Fast forward to the future: will ICS strategies deliver?

Let’s step into a twilight zone of health policy. A very different, time-travelling world where, simultaneous with any new policy’s announcement is the publication, delivered fresh from the future, of its progress five years on.

No time for new dawns or false hopes – reality comes in an instant.

For example, let’s take integrated care systems, each of which now has a published strategy (produced by their integrated care partnership and required by law) setting out what they wish to achieve. What verdict on the success (or not) of these strategies is the fantasy five-years-on report likely to return?

It’s an answer we at Kaleidoscope would love to know. We think strategy is often problematic: too ill-defined, too focused on ‘what’ not ‘how’, too much written for robots not real people. But, done well, we also see its potential for deep cultural as well as strategic change.

Tried everything?

We’ll be debating how best to deliver the hopes and dreams of system strategies with Rob Webster and others at our digital event on 27 September. It’s free and open to all, do join us.

I’m afraid we won’t be using the event to announce the invention of time travel. Instead, we have a worthy substitute in what we can glean from the past.

Nudging health and care systems to develop strategies for their local area is no exception to the rule that English health policy has tried pretty much everything over time. The idea was at the centre of the development of health and wellbeing boards, along with their accompanying joint health and wellbeing strategies (JHWS).

Popular at their inception in 2012, with lots of good intent to this day, the government still proclaims their purpose as to “improve the health and wellbeing results of the local community and reduce inequalities for all ages.” But have they worked?

Hope over reality

Their fantasy progress report isn’t fantasy, having been published in 2018 by David Hunter and team. Sadly, it doesn’t make for pretty reading:

“[there was] little ownership of the strategies and a lack of accountability for elements of them; they were not seen as an integral part of the health and social care landscape. Strategies…did not bring any added value; organisations could retro-fit their plans and strategies to reflect elements of the JHWS. Strategies were somewhat ‘motherhood and apple pie’ statements, with too many priorities and themes and no clear measures of success.”

Ouch. So what does this mean if ICS strategies are to avoid a similar fate? Three points:

First, they need to understand how different a system strategy is to an organisational one. Hierarchical organisations should (in theory at least) be able to make change happen using the power held by the board and senior leaders. Systems can’t, there are no magic powers to compel organisations to follow their ICS strategy. As such, these strategies can easily become an exercise of hope over reality.

As put by one of those interviewed for Hunter’s evaluation: “Because of complexity… it’s trying to feel like you’re in control of something that you’re probably not.”

There are no magic powers to compel organisations to follow their ICS strategy.

Second, this lack of compulsion makes the process by which these strategies are produced even more important. We’re fully with Myron Rogers that “people own what they help to create”. If system partners don’t believe they’ve helped to create their system strategy, then what chance have they got of owning what it says?

This isn’t a one-shot game – how ICSs maintain and refresh their strategies over time provides yet more opportunities to ensure ownership is shared.

Need to show progress

Third, the content of ICS strategies is almost always highly commendable: reduce inequalities, support population health, transform care. But that means we shouldn’t be surprised that success will be hard to demonstrate. Such outcomes take significant amounts of time, far longer indeed than we tend to give our structures (and their associated strategies) to prove their worth.

ICSs are not powerless: they need to find proxies to show that progress is being made even if the end-goal remains (understandably) out of reach. This is both a marathon and a sprint.

Without time travel, we can’t predict how much of this will come to pass. Making effective system strategies is hard, but it’s by no means impossible. Success will come down to how much learning, how much curiosity, we can commit to the task.