Leadership section.

Case studies and examples

LGA support and resources

Selected tools and resources from our partners