I am not convinced our local health and wellbeing strategy is terribly strategic. However there are some quite interesting, and even innovative things going on locally in health, adult social care, children’s mental health and other areas. There are person-centred approaches, a better use of prevention and community based work.
So, what to do? Should we just ignore the strategy and get on with the detailed delivery? Or stop the delivery until there’s a strategic framework within which it can operate? Or quickly revise the strategy, so it reflects what’s actually happening?
None of these sound very attractive options. I still think a strategy is worthwhile to lead us in directions we might not otherwise go, so we shouldn’t be throwing that away. It makes no sense at all to stop the existing delivery, just because the strategy is inadequate. Which leaves the option of quickly revising the strategy to bring it up to date. But wouldn't that just be a bit of bureaucratic nonsense: getting the paperwork right, when what it’s supposed to influence is already happening?
Several of those innovative and interesting projects were on the recent Health and Wellbeing Board agenda (referred to in the minutes or as substantive agenda items), so I (as the Healthwatch representative on the Board) made the point that even though the strategy hadn’t driven these changes, it should at least consider and perhaps reflect them. (Spoiler alert: they didn’t throw up their hands and so ‘OMG Adrian, you’re so right, I don’t know why we didn’t think of that, we’ll change things straight away’. But they didn’t dismiss the idea either.)
Actually, I think that not only is it reasonable to revise the strategy under such circumstances, it is quite normal and necessary. You can’t expect a strategy to think of everything (and if you’re trying to make it, you’re doing something wrong). So it makes sense to learn from practice on the ground to revise the big picture when appropriate.
There are at least three reasons for revising the strategy, even if some of what it might prescribe is already going on:
- to ensure any lessons from the innovative areas can be spread to other services;
- to co-ordinate activities between service areas, (e.g. if two different services are trying to involve the same voluntary organisations in their plans, to ensure the latter are not overloaded and there aren’t conflicting demands on them).
- to ensure there is a sufficiently coherent approach across the whole health and wellbeing system, so the implications of the innovations are taken into account by others (e.g. what would a person centred, community based approach mean for GPs, pharmacists, community health and social care?).
So strategy development can – indeed needs to – be an iterative process with the strategy driving operational change but also learning from it. However to do that, you need to accept the need to revise the strategy mid-way through its implementation period and have a process for revising it. As I suggested above, my proposal for revising the strategy wasn’t entirely dismissed and it was suggested we have a workshop session on it at an appropriate place in the planning cycle. So there’s still hope. Watch this space!
(This blog is also posted at: http://www.equwell.org.uk/strategies-going-round-in-circles-but-thats-ok/)