Attain’s Scott Matthewman, Ruth Smith, and Gareth Hartley talk about their recent experiences of developing long-term system wide health and care strategies.
Long term strategic planning – key challenges
Local health and care systems across the country are grappling with rising demand, constrained resources and greater expectations from local people and communities around the quality of health and care services they receive.
As we enter the winter period, local health and care systems are starting to think about the next round of medium to long term strategic planning; as a natural evolution of Sustainability and Transformation Plans (STPs) and Integrated Care Systems (ICS).
The key challenge to the design and delivery of safe and sustainable health and care services for the next five to ten years will be management of today’s pressures in the context of a longer-term vision and articulation of what the future should look like, with the commitment of all stakeholders to its realisation.
It’s also clear that health and care systems across the country are facing similar challenges in their ambitions to work collaboratively, namely:
- managing the competing priorities and internal drivers of different organisations;
- shifting from transactional relationships to truly transformational ones;
- delivering long-term change while still meeting short-term pressures, organisational needs, and regulatory requirements; and
- innovating to tackle long-standing problems when resources are constrained.
Here we describe our recent experiences of developing long term strategies, and how systems can navigate the complexity of the current health and care landscape to ensure services are safe and sustainable in the future. This approach is informed by Attain’s work with over a third of STPs and multiple place-based systems where we have facilitated collaborative working and implemented the delivery of more efficient and sustainable care services for millions of people.
Developing a coherent strategy – the essential building blocks
In order to meet these challenges and develop a coherent strategy which is truly owned by the system and will be embedded into local practice, a number of key building blocks should be in place across the health and care system:
- Understand that strategy development is not a simple linear process. In practice, systems will stall on, revisit, and adapt different stages of the strategy. The strategy will evolve as you understand more about the challenges and progress being made at an organisational, place and system footprint.
- Strategy development at a system level is complex and many factors will be uncertain or even unknown. An agreed vision, clear priorities, principles and consistent leadership will help keep you on track, in what at times, can be unchartered waters. A compelling narrative is essential as well as joint accountability.
- Ensure the strategy is truly ‘system wide’; incorporating both health and care, and also aligning with local strategies that may already be in place to ensure system integration and synergy towards a common vision and series of priorities. This will help to reduce duplication and confusion which can something cause system paralysis.
- Develop a common language which is agreed and understood across health and care and resonates with local people and communities. This needs to bridge what at times can be a language gap between health services and local government. This will be essential to establish a common ground and consensus.
- Spend time to develop and embed good relationships between stakeholders and continue to revisit this periodically so that executives, clinicians, politicians, social workers and healthcare practitioners know the challenges that they face at an organisational and system level and develop a culture of collective accountability.
- Adopt a population health management approach to strategy development which focuses on the needs of the population and the root causes of health and care rather than symptoms. Understand what outcomes you are trying to achieve for different population cohorts and how resources can be used most effectively to achieve these. Build on what strengths and assets exist and what people and communities can do for themselves via prevention and early intervention, and support people to regain their health, wellbeing and independence after a period of ill-health wherever possible.
- Agree the scope and breadth of what the strategy will include. Health and care systems will need to balance the desire to include as many care areas and pathways as possible, against the need to prioritise and select a few priorities which will affect real transformational change across the system – not everything can be a priority at the same time.
- Start the strategy development process as early as possible. Developing the strategy from a truly co-productive, bottom up approach will require significant time but tends to lead to better engagement and ownership which translates into delivery. However, there are circumstances which will require the strategic planning timeline to be shorted significantly to respond to external drivers or requirements. Both approaches are valid but be clear of the path being taken and the rationale for it, and actively communicate to all stakeholders.
- Be mindful of the need for consultation. Ensure robust arrangements are in place to understand the current strengths and challenges of the system and the future challenges the strategy is looking to address. Ensure the voice of patients, service users, and their families are at the heart of the strategic planning process and central to the priorities you are looking to address as a health and care system.
- Strong clinical and professional leadership is key which balances the principles of the clinical model of the NHS and the personalisation model of social care to drive strategy development and secure buy-in across the health and care system.
- Identify change champions and advocates for the vision and blueprint of the future and support them to play a full and active role in the strategic planning process from design through to delivery. Ultimately, for any strategy to be effective, clinicians and professionals across the system must understand and act upon their role in making the strategy a reality.
The NHS, local government and the broader public sector is facing unprecedented challenges to deliver services which meet the needs of people and communities, within finite resources across the Country. At Attain, we have the skills, experience, expertise and track record of supporting the NHS and its partners to design and deliver health and care services which are safe and sustainable and can support you through all stages of the strategic planning process.