Health and wellbeing boards as theatres of accountability: a dramaturgical analysis

Health and wellbeing Boards (HWBs) were established in England in 2013, bringing together partners from local government, health services and consumer champions, to ensure strategic planning based on local needs. Similar partnership-working arrangements have achieved limited success, particularly in terms of engaging members of the public in decision-making. Drawing on data collected in five heterogeneous case study sites, we examined the role of HWBs in enhancing local democracy and accountability. Interviews, focus groups and observations were used to explore relationships and interactions between HWB members and the public or their representatives. A dramaturgical perspective was then applied in analysing the data. HWBs were generally not perceived to have achieved their well-intentioned aims; instead, meetings represented carefully staged and scripted performances that tended to inhibit rather than enhance democratic accountability. Our dramaturgical analysis highlights key deficits in the governance of HWBs, which are explored in the paper.