Creating the Draft Route Map
To create the draft, we have drawn on UK and international lessons. The intention is to test out the process, and to identify and then create/signpost to tools and materials that an LA can use to enable it to create and use the route map. We hope that these materials will speed up the process for LAs, and share good practice as we know that some LAs are making strong progress on some elements.
We are working closely with four Pilot LAs. These were selected following an invitation to all LAs to put in an expression of interest. They represent a cross section of geographies, types of LA and local initiatives. We are using Appreciative Inquiry –a positive approach to sparking change in people, groups and organisations, and goes through an iterative process of Discovery, Dreaming, Design and Delivery. It focuses on what is working well (appreciative) by engaging people by asking questions and telling stories (inquiry), because positive values and stories are what is powerful in persuading others to change and in creating new futures and realities. It also generates an understanding of how an organisation works well in practice, and what are the characteristics of success that can inform a better way of tackling obesity that is more likely to work in that locality.
Working with the pilots is generating insight into the realities and possibilities for LAs, and enables us to test out emerging ideas to see what might work well, which we are then testing more widely to see how applicable it is more generally and if there are better approaches. In parallel, we are talking to colleagues in other countries, researching other sectors that are tackling complex problems and using systems thinking or other approaches, and consulting the Community of Learning, to create material to test with the Pilots. Bringing all of this material together will enable us to co-produce outputs that reflect what LAs want.
By interviewing a range of colleagues and asking: “what works well here and why?” we have been able to understand what are the characteristics necessary for success in each local area. These underpin the Dreaming stage because they describe what works well in each LA, and provide a framework for creating more robust action plans for obesity – colleagues in the LA and their stakeholders can refer back to them to understand what characteristics need to be in place in order for the obesity programme to work well, and how the programme needs to be shaped to reflect those characteristics. We are comparing these to see whether there are any common components that appear to be essential for any local area.
The next phase is to work with LAs and their stakeholders on the “dreaming” phase, to create a shared vision of what they would like their local area to be like in the future. We have also been analysing each LA’s documents and data to get a better understanding of how obesity currently fits with strategic plans and priorities, and the work that each LA has under way.
What might the route map look like?
Work to date suggests that it is the process that an organisation uses to create its approach that makes a difference to success: the co-creation of the approach at the same time as creating a living, on-going system that will deliver the approach, and which is robust and flexible enough to be able to cope with the inevitable changes in context.
Our current thinking is that the Route Map comprises a number of elements, but it is important to recognise that it is not a straightforward linear process of working through each stage: this needs to be accompanied by a change in the way that we think about the system and how each part works together: it is the activity at these interfaces that enables the system to work more effectively.
Our research so far stresses the importance of moving interventions upstream, and of combining approaches that address the wider environment at the same time as meeting the needs of those most at risk, including those already overweight and obese. If these two elements are not combined, there is a risk that the environment that drives obesity will remain unchanged making it harder for those at risk to maintain any changes to their lifestyles; conversely, if only the environment is changed without investing in tackling existing excess weight, then only those with greater social capital and other advantages will respond to campaigns and improve their health and the inequalities gap is likely to grow.
Therefore the process of creating a plan is iterative, but in essence we think it has the following key stages:
- Pre-systems thinking: building partnerships and collating preparatory information and insight
- Creation of a core group of leaders
- A Positive Conversation about what works
- Core group commences work on identifying consequences (to bring the right people round the table) and causes of obesity locally
- With a wider group of stakeholders, revisits the consequences and causes to gain strengthened and shared understanding and ownership
- Mapping out existing approaches, identifying gaps and opportunities for adaptation and partnerships – how can individual actions be strengthened, how can they come together for greater impact?
- Core and stakeholders work through the ideas to create an action plan, sense checking and considering whether the collective actions will be sufficient and whether there is a sufficient balance between tackling the wider environment and addressing the most at risk groups – the dual approach
- Maintaining and nurturing relationships and adapting the system, network and plans to reflect changing influences and emerging progress
- Including approaches to provide on going feedback into the system
- The route map looks both short and longer term: LAs can see benefits from building capacity and links with stakeholders and communities in the shorter term, before seeing changes in behaviour and then in obesity measures as the programme progresses over the longer term.
As well as the likely shape of the route map, we have also understood a number of other key issues:
The importance of top level leadership:
One of the most significant findings is that creating the right environment for change is crucial – “pre-systems thinking”. We have identified that there are effective methods for bringing stakeholders together and promoting collaboration, but that to do this effectively there is work that needs to be done to pull together a range of stakeholders and materials to create and strengthen systems and relationships, and build internal and external capacity such as:
- Building partnerships with the full range of stakeholders: who needs to be involved – what networks could a LA have and what benefits would these bring? How can different sectors get engaged in tackling obesity – what’s in it for them?
- Engaging local communities, to understand the local views and range of assets on which LAs can draw: LA feedback stresses that local groups and communities have a significant role to play in shaping and delivering the agenda, leading to more effective, locally owned and more sustainable approaches
- Collating a range of information to understand the current position and to inform decision-making
- Creating a shared vision of where people want to be, as the foundations for building relationships
- Understanding what are the LA’s most important drivers and priorities, and how does or could obesity relate to these?
- What are a LA’s biggest strengths? What works well, how do things get done and how can a LA use these to address obesity?
- How can a local authority review its overarching policies to map how obesity is reflected in them?
- What information can a LA access in order to gain the best picture of obesity – its causes, prevalence, what actions seem to be working best, and how are actions currently connecting?
- Analysing existing and planned interventions to see whether they work, how they can be combined to better effect to increase their impact and efficiency
- Plotting out how tackling obesity fits with major strategic priorities for the local area, so that obesity is seen in this wider context: how does obesity impact on achievement of these goals, and how can tackling it more effectively help to achieve those goals more effectively
Feedback from colleagues suggests that not all aspects are there yet for every LA, and that they would welcome support in understanding the complete picture of what is required and in some cases materials and guidance both about what the pre systems world should look like, the benefits and how to create one in the most efficient and productive way.
Discussions with LAs emphasise the importance of understanding and engaging local communities. This comprises many different groupings and views. The Voluntary, Community and Faith sectors (VCF) is extensive, contains many people with skills and knowledge, and who have connections in the communities that LAs most wish to engage. In some cases it seems likely that communities may respond more positively to messages from some sources than others, and that the skill in engagement or the trust and standing within a key community is often to be found in VCF groups not in statutory bodies.
The importance of taking a positive approach, focusing on what works well in a local area and building from that, rather than analysing the problems. This tends to lead to attempts to address specific problems and changing components rather than looking at the issue more widely, as a whole system.
Where the Route Map leads
We hope that the process will have a number of outcomes including a change in the way that we think about complex issues such as tackling obesity:
- It is more than “superior collaboration” or joined up working although this is a pre-requisite. Moves on from “joint plans” to “single plan”
- Acknowledges partners have different valid perspectives, cultures and allegiances and gets people to talk about these and deal with them more openly. It creates a framework by which participants can agree an agenda or plan to move forward
- It includes approaches that provide ongoing feedback into the system
- Getting the “right answers” may not be enough – the process of creation and ownership is key
- Operates at the interfaces between individuals/bodies – means the end result is more than the sum of its parts
- Stakeholders see the value of being involved, and that they see their own role in the system – why it matters to them and what they can contribute to tackling the issues
- Creates a mind set of how actions interact – understanding what systems thinking is about, and using this to link initiatives together, work out more effective approaches and use of resources, and identify and tackle unplanned consequences
- Real impact of obesity is recognised and plans to tackle it are grounded in a LA’s major priorities
- There will be positive results for levels of excess weight in children and adults in the longer term, but we anticipate that there will also be shorter term benefits including:
- A greater understanding of what works well here, in each LA
- Using local intelligence – so the approach is locally relevant
- Building stronger relationships with stakeholders including communities and businesses
- Getting people talking about things that matter to them
- In time, as people become familiar with the issues and approach, and start to see the benefits, using these types of approaches creates a culture of genuine and sustainable collaboration so that it becomes – “it’s just how we do things here”