Agreeing priorities for implementation should reflect the primacy of prevention (to reduce the avoidable burden of disease in Wales) and take account of various strategic directions to facilitate planning alignment, such that joint action produces measurable improvements in population health.
Key strategic direction
Alignment of cluster activities to key strategy documents will help ensure the priorities of other local agencies and partnerships (e.g. Public Service Boards) and national bodies (e.g. Public Health Wales) influence planned cluster actions—in addition to priorities identified locally. Key strategic direction can be found within the following:
- Well-being of Future Generations (Wales) Act 2015: Legislation that aims to improve the social, economic, environmental and cultural well-being of Wales.
- A healthier Wales: Published in response to the Parliamentary Review of Health and Social Care in Wales (here), it sets out the long-term vision of a whole system approach to health and social care through a model is focussed on health, well-being, and preventing illness. It also sets of the Quadruple Aim of delivering improved population health and well-being; better quality and more accessible health and social care services; higher value health and social care; and a motivated and sustainable health and social care workforce.
- Programme for government: Incorporates the Welsh Government commitment to deliver the well-being objective to provide effective, high quality and sustainable healthcare.
- Ministerial priorities: For 2022-23 these are Covid-19 response; NHS recovery; Working alongside social care; A Healthier Wales; NHS finance and managing within resources; Mental health and emotional well-being; Supporting the health and care workforce; and Population health
- Strategic Programme for Primary Care (SPPC): Key programmes for 2022-23 are Accelerated Cluster Development; Urgent Primary Care; Community Infrastructure; and Mental Wellbeing.
- National Clinical Framework: Describes how clinical services must be planned using whole-system, whole lifespan pathways with nationally agreed outcome/ experience measures and standards, but locally delivered according to population and workforce characteristics.
- Our strategy to 2024 (Welsh Value in Health Centre): Enabling a whole system approach to value-based healthcare for Wales.
- Regional Partnership Board (RPB) area plans: Each RPB (listed here) produces a regional area plan.
- Public Service Boards (PSB) well-being plans: Each PSB (indexed here) produces an annual local well-being plan.
- Local health board (LHB) annual plan/ IMTP: Each LHB (listed here) produces and annual or integrated medium term plan (IMTP) in accordance with the annual NHW Wales planning framework.
- Public Health Wales (PHW) annual plan/ IMTP: As the national public health institute for Wales, PHW also produce strategic plans that identify priorities for population health improvement.
See also Population health information by topic which incorporates topic-specific strategic context.
Types of decision making
The Stacey matrix is a means to understand different types of decision making; this is described further in Resources to help you develop your cluster (part of Cluster working in Wales):
- Rational decisions result from the presence of high levels of both agreement and certainty
- Political decisions are characterised by high levels of certainty, but with lower levels of agreement over the best course of action
- Judgemental decisions are characterised by high levels of agreement in the presence of less certainty around the best course of action.
Political decisions can be influenced by factors including:
- Technical/ professional advice, based on evidence (which will ideally indicate a high return on investment, and/ or value-for-money relative to potential alternatives i.e. an acceptable opportunity cost)
- Personal beliefs
- Perceptions about public/ service user opinion
- Party/ organisational politics (and local and national levels).
Developing a business case
The combination of data describing unmet needs, evidence for remedial action, alignment to existing strategic direction, and proposal for prioritisation may be captured within an outline business case to support formal decision making. The business case will ordinarily be revisited in preparation for implementation (see section 3) and evolve as needed in response to influences on it—which could even invalidate it.
Other prioritisation resources
The following additional resources may support cluster decision making:
- Cluster decision making: Cluster Governance: A Guide to Good Practice covers principles, systems and processes for cluster decision making (Appendix 5). See also samples of a decision-making framework, prioritisation framework, and decision tracker.
- Options appraisal: Although in reference to cluster models, the generic principles of options appraisal as outlined in Cluster Governance: A Guide to Good Practice Appendix 9) can be applied to other types of decision, including prioritisation.
- Working in Wales: Summaries of key policy and strategies influencing health and well-being in Wales (part of Cluster working in Wales).
- Themes from the Clinical Governance Practice Self-Assessment Tool (CGPSAT) and Welsh Information Governance Toolkit reviews may also provide additional intelligence for wider service planning, ensuring that learning from incidents and concerns informs service development.