As I’ve written before (here and here) I think there is tremendous potential for Health and Wellbeing Boards (HWBs) to make a huge difference through their Joint Health and Wellbeing Strategies (JHWSs). But it’s deceptively complex.
So I drew a diagram (attached) that sets out the key elements a strategy could focus on – those things that could make most long term difference to efficiency, quality and equality. Those elements (which can also be found in the Five Year Forward View and other places) are:
• services (making health and care services better, integrating, restructuring, Better Care Fund, new models of care etc.)
• prevention (individual risk factors and the wider determinants of health)
• innovation and technology (new ways of doing things, exploiting ICT and other technology)
• co-production (self-care, peer support, the role of carers, the public as equal partners in the wider health and wellbeing system)
It’s not the only way of looking at things, but I find it a useful one. It’s imperfect and also only a first step (not that many places are still at that first step, but we all need to keep going round the Escherian staircase).
Some of the other things that need to be done are:
- Wider conceptual mapping – building on this framework, to have several other diagrams from different perspectives providing an overall sense of the territory you’re working in
- Desk research to identify areas where it is possible to make the biggest improvement over various timescales. For instance, what is the maximum possible impact on premature mortality, quality of life and health inequalities of reducing obesity, increasing physical activity, service integration etc.? We see figures on those things every day, but usually in relation to individual causes or conditions; it is rarely brought together in a way that would enable us to make comparisons and choices.
- Engagement with stakeholders and the public – all the professionals, agencies and members of the public who can make change happen. Or stop it happening.
- Analysis, to see what’s possible, how the system works as a whole, what the points of leverage are and where there is potential to generate non-linear effects through positive feedback loops
- Build the components together into a coherent, long term strategy, recognising that there is too much complexity for a blueprint, and there is a need for regular revision and adaptation
- Implementation and delivery. The strategy should be clear and compelling enough to drive commissioning, not just of health and social care, but other services too. It also (as the framework suggests) needs to drive change beyond simple service delivery, including changes in how the public addresses its health and wellbeing.
- Reviewing, learning and revision of the approach and objectives. This includes learning from experience, learning from each other locally and learning from other areas.
Again, it’s not as if these things aren’t being done. But are they being done well enough anywhere to make a substantial difference?
Isn’t this something where there’s great scope to learn from each other and develop approaches together? I’ve started a forum thread here, so why not contribute any experiences or ideas there?
[A slightly longer version of this blog appears on my website here]