Christie Commission on the future delivery of public services

5. WORKING TOGETHER TO ACHIEVE OUTCOMES

A second key objective of reform should be to ensure that public service organisations work together effectively to achieve outcomes - specifically, by delivering integrated services which help to secure improvements in the quality of life, and the social and economic wellbeing, of the people and communities of Scotland.

INTRODUCTION

5.1 The previous chapter set out a picture of people, communities and services collaborating to achieve positive outcomes. This chapter looks at the related question of how public service organisations can best work together to achieve outcomes.

5.2 In recent years there have been efforts to encourage an 'outcomes-based approach' among public service organisations, including the Scottish Government's introduction of the National Performance Framework in 2007. Our evidence suggests, however, that the wider system of governance and organisation of public services still does not fully embrace this approach.

5.3 Our evidence also suggests that reforms are available that should drive a stronger focus on working together for the common good. It seems obvious to say that different public services should work together to focus on the achievement of outcomes - positive outcomes in people's lives. But we know, in practice, there are barriers to achieving this simple goal:

• different accountability frameworks (statutory duties, audit and inspection) often pull organisations in different directions;
• performance management processes are generally expressed in terms of inputs and outputs (activities and service standards) rather than outcomes;
• different arrangements for funding, budgeting and accounting for the use of resources act as a constraint to joint activity;
• established ways of working often do not make the most positive impact on outcomes;
• services may not know enough about the outcomes most valued by people and communities; and
• a narrow or short-term focus on the objectives of particular organisations acts against the adoption of preventative initiatives.

5.4 A key objective of public service reform should be to ensure that public services are enabled and incentivised to work together effectively to achieve outcomes. Specifically, they should deliver integrated services helping to secure improvements in the quality of life, and the social and economic wellbeing, of Scotland's people and communities.

WORKING IN PARTNERSHIP

5.5 What has long been identified as a key issue is that at a reasonably local level, the relevant public service organisations should be able to come together to work in partnership, to design and deliver an integrated pattern of service provision for the area. In doing so, they should involve fully the local public and communities (as discussed in Chapter 4), along with other stakeholders including the third and private sectors.

Box 5.1 - Operation Focus, West Lothian Community Planning Partnership Operation Focus brought together a wide range of public bodies in West Lothian to collectively tackle drugs and community safety. These partners worked together for several weeks to plan the operation which combined police enforcement with community engagement and prevention activity. Housing was on site to repair and make properties secure while social work provided immediate support to families, including children whose parents had been arrested. Community police officers explained what was happening and sought community support for tackling drugs. NHS services gave support to drug users unable to access their drugs, preventing them from reaching crisis point. Neighbourhood Environment Teams cleaned up the areas, removing graffiti and over 53 tonnes of rubbish, so that the community looked better. A total of 63 people were arrested in communities across West Lothian over a five day period. The overall message from the wider community was positive and supportive - local people were part of the solution, not the problem. Operation Focus worked because it brought agency staff together around a shared problem, with all having a good reason to work together, and making a significant difference to the community.

5.6 This integrated approach is vital to the achievement of outcomes for people and communities. Because many services are organised at a local authority level, and because of the democratic accountability of elected councillors, the local authority area level has been identified as the appropriate level for partnership working of this kind.

This collective response is the key to success: a seamless integration of public services, regardless of structures and boundaries, which maximises professional experience and expertise to the benefit of clients.

Perth and Kinross Council

5.7 The main vehicle for local partnership between public bodies has been 'community planning', as defined in the Local Government (Scotland) Act 2003, operating in each of Scotland's 32 local authority areas. The Act places duties on:

• local authorities - to initiate, facilitate and maintain community planning, including consulting and cooperating with communities;
• core partners - health boards, the enterprise networks, police, fire and regional transport partnerships - to participate in community planning; and
• Scottish Ministers - to promote and encourage community planning.

5.8 In 2007, the Scottish Government and Scottish local authorities (through COSLA) agreed a Concordat covering various aspects of the relationship between national and local government. Central to this relationship has been the development, for each local authority area, of a single outcome agreement ( SOA), which set out priority 'local outcomes' for the area, agreed between local partners and the Scottish Government. The SOAs are intended to focus work within and between local partner organisations to develop service strategies and delivery plans for that area.

5.9 The agreed local outcomes should reflect the 'national outcomes' set out in the Scottish Government's National Performance Framework ( NPF). The arrangements are also intended to express the accountability of the Scottish Government and local government to the public and to each other for their contribution to the achievement of the local outcomes.

5.10 The Commission heard a consistent view that the potential benefits of a local partnership approach are far from being fully realised; that there are significant variations in the effectiveness of community planning partnerships; and that, for the most part, the process of community planning has focussed on the relationships between organisations, rather than with communities.

The public sector needs to continue to develop collaboration and joint-working to deliver more efficient and user-focussed services. The key issue is that councils cannot on their own deliver the kind of radical change to service provision that is needed.

Audit Scotland, An overview of local government in Scotland 2010

5.11 As a Commission we agree that effective, locally integrated service provision is crucial to the achievement of outcomes, and that local authority-area level partnership is crucial to the development of that integrated service provision. The continued development of local partnership arrangements should therefore be a key element of the public service reform process.

5.12 A primary purpose of each partnership should be to develop consistent and coherent plans for the achievement of agreed outcomes, in particular around the integration of service provision.

5.13 Given its key role in the governance of a number of the local partners, most notably health boards, it is critical that the Scottish Government plays a full and active part in the operation of local partnership arrangements in each part of Scotland, and in particular in the integration of service provision. The Scottish Government should also support and incentivise the integration of service provision, for example, through a 'change fund' scheme (as recommended below).

5.14 These arrangements should enable the Scottish Government and the local authority to agree area priorities and hold each other to account for the achievement of outcomes. The Scottish Government should in turn be held accountable by the Scottish Parliament for its contribution to this process.

5.15 These processes should also be extended into local communities to address their specific circumstances. As previously discussed, they should allow for meaningful engagement with people in those communities in the design and delivery of services. These arrangements should be based on more specific, disaggregated information about the needs of those communities, and reflect the wider arrangements for accountability and funding outlined elsewhere in this chapter.

5.16 The Commission recommends public service organisations should work to extend and deepen a local partnership approach, building on, but going well beyond the current community planning partnership model. In particular, there should be a much stronger focus on engaging with people and communities in partnership processes, including the design and development of a pattern of integrated service provision.

5.17 The Commission recommends the current outcomes-based approach be underpinned by a revamped political agreement between national and local government, as currently expressed in the Concordat. It must be a mutual requirement of this agreement that, alongside a single outcome agreement, each community planning partnership develops and agrees with the Scottish Government a clear plan setting out how partner organisations will pursue local service integration to achieve outcomes.

ENGAGING WITH, AND ACCOUNTING TO, PEOPLE AND COMMUNITIES

5.18 The Commission has seen a number of examples where local partnerships have involved people and communities in their operation effectively. The evidence supports the principle of involving people and communities in the design and delivery of services (discussed in the previous chapter). This should be built into the operation of local partnerships.

5.19 In the majority of cases, the best level at which to engage people and communities in the design and delivery of services will be more local than the local authority-area level. We have heard about positive examples of local authorities developing and supporting arrangements for community engagement at a more local level (for example, where Aberdeenshire is divided into six areas for the purposes of community engagement). These arrangements should tie in with the development of plans (as outlined above) for the design and delivery of integrated services at a more local level. They should also provide for stronger accountability of all service providers, directly to the public, for their individual and collective contributions to achieving outcomes in those communities.

5.20 Arrangements for direct public accountability provide an opportunity for locally elected members (either of the community council, the local council, or the Scottish or UK parliaments) to play a pivotal role as representatives of, and advocates for, their communities. In the case of members of the local council, this would be alongside but distinct from their formal role in relation to local authority services.

5.21 The Commission recommends community planning partners should:

• ensure people and communities are involved directly in the development of key elements of the local partnership process, such as the development of priority local outcomes within a single outcome agreement;
• develop and extend arrangements at a more local level (more local than the local authority area) which facilitate public engagement and participation in shaping priorities, and in the design and delivery of services; and
• establish arrangements to enable all parties to a single outcome agreement to account to the public for their contribution to the achievement of outcomes in those areas. Elected representatives should have a pivotal role to play in those arrangements.

POWERS AND DUTIES

5.22 The mix of powers and duties applying to statutory public service organisations is complex and confusing. Without wishing to increase the statutory burden on organisations, we argue that some form of common powers and duties to achieve outcomes would help ensure a consistent level of service and innovation.

5.23 The National Community Planning Group ( NCPG) submission argues that what drives public bodies in practice is what they have a duty to do. As such, NCPG's prime concern is what public bodies are accountable for - and that accountability should be for the achievement of positive outcomes. So the NCPG proposes a suite of powers and duties be applied to statutory public service organisations on a common basis. Their full proposal to amend the statutory framework to this effect is given in Box 5.2 below.

5.24 We agree that introducing a common set of duties and powers, focussed on the common pursuit of outcomes, would be a positive development.

5.25 The Commission recommends that the Scottish Government should work with local government and other partners to devise and put in place an appropriate set of common powers and duties.

5.26 We also recommend assessing the value of existing statutory duties which apply to individual public service organisations, in terms of outcomes.

5.27 We suggest that this work be carried out as part of the rolling programme of service reviews we recommend in Chapter 7.

Box 5.2 - National Community Planning Group Proposals "Our proposal is to amend the statutory framework, through a set of mutually reinforcing provisions, as follows: The power to advance well-being should be extended to all public bodies, so that they may do anything which will promote the well-being of an area and its people, either directly or through support of another public body. This is in line with the Scottish Government / COSLA guidance on governance and accountability and will enable all bodies to take account of and improve all of their impacts upon their communities. (This would not enable a body to do anything which other legislation prevents, or to unreasonably duplicate the legislated functions of another body.) The application of the power to advance well-being should be through Community Planning and on the basis of a published area profile - an assessment of the evidence of the social, economic and environmental conditions of the area and its people and of their needs. This will build upon a key strength of the voluntary SOA process, which is its evidence base. Community Planning should be defined as a process by which the public services in an area are consulted upon, planned, delivered and reported, on the basis of a published area profile and for the purpose of achieving measurable outcomes for the area and its people. This will help refocus partnership working toward the achievement of outcomes. Each public body delivering services within an area should have a duty to participate in Community Planning, as defined, through working with the other public bodies which serve the area . This will help embed partnership working and local integration of services, and will provide a stronger and shared basis for dialogue and co-operation between local public bodies, voluntary and business interests, and the Scottish Government. Scottish Ministers should have a duty to ensure that all public bodies within their accountability participate in Community Planning, as defined. This will reinforce the embedding of partnership working. The statutory duty of Best Value should be extended to all public bodies and should be defined as continuous improvement in the performance of the body's functions for the purpose of achieving measurable outcomes for the area/s and people served by that body . This will refocus accountability to focus on the intended results of performance. The setting of measurable outcomes by a public body should be on the basis of an assessment of the evidence of the social, economic and environmental conditions of the area/s and people served by the body and of their needs. The statutory guidance on Community Planning and Best Value should be revised to reflect the new duties and their purpose. Finally, the powers and duties of external scrutiny and inspection bodies should be framed so as to focus on the achievement by public bodies of measurable outcomes and on the effectiveness of their partnership working."

BUDGET AND RESOURCE SHARING

5.28 We have heard repeatedly that budgetary inflexibility can hamper joint working to achieve outcomes. At present, the overwhelming bulk of resources within public services has a strong organisational 'identity', which is hard to shift. Creating a focus on the needs of a particular place or a group of people, rather than the funding streams of individual organisations, can be an effective way to target attention and provide a basis for partnership.

The resource allocations for health and local government services, at a national level, are distributed on a different basis, with limited consideration of the outcomes to be delivered in each locality and the cost of doing so. If public sector reform is to lead to better outcomes across the public sector, then we should also consider a more holistic means of funding public services.

Chartered Institute of Public Finance and Accountancy ( CIPFA)

The success of any partnerships often is dependent on the ability of organisations to pool budgets. This remains a challenge for the public sector with many partnerships simply aligning budgets.

Association for Public Service Excellence ( APSE)

Age Scotland believes the pooling of budgets could be a catalyst for change in promoting more effective joint planning and delivery of services across the health, social care and housing spectrum if the obvious bureaucratic hurdles can be overcome swiftly.

Age Scotland

5.29 Place-based approaches, such as Total Place, ¹⁵ aim to map the totality of public spending (current spending and capital) in an area to illuminate the interactions between local partners and expose any gaps or duplication in service provision from the viewpoint of the citizen. Evidence suggests that a spending analysis of this kind is a useful tool in delivering outcomes and improving value for money. ¹⁶ Place-based analysis can also help to weigh the benefits of local partnership against the alternative of structural reorganisation, which is often designed to realise economies of scale by merging units of production.

Box 5.3 - A Place Based Approach to Integrated Working in the Scottish Borders At a community planning forum in Galashiels in July 2010, Scottish Borders Council and NHS Borders revealed a new place-based model of service redesign. Based upon the Integrated Resource Framework ( IRF) from Scotland and the English experience of Total Place, services are being re-designed across the Borders area by area. Stakeholder involvement is key to this approach and therefore, in addition to ongoing service user consultation, a local event is planned for July 2011 to ensure an opportunity for local people and organisations to express their views and propose ideas which will take the project further. The first phase of the Cheviot programme, which includes Kelso and Jedburgh areas, aims to ensure that individuals can live safely in the community for longer, thereby reducing the need for hospital care or residential care home. A return on investment of 15 per cent has been agreed as part of the programme design. In pursuit of this, a range of existing health and care services are being reshaped, to improve outcomes and to release efficiencies, for example: the day service has been redesigned with the voluntary sector being funded to provide three rural social centres, realising efficiencies rising to 30 per cent by 2012-13 and helping to boost funding for the Social Centre and Neighbourhood Links; planned co-location of the day service into Kelso Hospital will enable the Learning Disability Service to set up a local service and realise further efficiencies; and the development of joint management and joint teams across NHS and social care will further enhance opportunities for joint working while also offering the potential to release property costs.

5.30 The Commission shares the commonly expressed view that the focus of budgeting should increasingly move away from institutional silos towards outcomes. We recommend the Scottish Government and local authorities explore Total Place-type approaches across Scotland.

5.31 More generally, we consider the flexibility which public service organisations have to share resources - for example, for one organisation to fund activity by another - to be critical to their success in achieving shared outcomes. We recommend that the Scottish Government and local government review jointly the current funding arrangements for public service organisations to increase flexibility.

5.32 Given its importance to achieving outcomes and reducing cost and demand, we believe there should be significant incentives in place to drive the joining up of services across sectors and organisations at local level. We therefore recommend the Scottish Government develops and extends the use of funding models which expressly require the integrated provision of services - for example, through a 'change fund' scheme.

5.33 One specific issue on which public service organisations can and should work closely in partnership is over the use of capital budgets . These budgets are, and will likely remain under significant pressure over the coming years, but it is vital, not least to the economic recovery, that appropriate steps are taken to maintain and improve our capital infrastructure.

5.34 We recommend all relevant public bodies must participate in the preparation of a joint long-term asset management plan under the aegis of each local community planning partnership, based on a shared assessment of the current condition of their assets.

NATIONAL POLICY APPROACHES

5.35 We have observed inconsistencies and tensions between national targets and local outcomes which have constrained local partners' ability to work together. These can stop people and organisations identifying and working towards shared outcomes, keep them and their resources in silos, and miss opportunities to improve local outcomes and efficiency.

The most significant systemic issue is that different local partners face different performance and accountability frameworks. Central requirements, targets and commitments make integrated effort around delivery of local outcomes more difficult.

National Community Planning Group

5.36 Tensions of this kind are to a degree inevitable when any form of target or wider 'requirement' on local service delivery is set at a national level. Realistically, the Scottish Parliament and/or Scottish Government will always specify levels of inputs or outputs in certain fields. Indeed, requirements of this kind can be an important way of ensuring consistency of important standards or entitlements across Scotland, helping express 'the kind of Scotland we want to live in'. The Scottish Government should be held accountable by the Scottish Parliament, and be accountable to the people of Scotland, for the setting of any such national targets, standards or entitlements.

Improvements can also be made in the setting of national policy aims - which should be reflected in a clearer statement of shared priorities between national government, local government and community planning partners. These priorities should be clearly articulated around outcomes for citizens and communities. This approach will help clarify the different roles and levels of governance in Scotland and help embed the principle of subsidiarity within policy and priority setting.

Society of Local Authority Chief Executives ( SOLACE)

5.37 At the same time, it should be recognised that this tension can have a negative impact on the delivery of local outcomes. It is vital that any national targets, standards or entitlements are based on a clear and explicit account of their contribution to achieving the desired outcomes (for example, using a logic model or contribution analysis), jointly developed between the Scottish Government, local government and other partners and stakeholders. This should accompany a general move towards increased flexibility for delivering services at a local level to achieve agreed outcomes, and to be accountable for them.

5.38 More generally, the nature of national policy in particular fields can have a significant impact on the capacity of local organisations to work together to achieve positive outcomes with and for their people and communities. Our analysis and key objectives favour policy approaches which:

• are focussed on the achievement of outcomes in the lives of people and communities;
• are designed to build the capacity of those individuals and communities;
• support the local integration of service provision; and
• prioritise prevention and tackle inequalities.

A POSSIBLE DESTINATION FOR THE REFORM OF LOCAL PARTNERSHIP WORKING

5.39 This chapter has made recommendations for the reform of local partnership working. We now set out what the possible destination of this process of reform might look like, to help to shape and inform that process:

• there is a full and proper public and political process for determining and prioritising the outcomes which public services should seek to achieve. These should reflect the national outcomes determined by the Scottish Government and have their full participation;
• all public service delivery organisations working in that area must then collaborate with each other, people and communities, to design and deliver an integrated pattern of service provision using their budgets flexibly;
• the partner organisations are held to account by the public and their democratically elected representatives, and by each other, for their achievement of these outcomes;
• wider governance arrangements are also built on that achievement with a foundation of common powers and duties;
• all processes for public engagement are built up from engagement at a more local level, at or around the level of multi-member wards;
• all public service organisations operating in a given local authority area see themselves as part of a common framework for public services in that area, and at least in part define and describe themselves as part of that framework; and
• organisations develop a collective public identity and branding (such as 'Public Services South Lanarkshire'), and become judged on their individual and collective contributions to achieving successful outcomes for and with the people and communities of that area.