Why is 'strategy' such a dirty word?

I've been working in and around the strategy arena for over five years now and I've noticed an increasingly common trend. Whenever the word 'strategy' is mentioned people tend to switch off. You can tell by the sudden glazing or rolling of the eyes - or a wrinkling of the nose as if some unpleasant smell has wafted over.

Why? Well - unfortunately the term itself has been so over-used as to become virtually meaningless. From job titles that include 'strategic' (a friend tells me he saw an advert from the London Borough of Ealing for a 'Strategic Involvement Officer', whatever that means) to documents that are given the tag 'strategy' or 'strategic' to somehow legitimise them. Like the infamous Iraq dossier, I'm afraid the term seems to be used to 'sex things up' . . .

So - do we need a new term or a new language for that which is 'strategic'? Perhaps - but who's to say that language won't in its turn be misused? I think it would be better to come back to what I believe strategy is all about - answering the 'why' for organisations, setting direction and purpose - not necessarily the detailed 'how'. So strategy is about outcomes, results or goals - the purposive changes that organisations set out to achieve.

So the next time someone glazes over or wrinkles their nose at the 'S' word, try talking instead about results - why are they taking their organisation in a particular direction? What outcomes are they hoping to achieve? And why those outcomes and not something else. In other words - where's the evidence to support their - and I use the term advisedly - Strategy?

UK Spending Cuts - a Damp Squib?

I have to say that I was heartily disappointed by the spending cuts announced last week. Not so much for what was said - though the asymmetric impact on the most vulnerable in our society is in itself disappointing. No; it was actually more for what was left unsaid.

What I see now is effectively 'target savings' that UK departments have to meet. That is - their budgets have been reduced going forward. But there is no detail saying how those savings will be delivered. So my fear is that we will have a non-strategic, 'salami-slicing' approach, where departments cut internal budgets by an arbitrary percentage across the board.

In my view, this is an opportunity missed. Times of pressure and challenge are precisely the times during which a more strategic approach is required, so that service provision can be prioritised around key outcomes - those things that can help make the UK a better place.

As highlighted in the recent report from the Public Administration Select Committee entitled 'Who does UK National Strategy' (click here for a link to the report), I suspect the problem lies in a lack of both appetite and capability in strategic thinking. Sadly, the report concludes that the problem is pervasive amongst both the UK Senior Civil Service and minsters - with some honourable exceptions in both camps. So there is often a lack of clarity about what the key strategic outcomes are for any given department. That makes it pretty difficult to prioritise sensibly.

I fear that the result will be further asymmetry in terms of impact - despite the conspicuous overuse of the word 'fair' during the announcement itself. That is - the most vulnerable citizens, businesses and communities in our society are often the hardest (and therefore the most expensive) to reach. My guess is that, as the cuts translate into operational reality, it will be precisely those services that are reduced or eliminated first.

Hopefully I am wrong and the key Department's of State do indeed have their Baldric-like cunning, strategic plans in place for safe-guarding outcomes and prioritising services. Time will tell.

New delivery models in a 21st century NHS

What does ‘free at the point of delivery’ mean for a 21^st Century UK health service?

I recently attended a conference at which two clinicians – one a GP, the other a Consultant – jointly presented their experience of how joined-up patient records are transforming healthcare delivery in the UK. I found it an inspiring session. Talking explicitly about a vision for ‘patient-centric care’, the two doctors explained how technology was changing both their and, more importantly, their patients’ lives. Here are just two quick examples:

·         By using a digital camera to photograph a lesion on a diabetic patient’s foot, the GP was able to then share the record with a diabetic consultant at the hospital, get their expert opinion and agree treatment. All without the need for the patient to wait for an outpatient appointment and then attend a clinic. And this was achieved in a matter of days, rather than weeks.

·         By using a set-top web-cam, the Consultant was able to have a virtual consultation with a patient who found it extremely difficult to travel. Even though the person concerned was elderly, he found this approach suited his needs perfectly and was happy with the treatment. And his GP was immediately updated on the treatment provided through the shared electronic patient records.

This got me thinking – if it’s possible to move to ‘virtual’ consultations for at least some conditions, coupled with a widening use of alternative service providers (for example private healthcare staff, rather than only those employed by the NHS) – what might this mean for the shape of the NHS itself? It could for example mean:

·         ‘Outsourced’ services for the majority of treatment of some conditions

·         ‘Off-shored’ services – perhaps going beyond interpretation of things like MRI scans (which already happens in some cases), but virtual consultations with doctors based abroad

·         ‘Self’-diagnosis through smart technology for certain simpler conditions.

Provided the services are capable of being provided remotely – or perhaps if patients choose to receive treatment in that way - AND the principle of ‘free at the point of delivery’ is preserved – does it matter that (possibly the majority of) services are provided by non-NHS staff? And interestingly – the quid pro quo might be that the ‘point of delivery’ moves to somewhere more convenient for the patient. For example, their own home.