Domain 1 focuses on the board's culture, identity and self-understanding. It asks whether members know why the board exists and whether they hold that purpose collectively. Questions about meeting structure, agenda design and officer support belong to domain 7 (about the conviction and shared story that governance structures either serve or fail to serve).
Does the board have a clear, shared understanding of what it exists to do, and does it lead as a strategic partnership rather than a committee? The board’s sense of its own purpose does not extend much beyond its formal statutory remit."
Score 1: Not evident (floor)
The board's sense of its own purpose does not extend much beyond its formal statutory remit.
If asked what the board does that could not happen without it, members give different or uncertain answers. The board has not had a substantive conversation about what it means to operate as a strategic partnership rather than a council committee, and in practice it functions closer to the latter: proceedings are formal, challenge between members is rare, and the agenda is shaped more by what organisations need to report than by what the board needs to influence or decide.
The board does not understand itself as a decision-shaping body: one whose value lies in ensuring that decisions taken across partner organisations are better informed, better aligned and more likely to improve population health and wellbeing. Leadership rests with the chair. Other members attend primarily as representatives of their organisations, bringing positions rather than working collectively toward shared goals. Between meetings there is little evidence of board-level activity, and the board has no agreed narrative that members use consistently in their wider system roles.
Score 3 note: Growing
The board has articulated a shared understanding of what makes it distinctive, and most members can give a broadly consistent account of its purpose.
Some members are beginning to use their organisational influence to shape decisions in ways that advance the board's population health and wellbeing priorities.
Score 5: Embedded
Every board member can give a clear and consistent account of what the board exists to do and why their own contribution matters.
The board understands itself as a decision-shaping body: its primary function is to create the conditions in which partner organisations make better decisions for population health and wellbeing and wellbeing across the whole of the area, not to manage services or govern delivery directly. This understanding shapes what the board puts on its agenda, how it invests its time, and how members act between meetings.
The board has a simple, compelling narrative about its role as a strategic partnership, grounded in the understanding that the conditions determining health, including employment, housing, education, environment and social connection, lie mostly outside the health system, and that the board's distinctive contribution is to bring together the public, voluntary and community power needed to act on those conditions. Members use this narrative actively inside their own organisations to align resources and influence decisions. There is a strong and shared sense of what only this board can do, and it shapes how the board decides what is worth its attention.
The board understands its value as the system's democratic anchor for population health and wellbeing: a statutory, locally accountable body whose long-term continuity and grounding in the needs of its whole population provides coherence across a complex and changing governance landscape. This is particularly important in periods of structural change, when NHS bodies are reorganising and the board's clarity of purpose is itself a public asset.
Leadership is genuinely distributed. The board does not depend on any single chair to function: governance arrangements, whether through co-chairing or other structures, embed shared leadership in a way that reflects the board's identity as a cross-sector partnership rather than a council body. Members lead on specific priorities and hold themselves and their organisations accountable for contributing to them. The board's work does not stop between formal meetings: members act as system leaders and influencers in their own sectors, convening partners and making the case for the board's priorities.
Related resources for the Rationale, HWB Maturity Matrix, HiAP and the PHIP page