GETTING STRATEGY RIGHT - October 2025

NOTE TO READERS: The following article on Reforming Health Care in Scotland offers excellent real world advice to Social Entrepreneurs for getting Strategy Right.

Reforming Health And Care In Scotland: Getting Strategy Right By Being Properly Strategic – Peter Williamson

EXCERPTS (Edited for length)

“What follows are five proposed steps to improve the way the development of health strategy is pursued in Scotland, followed by consideration of what at heart is fundamental to major strategic change for health and social care.

Strategic Capacity And Expertise

The first step is to recognize that those individuals with a leading role in developing strategy really need the strategic skills and mindset to make it happen. It is perhaps not a sufficiently recognized specialist role. The role particularly requires the abilities to: vision/imagine the future, think long-term and identify what the critical factors are that help and/or impede major change, adopt a systems analysis perspective, employ data analysis, and have strong advocacy skills to address the differing views of stakeholders.

Stakeholder Engagement And Strategy

A second step needed is to recognize that the dynamics of a strategy development process, which prioritizes significant engagement of stakeholders, including different NHS Boards, professional groupings and public/patient interests, can lead to sub-optimal strategic outcomes…….the compromises involved in this process can lead to emphasizing the position of particular interests at the expense of the wider collective benefit. One feature of this historically has been the tendency to provide ‘too many’ services in ‘too many’ locations.

Finance-Led Strategy

A third step in changing the approach to strategy development is to avoid being overly driven by short term financial constraints…… major strategic developments – as well as many smaller initiatives – often from the outset start with the question of ‘what can we afford?’ This confuses economy with efficiency.

Making Strategic Objectives Tighter

…..The 2023 Scottish Government Mental Health and Wellbeing Strategy had 14 separate provisions on objectives and principles. This included a vision with nine outcomes, ten priorities, ten core principles, 20 policy priorities and a non-exhaustive list of 71 key policy drivers with which the Strategy has to connect. The strategy is just excessively complex and obscures what are the critical, top-level changes needed to give the whole endeavour a focus.

Supporting Service Strategies With Resource Planning

The fifth and final step relates to strategic resource planning…… Most importantly, there was no overall financial plan setting out past and future total spending………

There are also causes for concern on workforce planning. The complete mental health workforce plan was not set out. This made it difficult to understand how the strategy’s aims, for instance the reduction in mental health inequalities, would be supported by any changes to the make-up of staffing or not.”

https://www.enlighten.scot/reforming-health-and-care-in-scotland-getting-strategy-right-by-being-properly-strategic-peter-williamson/