Domain 4 focuses on the quality of relationships between the board and the statutory, NHS and public sector organisations whose collective effort is needed to deliver the board's population health and wellbeing priorities. It is distinct from domain 5, which focuses specifically on engagement with communities and the Voluntary, Community, Faith and Social Enterprise (VCFSE) sector. The deliberate separation is designed to ensure that strong ICB relationships cannot mask absent or superficial community engagement.
Do the relationships among board members and with key statutory and organisational partners enable collective action across organisational boundaries?"
Score 1: Not evident
Board relationships are primarily formal and meeting-based.
The closest relationship is between the council and the ICB; engagement with other statutory partners is thinner, and the board has not systematically considered which organisations and voices need to be involved to deliver its population health and wellbeing priorities. Members attend as representatives of their own organisations, presenting positions rather than working collectively toward shared goals.
Accountability is understood as individual organisations reporting on their own work, not as collective ownership of shared population outcomes.
Tensions between partners are managed through politeness rather than addressed directly. The board has no agreed way of handling disagreement, and constructive challenge between members is rare. There is limited investment in building trust outside formal meetings, and little evidence that board relationships translate into changed behaviour within partner organisations.
Score 3 note: Growing
Board members are investing time in understanding each other's constraints and pressures, and there is an emerging shared language around the board's population health and wellbeing priorities.
Some honest exchange is beginning to occur, including acknowledgement of where progress has stalled.
Score 5: Embedded
Relationships between board members and key partners are sufficiently strong and trusting to enable genuine collective accountability for population health and wellbeing outcomes.
Members challenge each other constructively when organisations are not delivering, and accept challenges in return. The board has agreed a clear, specific account of what each member organisation will do differently as a result of the board's priorities, and reviews this regularly: accountability is for shared outcomes, not for individual organisational activity.
The board is clear about which statutory and public sector stakeholders need to be involved to achieve its goals and has systematic arrangements to involve them, beyond the minimum statutory membership. It is outward-facing: members use their collective influence to shape decisions within their own organisations and across the wider system. There is an open learning culture; what is not working is shared as readily as what is. The board's strong statutory partnerships actively create space for, rather than crowd out, the community and VCFSE engagement that is addressed in domain 5.
Related resources for the Rationale, HWB Maturity Matrix, HiAP and the PHIP page