Professor Lisa McNally is director of public health for Worcestershire County Council 

The Government has emphasised the role of health and wellbeing boards in the strategic development of neighbourhood health. Reactions within the NHS to this will be mixed.  For some, it's an opportunity to broaden the scope of neighbourhood health and enhance the ‘left shift' elements of their plans. Others will naturally fear unwarranted interference in the complex tasks of pathway redesign and healthcare resource allocation. Both reactions are valid. So how can NHS leaders maximise the former while mitigating the latter?

We won't change the fact that neighbourhood health means different things to different people. This was highlighted at a recent Healthcare Management roundtable by Richard Kirby, chief executive at Birmingham Community Healthcare NHS Foundation Trust, who said: ‘I think there's still a bit of a battle for the soul of neighbourhood health going on — between, is this just about redesigning NHS outpatients and moving some activity to a different kind of building with a different sort of label? Or is this genuinely about a different kind of partnership with communities?

‘I really hope we don't miss the opportunity to build that bigger, more preventative, more community-based approach.'

Richard is right. There is an opportunity for both concepts of neighbourhood health to thrive and contribute to the whole vision. Indeed, it can be argued that one can't genuinely have the desired impact without the other playing its part.

Health and wellbeing boards have their strengths and weaknesses. The best boards know what they're good at and stick to it. They convene system wide partners, including elected members and the voluntary sector, and pursue the contribution those partners can make to community led health improvement. Other boards too often slip into the role of a health overview and scrutiny committee, challenging NHS leaders on complex healthcare management decisions. 

The first type of board is somewhere NHS leaders can bring their problems to. The second type is somewhere they get their problems from. 

We can encourage the former role by engaging health and wellbeing boards on the questions they are well placed to answer. How can we effectively engage the public in the aims of neighbourhood health? How can the voluntary sector add value to integrated neighbourhood teams? How can we positively influence social determinants of health such as education, housing and employment?  

In developing strategic plans for neighbourhood health, it's important to engage health and wellbeing boards early. The longer this is avoided, the more tense curiosity will build as to what the NHS is doing. The earlier it happens, the easier it is to set the agenda and channel board contributions into the right space.

This engagement shouldn't just be about reporting on neighbourhood health progress and surviving the questions. Rather, let's make it clear that health and wellbeing boards have their own questions to answer and their own contribution to make. We can challenge boards to form plans for public engagement on neighbourhood health. We can ask them to host discussions on the role of voluntary groups and community organisations. We can ask them what they are going to do about primary prevention, social isolation or digital inclusion.

This isn't about distracting health and wellbeing boards while the NHS gets on with the ‘proper work' of healthcare transformation. Rather, solutions to these issues are crucial to the success of neighbourhood health and the partners around the health and wellbeing board table are the right people to make them happen.

Make role clarity someone's job. There are people in the system who effectively straddle the worlds of local government and the NHS every working day. These include directors of public health and directors of adults and children's social care. So why not ask for their help in encouraging health and wellbeing boards to play to their strengths when it comes to neighbourhood health?

These colleagues will have a close relationship with health and wellbeing board chairs, who are usually the cabinet members they report to. As such, they are well placed to promote board agendas that support the role clarity described above.

They are also usually well connected to other agencies that can put the ‘neighbourhood' into ‘neighbourhood health'.  For example, can they fund the local voluntary sector to deliver projects aligned with neighbourhood health aims? Can they engage education and housing teams in primary prevention? Can they be the ambassadors that NHS Leaders need in those varied sectors?

Health and wellbeing boards will inevitably exert their right to be involved in neighbourhood health. And why shouldn't they? But we can encourage that involvement to be about proactive contribution rather than retrospective scrutiny. This will require early engagement, setting boards challenges and harnessing relationships within the system. If we do that, role clarity will be achieved and maybe we'll find ourselves all paddling in the same direction.