Co-production rather than consultation embeds a strategy

Rich Taunt’s recent blog on how strategies often get developed, hit a nerve. I feel for people tasked with writing strategy in the NHS, and indeed many large organisations. Although NHS Boards are responsible for huge enterprises, with massive budgets and a substantial workforce, they are ultimately subsidiaries of a truly enormous organisation which is never out of the political and public eye.

Before the Director of Strategy and colleagues put pen to flip-chart, they have already been told to include a list of priorities. Things most independent organisations would reject as being too unwieldy and disconnected even to make the first draft. And then they have to consider the issues which their system partners would like them to sign-up to.

Although I am an enthusiast for integrated working, it does add to the complexity of an already challenging task. Asking yet more stakeholders for their views must feel like a refined form of punishment to the poor planners.

The process is a means, not an end in itself

However, the fundamental problem in many large organisations is that producing a strategy is seen as an end in itself, rather than a means to an end. By definition, strategies are developed less frequently than other types of plan, which should allow time for reflection on deeper questions such as “are we still crystal clear about our
purpose?” or “what radical changes are required to the way we operate?”

Too often the process of developing the strategy becomes more important than the opportunity to hear the perspectives of those we serve. Or the people who are on the front-line, and to think deeply about our future direction.

Empower people to think, share and listen 

After my NHS career I was fortunate to take on the role of Chair of a large local mental health charity; Solent Mind. We’ve just published our new strategy, and the way that my CEO and her team have developed it was the antithesis of writing a document in a darkened room.

…was our operating model still right for our changed circumstances, do our core values still make sense?

We started with how do we deliver our core “mission” in a much more challenging context than hitherto? The deterioration in the funding environment forced us to address fundamentals; was our operating model still right for our changed circumstances, do our core values still make sense?

Once it was clear to the team that they were empowered to think radically, they embarked on an 18 month process of engaging the widest possible range of interested parties; service users, staff, commissioners and more. People with common interests were brought together. We held large events for our external partners to share views, we used our annual staff and volunteer conferences amd we asked every team to consider 3 questions within their own team meeting and share their answers.

This created safe and confidential spaces to challenge the status quo and allowed everyone of our 400 strong staff team to participate. We tried hard to make this a process of co-production rather than consultation; inevitably as ideas began to coalesce this became harder. But we reappraised earlier thinking if it was seriously challenged by later engagement events. We also reviewed how we work as well as what we do, leading to the development of the “Solent Mind Way” as well as our new strategy.

So what next? 

Has anything changed as a result of this approach? Inevitably, some aspects of the strategy are evolutions of our recognised strengths; using people with lived experience to support our service users (“peer support”) is core to all local Minds not just ours.

However, we will also be making a fundamental shift from a strategy which has previously served us well. This will involve reaching out to our very diverse communities and shaping our service around their specific needs, rather than just responding in the main to tenders that are issued by our local commissioners.

This may make things harder for us; we have more than doubled in size over the last five years as a result of taking on new statutory contracts, and during the pandemic our reliance on statutory contracts enabled us to survive when other charities did not.

we will need to find new ways to develop services if we are to meet our ambition of being there for everyone

We have good relationships with statutory partners so they are already open to reshaping service contracts if we can demonstrate that they don’t meet local needs. But, we know that we will need to find new ways to develop services if we are to meet our ambition of being there for everyone, not just the people that have used our services historically.

Beyond the tangible changes in our strategic priorities, using a co-production approach has brought other important benefits. Like many organisations in the NHS, we are going through a period of rapid and unsettling change, which is difficult for both staff and service users.

Taking time to talk and listen to what really matters, to incorporate those views nto the organisation’s priorities, is always important, but particularly at a time of change. There will be understandable scepticism about whether this was a just a passing enthusiasm or if this becomes “the way we do things round here.” Assuming we do the latter then it will become a part of our wider culture, and as the saying goes “culture eats strategy for breakfast, every time!”

It was great to read NHS organisations are using a co-production approach to developing their strategy, and we are always keen to adapt or adopt other people’s work to improve further. Equally , if people would be interested to hear how we have gone about redeveloping our strategy then please feel free to get in contact.