[A more detailed version of this blog appears here.]
How can Health and Wellbeing Boards make the most difference? I think it’s through Joint Health and Wellbeing Strategies (JHWS’s). No, wait, come back. Hear me out. OK, so they’re not making that much difference at the moment (I’d love to hear of any examples where they are) but they could.
Of course it’s not the piece of paper that’s important, but how it can act as a focus for well thought through, evidence based, collective action. But the piece of paper is where you write down what that ought to be, and if you get that wrong you’re unlikely to get results.
So what should the strategy include? I think there should be at least the following six elements:
(1) Aims – where you’re trying to get to over the next 5-10 years. Most strategies I’ve seen do this pretty well.
(2) Current context and future environment. That’s things like trends in medical conditions, funding, social determinants of health and technology. What’s the terrain your journey will take you over, and have you any influence to change it?
(3) Analysis. How, given that context and future environment, could you meet the goals. This is the hard bit. It needs to be high enough level to see the big picture but detailed enough to be realistic. It needs to note what is happening anyway (such as improvement and integration projects) but focus on what can be done differently and how the different sectors can work better together.
It might say something about changing the balance of resource allocation, such as spending more on prevention, and how that is to be achieved. The interesting bit, though, is how you can achieve more by working together. It could be finding the points of leverage (such as working with ‘troubled families’ to have a big impact on outcomes). It could be how a concerted series of actions could achieve more than the sum of their parts (e.g. a combination of campaigns, changing the environment, incentives to increase exercise and activity). Or it could be finding ways in which one good thing can lead to another, such as building a critical mass where enough people see others improving their health through diet and more activity that it becomes more normal for them to do the same.
(4) Options. Rather than launching straight into the solution, there should be consideration of different options, taking into account variations in cost-effectiveness, risk and values.
(5) The path towards a solution. This can’t be a precise blueprint, because the world is too complex and messy for that. But equally it needs to be more than generalities and banalities. It should at least give an idea of the level of resources to be applied to the high level areas and a sketch of the broad programme areas within those.
(6) Implementation. However, the kind of change required is complex and difficult to predict. So while there is a role for project and programme management, there also needs to be a process of continuous sharing, learning and revision. It needs to be an iterative process where the strategy drives change, but experience of that change leads to revisions of the strategy. The strategy, in other words, is a tool. The real work is in the discussion of what needs and can be done and in the collaboration between sectors. The strategy is where you record what’s been agreed.
All of that isn’t easy. It takes time, effort and resources to achieve. And who has got those to spare at the moment? But how else can we have any chance of dealing with the massive cuts yet to come in council spending or the £30bn NHS black hole, never mind helping people be healthier and happier?