System-wide care and health peer challenge

The Local Government Association (LGA) has been delivering a range of care and health improvement support under the sector-led improvement banner for a number of years working closely with stakeholders.


A system wide care and health peer challenge involves a small team of peers spending three days in a care, health and wellbeing system to identify strengths and areas for improvement.

Places that have had a peer challenge have said that it has helped with:

  • clarity of thinking
  • new ideas and approaches
  • challenge and encouragement/coaching
  • the whole system recognising the importance of community based prevention strategies and the involvement of primary care
  • moving on from project by project to ‘system wide’
  • ‘permission to act’
  • a focus for action
  • energy, learning and motivation injected at the delivery level as well as the leadership level
  • helped us to move on from doing more of the same.

Great strides have been made to tackle the wider social and economic determinants of poor health, making the most of the opportunity of having public health functions embedded in local government. Having a peer challenge can help your system/place understand the degree to which prevention activities, plans and priorities are making a real difference to promoting the independence of people with long-term chronic conditions, preventing ill health, improving health and wellbeing and tackling health inequalities.

Peer challenge involves a team of trained peers from across local government and health spending three days with key officers, elected members and other system leaders across local government, health and other partners examining opportunities and challenges that the local system is facing. Peers champion change and recognise excellence and the achievements of the places they approach. They understand the pressures and challenges of leading in complex environments and are there to offer challenge by acting as critical friends.

The peer team meet with representatives from the system at the earliest opportunity to understand the local circumstances and scope the peer challenge and encourage systems to tailor the focus to support local priorities. It’s critical to get the whole system involved from the very start to ‘own’ the peer challenge process and feedback.

The peer review team will study documents, policies and performance information prior to arriving on-site and will gather information throughout the days spent ‘on-site’ talking to a range of strategic leaders and people involved in delivery. System leaders/sponsors are kept regularly updated as to emerging findings before the peer team deliver their feedback on the final day including recommendations aimed to help drive improvement and agreement on local action.

The peer challenge planning begins at least eight to 12 weeks before the peer team arrives on site. Its findings are delivered immediately after the challenge is completed with the option of follow up support available.

It is important to recognise that peer challenge is not part of assurance, regulation or inspection. It is a voluntary undertaking aimed at bringing system partners together in a safe space to consider new and better ways of working together. It provides a rare and valuable ‘time out’ for system leaders to reflect and take stock and plan for the future and is an independent, objective and purposeful process focused on what can change within that system/place. The most appropriate composition of peers is discussed with you based on the scope and required outcomes, however a typical core team would comprise:

  1. Lead peer – usually a local authority chief executive
  2. Director of Public Health
  3. Clinical Commissioning Group (CCG) accountable officer or clinical chair
  4. Local authority elected member peer
  5. NHS peer with strategic lead for prevention
  6. Voluntary Community Sector (VCS)
  7. Peer Challenge Manager

The aim of the peer challenge is to support:

  • local place based leadership recognising each context - including footprints and ambitions
  • progress on locally identified system challenges and opportunities
  • relationships across organisations and the local system, including public health and health and wellbeing boards
  • sharing of innovative practice
  • bringing together a range of peers from across care and health to become members of carefully selected peer teams to meet the particular scope/needs of the system/place.

Contact kay.burkett@local.gov.uk on 07909 534126 if you are interested in having a peer challenge or in joining us on one of the peer teams.

Further information For more information on the new and developing support available for Health and Wellbeing Boards and local systems please contact your Regional Principal Adviser.