People, Places and Health – Change the Welsh Way: Reflections for Health Policy Futures by John Wyn Owen CB

Introduction by Marcus Longley, Director of WIHSC and Professor of Applied Health Policy

This week’s blog, the sixth in our ‘20 blogs for 20 years’ series, is by John Wyn Owen CB, the Director of the NHS in Wales for the ten years between 1984 and 1994, and now a member of the Bevan Commission.  It was under John’s leadership that NHS Wales coined the term ‘health gain’ and led the UK as an integrated planning system.  In this blog, he reflects on what this experience now has to say in the era of ‘Prudent Healthcare’, the subject of Mansel Aylward’s blog last week.


People, Places and Health – Change the Welsh Way: Reflections for Health Policy Futures  

WIHSC’s establishment coincided with the reforms of the NHS in the 1990’s which fundamentally changed its management and organisation.  The hall marks of Change the Welsh Way[i] were strategic planning and operational management that integrated public health, quality of health care, people centred services and resource effective using protocols of investment for health gain to enable the people of Wales to enjoy a level of health amongst the best in Europe. Overall it was time of great innovation in service delivery and influenced developments internationally informing the WHO Ljubljana Charter on Reforming Health Care[ii].

“The future has no place to come from but the past, hence the past has predictive value.”[iii]

Globally governments are facing a number of major challenges which go beyond the health sector; aging populations, economic uncertainty, migration and the impact of climate on the fundamentals for health – clean air, safe and sufficient drinking water, a secure food supply and shelter. Business as usual is no longer an option and transformational change is essential.

So what are the lessons from Change the Welsh Way mid 80’s to mid 90s for today’s prudent health agenda?

  1. A clear Strategic Intent and Direction integrating health services and the public health agenda with benchmarks to assess progress – a clear and understandable bottom line –health gain: years to life and quality life years.
  2. Health services research and involvement of the academic community in policy advice in Wales as a priority after all bad policy hurts people.
  3. Smart governance businesses like – health gain the bottom line- but not a business.
  4. Futures focus – ensuring the future is better than the past – and thinking whole systems for health and wellbeing and health and social care as learning systems.

“There is little research on managing systems and relatively little taught about it in our universities.”[iv]

‘Smart’ governance requires high-level systems thinking and theories of complexity science are increasingly relevant to public policy and “rethinking a whole new systems approach to public service.”[v] Now is the time to adopt the Cynefin Framework[vi] – a place where we instinctively belong.

The Cynefin Framework explores the relationship between people, experience, and context and draws on research into complex adaptive systems theory, cognitive science, anthropology, and narrative patterns to describe problems, situations, and systems and has been used by governments internationally for analysis, policy making, organizational strategy, and cultural change.

The time has come to test the practical application of complexity science “Cynefin” to health governance of and for health in Wales and to “demonstrate the importance of knowledge as the foundation for sound policy making for the public good, for engaged educated citizens and wise responsive government”.[vii]

John Wyn Owen CB, Director NHS Cymru Wales 1984- 1994, Member Bevan Commission

[i] JW Owen. Change the Welsh Way: health and the NHS 1984-1994. Health and Society in Twentieth Century Wales. University of Wales Press, Cardiff 2006.

[ii] Ljubljana charter on reforming health care in Europe .WHO Europe 19 June 1996.

[iii] Neustadt and May. Thinking in time: the use of history for decision makers 1986. Free Press New York 1986.

[iv] Nigel Crisp 24 Hours to Save the NHS Oxford University Press 2011.

[v] J Wallace, M Matthias, J Brotchie. Weathering the Storm? A look at small public services in a time of austerity. Wales Public Service and Carnegie Trust UK 2013.

[vi] D Snowden , M Boone. A Leaders Framework for Decision Making. Harvard Business Review 69-76 2007.

[vii] 110th US Annual Congressional Debate 2007-2008. Washington DC.


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