COOPER, S. and GRUBNIC, S., 2018. Discharging democratic accountability: The role of strategy and performance information in local authority Health and Wellbeing Boards. London: CIMA.
The Health and Social Care Act (2012) required
the creation of Health and Wellbeing Boards
(HWBs) to provide strategic leadership for
health outcomes for localities across England.
It was suggested that HWBs would enhance
democratic accountability and provide a forum
for key leaders to come together from across
the health and social care systems. This
research explores the extent to which HWBs
have, or have not, enhanced democratic
accountability through the use of strategic
planning and performance information. The
study is informed by a total of 39 interviews
with experts and members of two HWBs and
has resulted in the following key conclusions:
wUnderstanding of what is meant by
democratic accountability was variable
across the interviewees. Many interviewees
felt that their key obligation was directly to
their local public rather than being held
accountable through the political process.
The low level of public engagement with
HWBs also suggests that democratic
accountability is indirect and limited.
w Many members of the HWBs also recognised
that they felt they had multiple accountabilities.
There appeared to be a tension between an
interviewee’s perceived accountability for
local health outcomes as a member of the
HWB and their accountability for their own
organisation’s operations in long-established
accountability relationships. For instance
interviewees representing organisations
operating within the health service have long
been accountable to NHS England and the
Department of Health.
wHWBs have been required to develop a Joint
Health and Wellbeing Strategy, but doing so
effectively has proved challenging. Our
evidence suggests that important lessons
have been learnt about the potential scope
of HWBs as reflected in their strategy. Our
interviewees point to how there has been a
need to ‘refresh’ strategies and to reduce the
number and scope of priorities. In particular
emphasis has shifted to priorities where there
is the potential for joint working from the
different members of the HWBs.
w We find that there is some level of agreement
that, whilst the use of performance information
in our two HWBs has been limited, it may
become more important into the future. It is
suggested that performance information
accompanied by associated narratives could
be used as a way to further improve the work
plans and structure of HWB meetings.
wHWBs are strengthened by the developing
relationships between the key leaders from
across the health and social care systems.
Their potential to improve health outcomes,
however, is inhibited by a lack of financial and
human resources and a lack of integration
and system leadership. Policy initiatives such
as sustainability and transformation partnerships
(STPs) also contribute to uncertainty that can
hinder the progress of HWBs.