Congress report - European Health Forum Gastein

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European Health Forum Gastein 2001
the planning of interventions and the setting of goals or outcomes. The final policy shape
was represented in pyramidal terms. At base was the fundamental goal of health on equal
terms for all. In turn this constituted 6 overarching guidelines. These were translated into 8
working goals, a further 50 sub goals and 115 candidate indicators for use in monitoring the
success or otherwise of the policy. This offers the possibility of wide-ranging action at
primary care and health promotion level, facilitates inter-sectoral action by clarifying the roles
and responsibilities of all in achieving outcomes, provides a feasible working framework for
health impact assessment and facilitates intermediate evaluation. The policy will set out a
plan of action up to 2010. This process also revealed underlying ideologies and challenged
politicians in particular to examine their social values in relation to the solution proposed.
Political patience with the pace of the process was helped in large part by the preparation of
the need for this approach by the responsible civil servants and others.
Mike Ponton is a member of the new Welsh assembly and responsible for the new Welsh
strategy. By contrast with the Swedish experience, the period of policy development was
short, less than six months, because the need was already established, the challenge lay in
consulting on the process of implementation. This meant clarity about milestones and a
means of learning from experience and modifying the agenda accordingly. Better.Wales.Com
is an all-embracing strategy in many ways, that aims at improving the overall quality of life,
so that what would emerge was a prosperous, healthy, well-educated country. In this sense
health impact assessment would be, or indeed had already become, a way of life that
conditioned thinking not just of politicians, but also of officials. It meant a change in the
nature of the public servant. Now all heads of function have to work not just to their own
brief but also as a concerted team. In the case of the public health strategy people had to
be persuaded of its personal importance to them as individuals, so that agenda setting was
driven by this. Issues like workplace or housing standards rose to the top in this process.
There was also a pragmatic realisation that if we do not proactively manage change it will
happen in some forms anyway. It was not just about reforming the National Health Service
but re-positioning it. In following this investment for health concept, well-being becomes
hugely important and community development a key. It was about putting individuals in
context.
A major distinguishing feature of this system was the separation out and doing away with,
layers of bureaucracy. In effect the five regional boards were abolished, with a National
structure and 22 local authority/local alliances. In this structure it is all-important to improve
democratic participation in decision making by stakeholder representation. A process of
listening to what local people were saying was brought about, as well as ensuring local
accountability for decision making. A means of achieving this has not been finalised but
statutory partnerships governed by legislation are envisaged. In this sense it is very much a
bottom up structure, feeding these various local plans into an aggregated national plan. It
therefore has three hallmarks, a bottom up approach, a framework of health impact
assessment and means of delivery in place with a system of accountability. This aspiration
of a “people’s NHS” is an example of progressive management to make a difference.
Both these National approaches take account of the relevant contribution of expertise and
the need for meaningful consultation and both contain both top down and bottom up
elements. However the Swedish model appears to hinge crucially on evidence underpinning
credibility, whereas the focus in the Welsh model is on the need to involve and deliver. This
difference in emphasis may be explained by the historical differences between the two
countries. Both have a strong epidemiological tradition but Sweden has a history of
participatory action in other sectors whereas this type of process is perhaps more novel in
Wales.
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