The health and care system can be bewildering. New initiatives, policies and acronyms fall into an already dynamic mix of arrangements between ever-changing organisations, teams and individuals. It is not easy to improve care under these circumstances.

Yet the system is full of inspiration as well as complication. Clinicians, managers, patients, policy makers, the analytical community and others are constantly seeking ways of improving outcomes.

This inspiration often needs guidance. So this short series of blogs sets out a few of the tools used by the Strategy Unit to provide it. The series aims to stimulate interest and provoke thought rather than provide a comprehensive guide; those wanting further support should contact us.

We also focus on ‘the basics’. This is done knowing that these tools have a power that belies their simplicity…and in the hope that they can provide some antidote to bewilderment!

Tool 1: Learning from the past 

“If there is anything unique about the human animal, it is that it has the ability to grow knowledge at an accelerating rate while being chronically incapable of learning from experience.”

John Gray

One of my reflections on the NHS’ policy making process is that it is both hyper-active (with ‘change’ treated as a synonym for ‘good’) and hyper-personalised (a change of personnel implying a change of policy). Both features are unhelpful to the task of learning from experience.

To cite a recent – and high profile – consequence of this, the National Audit Office report on the new care models programme noted that:

“The NHS had several initiatives to promote integration of services before the vanguard programme. These included integrated care pilots between 2009 and 2011 to develop integrated care organisations, and integrated care pioneers that started in 2013 to test new ways of joining up health and social care…Each new initiative requires effort and money to set up, and relies on the goodwill of local NHS organisations, but we have seen a pattern of initiatives being continually folded into a successor initiative, sometimes before their objectives are fully achieved.”

This will not be an isolated example. So what is to be done?

My suggestion is simple and two-fold:

1: No new policy / programme / project / innovation (etc) is launched without a satisfactory answer to the question:

How does your proposal build on lessons from similar initiatives?

The more costly / risky the proposition, the higher the bar.

2: There should be a far greater commitment to evaluation and learning. There must be system-wide recognition that the honest generation and active sharing of learning is vastly more productive than the current audit / blame dominated approach (or its relation, the ‘good news’ case study presented at conferences).

The Strategy Unit is in a position to support this work. We have a dedicated evidence review team and a national reputation for our evaluation expertise. Our recent work with Dudley also shows the value of working with programmes to harvest and share insights, leaving the NHS better able to learn from its past.