The strategy is strong on principles – particularly with regard to the aspirations that the ICB has with regard to developing strong and trusted relationships with the public in South Yorkshire.
I was surprised but pleased to see a photograph of Dean in the strategy. Dean is the butcher I go to every Saturday down at the Moor Market. So when I popped down for some home cured bacon (which I strong recommend) and a couple of Barnsley Chops I showed Dean his photograph. Both Dean and his wife were surprised to see him in the strategy – they knew nothing about it and had not been approached for their permission. To be honest as I said to him, I was surprised too – I know that he has an excellent reputation for a finely cut piece of sirloin – but I was not aware that he had strong views on collaboration and co-design in the NHS.
There is a serious point here – if you say that your NHS strategy puts the relationship with the public at the heart of your work then you need to live by that. The photographs in this strategy are of real South Yorkshire people – yet it feels as though they have been used as stock images to bring a bit of local colour to give the report authenticity. That is not right.
Moving on….to inequalities
The strategy identifies a range of areas that the ICB will be focussing on here and references the NHSE Core20PLUS5 framework. However it is not possible to understand how the actions that are set out here relate to these. It is also hard to understand the relative ambition with regard to scale and impact here. These feel like a disparate collection of projects that have been hoovered up into this space.
What is lacking is an analysis that tells us what the problem is, its scale and the actions that the NHS will be taking to address it.
I think part of the reason for this deficit lies in the very simplistic “Theory of Change’ that the ICB is using – this is listed on page 38 of the report – and I show it below.
Most theories of change start by analysing the problem that needs solving – and then considering what the goal should be with regard to addressing this problem. Many – particularly when addressing complex whole systems problems also recognise that a key early step is to consider who needs to be involved, influenced or engaged in order to take effective action.
The (uncredited) theory of change in this strategy does none of these things. Sadly, I do think the NHS has history here – tending to default to project delivery planning tools when trying to achieve system change.
There are more appropriate theories of change – check out the United Nations one or closer to home – NESTA. Both have an upfront analysis of what the problem is – which for a new organisation with ambitions to be accountable and transparent would seem like an essential thing to do.
Finally! … a real problem
For me the most important paragraph in the whole document is tucked away at the end of the section on the Voluntary and Community Sector – page 9 – which states:
When I read this paragraph my thought were:
- Is this really the case?
- Why do communities distrust the NHS?
- Which communities distrust the NHS?
- What does this mean for the health of populations?
- What does this mean for the way that NHS are provided?
- What actions need to be taken to change this perception?
- And most importantly has the lack of trust maybe got something to do with inequalities?
So, coming full circle – yes, it is really important to be upfront about principles – but communities will not trust us if they feel that we are just playing lip service to how we represent and involve them and present unconvincing strategies to address the real problems they and the health systems faces.
WHAT DO YOU THINK?