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The lessons from St Paul’sWay are being transferred
to 10 towns and cities in the north of England through
a newlycreated organisation called Well North with
support from Public Health England. [14] Like Par-
kinsonnsnet.orgthis approach is characterised by
experimentation and “learning by doing” combined
with committed long-term leadership. It also has a
focus on building relationships and not just on creat-
ing systems. Both are important but the significance
of relationships tends to be ignored in formal plan-
ning mechanisms.
These two examples can be rather crudely charac-
terised as succeeding
despite
the system. Lord An-
drew Mawson the founder of the St Paul’s Way Pro-
ject talks explicitly about how the way that the NHS
and local authorities operated often caused problems
for him and his colleagues. The normal ways of do-
ing things were too slow and bureaucratic and didn’t
allow for the sort of experimentation and creativ-
ity which brought the big results. He also noted that
there tended to be high turnover in leaders in these
public bodies and that he had to keep starting at the
beginning with their successors.
These examples, which are characteristic of many,
present a challenge for health planners: how can they
structure their work so that it can support this type
of activity – rather than frustrate it – and in doing so
develop a different way of thinking and behaving?
This question has been partly addressed in recent
years with the development of improvement science
which explicitly adopts an experimental and learn-
ing approach to making improvements and builds on
the work of theorists and practitioners of continuous
quality improvement. Juran, for example, sees quality
planning alongside quality improvement and quality
assurance as part of his trilogy of essential activities
for making improvements in quality. [15] His work
has been adapted for healthcare by the Institute of
Healthcare Improvement which is now having a great
influence globally, while other organisations are using
similar approaches and training health workers in dif-
ferent ways of thinking and working. [16,17]
Improvement science is now being used in many
countries to develop and improve services, learning
in part from the examples of people like Professor
Blom in Holland. However, it has not yet become
very developed in dealing with the multi-sectorial
activity that is so important in St Paul’sWay, with its
focus on a range of improvements to peoples’ lives,
of which health is just one. More work needs to be
done on this and in understanding the appropriate
styles of leadership as well as the ways of developing
the productive and creative relationships that are so
evidently important.
Conclusion
This brief paper provides an overview of health
planning and some of its weaknesses particularly in
relation to supporting visionary and entrepreneur-
ial leaders; however, planning also has important
strengths. It can look at the big picture setting out
the priorities such as the Sustainable Development
Goals which will guide and shape health and devel-
opment over the coming years.[18] It can address
strategic questions which the entrepreneurs may ig-
nore such as: are there enough health professionals
being trained, how much should be invested in re-
search and development; and where are the gaps in
healthcare provision.
Health planning is at its best when it deals with ev-
idence and priorities, seeks answers to these stra-
tegic questions and – something that is sometimes
missed – brings people together to build consensus.
Planning together can be an enormously important
prelude to working together. Planning is at its worst
when it deals inadequately with implementation or
attempts to prescribe in detail what they need to do
to deliver the plans. As health planners with their
planning and policy cycles know very well, planning
needs to be dynamic, responsive and inclusive.
Looking forward I would argue that health planning
needs to develop in two different ways. Firstly it
needs a better understanding of implementation, the
role of leadership and the development of relation-
ships. These understandings will help improve and
develop the whole doctrine of planning. They need
to be built on improved skills and an understanding
of the science of improvement.
Secondly, the whole agenda needs to be widened and
thought about in a different way. There needs to be
a shift in focus away from an over-concentration on
health services towards wider concepts of health and
well-being as described, for example, in the Gulben-
kian’s Commission’s “Future for Health in Portugal”.
[19] This built on the growing understanding of the
social and wider determinants of health in recent
years which are at last being incorporated into policy
and planning globally and beginning to find their way
into action on the ground.
In the UK I and a group of clinicians, scientists and
social entrepreneurs have recently published a mani-
festo that draws out 4 themes which we are argue
will be essential in the future:
•
The linkage between health and the economy –
where a healthy workforce improves productivity
and the bio-medical and life sciences strengthen the
economy
•
The importance of transitioning from a hospi-