As I noted in the last blog, the four-month consultation period on our local Joint Health and Wellbeing Strategy (JHWS) has just ended.  Last time, I reflected on how the feedback could and should be used.  This time, I want to ask whether I was able to get my points across (spoiler alert: no).

The context of this is that I think the way this JHWS has been produced is extremely flawed and I have a good idea of how it should be done and what the strategy should look like (IMHO!). (This is not just a problem for this area; I don’t think most JHWS’s are good strategies).  These are ideas I have been discussing in blogs over the last year or so and I won’t try and recap them now as I am unable to do so succinctly. Of course, I could be completely wrong but for the sake of this blog let’s assume I’m not and we’re talking about a situation where there is a “solution” available from those being consulted and it is not picked up.  When looking at the reasons for this, we can distinguish different parts of the process: the consultee and how effectively they can put the message across; the nature of the message; the context, including the pattern of arrangements for feeding views back, the nature of the meetings, the participants, time available and so on; and the people hearing the feedback.  So, let’s look at each of those in turn.

As the consultee giving the message, I think it’s fair to say that I am not very good at explaining or persuading. While it might be quite cathartic for me to explore the reasons for that, it’s probably not of much interest to other people. The main lesson here, then, would be the risk of underestimating what any given individual has to say and the need to listen fully and carefully.  However, that has to be set in the context of many contributions, however interesting, not necessarily being earth changing.  The problem, then is how to separate the signal from the noise.  It is also worth saying that, while I have a good idea of what’s needed, it is not complete and I’m still developing my thinking.  So perhaps there was also an issue with, not just my articulation but the content of ‘the message’.

And the nature of the message is the second aspect. I think, in this case, it is quite a hard argument to get across, since strategy is as much an art as a science. There is so much variety between approaches to strategy and the nature of successful strategies, that it can be hard to pin down or specify in axiomatic statements.  What would perhaps work best is to provide some examples of effective strategies and let people work out the principles themselves and apply them to this situation.  I did try to do that to some extent but perhaps didn’t have enough examples or time to present them.  Which leads me onto the third aspect.

I hosted about half a dozen focus groups on the strategy but for around half of them I was acting on behalf of the JHWS engagement group on which I sat and I therefore felt a collective responsibility to present it in line with what had been agreed. There were other groups where I wasn’t playing that role and I gave PowerPoint presentations trying to set out my views. However, even there I wanted to give other people time to say what they wanted to and to allow for general discussion. So perhaps I never actually had enough time to explore and explain what I wanted in enough depth.

The fourth aspect is the nature of the people hearing the message and I would include here not just the people responsible for producing the strategy but also other participants in the engagement events. If I had managed to persuade the other participants, then the overall message would have been amplified and maybe got through. To be fair, I think the other people did have some sense of my input being significant.  However, it was not enough to produce a consistent, coherent, picture of what I was saying, that stuck with them.  Even if they didn’t have a clear view from what I’d said about what a strategy should look like and how it should be produced, they might have had a sense that I had “an answer” and made reference to that, but they didn’t.

While the main reason for that might be my inadequacy in explaining, another reason could be the way people’s mental models are entrenched. We have our paradigms and ways of looking at the world and tend to seek information which confirms them and filter what we hear accordingly. It is therefore quite hard to hear other points of view properly and even harder to take on board the full implications if that means changing our world view.

There was another reason why many of the points weren’t being taken on board namely that a process for producing the strategy had already been agreed with the senior decision-makers and it would be hard to change that. So, they were working on the basis of identifying 3-5 priorities and producing a strategy based on that within the space of a couple of months. That is not likely to work if you are trying to produce a decent strategy but it would be a tough ask to go back to the decision-makers and get them to change it (the strategy is currently being written, so I could yet be proved wrong on this).

Associated with that, and perhaps an amalgam of the previous aspects, was my relationship with the strategy team. I had wanted to play a useful role and shied away from conflict, so perhaps didn’t express my reservations as frequently or strongly as I could have. So I ended up making general points (such as why not bring in social determinants here, or use proportionate universalism there, or consider cycles of decline) rather than consistently questioning the underlying basis of the whole thing.

So, are there any useful conclusions from all this?  Work hard on making the message appealing and understandable.  Use the opportunities for getting it across wisely and make new opportunities if you can.  Recognise that it’s hard to change people’s worldviews and you may need to go through a series of stages: first get the underlying ideas accepted and acknowledged and then focus on the implications.  Recognise the difficulties there may be in following through on those implications.  And if you’re the people doing the consultation, listen extra hard.