External Review of ASH Scotland 2014

4 Effectiveness of Partnerships

Partnership working and its contribution to impact and value for money

4.1 Working with alliances and partners is an explicit objective for ASH Scotland in achieving impact. Partnership working strengthens impact, and enables the organisation to have a far wider and deeper reach and more dynamic dialogue than it could otherwise have. Partnership working is seen by the ASH Scotland leadership as integral to all its work and key to its success.

4.2 ASH Scotland works with two principal networks, SCOT, a coalition of partners campaigning on health and tobacco use originally set up by ASH Scotland in 1999, and the STCA, a forum for information exchange and collaboration on tobacco related issues. ASH Scotland co-ordinates and provides administrative support to the STCA and its Chief Executive chairs SCOT.

4.3 The SCOT group's main function is to campaign for better tobacco control and to share and develop information and good practice across its members. The organisations involved in SCOT seek to influence policy, respond to consultations and provide advice and information to the public, politicians and the media. The STCA has a greater focus on information exchange, and collaboration on all aspects of tobacco control and health promotion relating to smoking. In addition, ASH Scotland has a number of partnerships with academics, local authorities, health boards and voluntary sector groups and alliances to address different specific issues.

4.4 ASH Scotland's work with SCOT is seen as a very effective way of influencing public debate and challenging the tobacco industry. The combined strength and credibility of the members of SCOT (which includes representation from the Royal Colleges and British Medical Association as well as major charities such as the British Heart Foundation and Cancer Research UK) contribute to the power and impact of its communications and influencing work. ASH Scotland supports this work and actively engages in policy work with SCOT members. The SCOT group also highly values ASH Scotland's contribution in reviewing evidence to support campaigns. Members observed that ASH Scotland is very good at involving different organisations appropriately in campaigns, and engaging and coordinating the wider sector to develop a shared campaigning voice.

4.5 The STCA was established by ASH Scotland in 2002 with the objective of strengthening tobacco control activity and policy at the local level, by using the alliance to increase reach and depth, and add value. Specific support to the STCA has come from core funding and there had been time-limited funding for a post to support the local alliances, which ended in 2010. Since the post funding came to an end, ASH Scotland's input to local alliances has reduced, but it still provides support to the alliance to promote and develop local policies and events. There is allocated staff time from ASH Scotland to provide support to the coordinating group, provide a weekly bulletin of news and research, and arrange meetings and conferences proposed by the wider membership. Sub-groups of the STCA lead on research, youth, and cessation and health, and they are active both locally and nationally.

4.6 In addition, there have been partnerships such as REFRESH (Reducing Families Exposure to Second-hand Smoke in the Home), a joint project established by ASH Scotland, in partnership with the Universities of Aberdeen and Edinburgh and with a wider advisory board. REFRESH was funded by the Big Lottery Fund to manage a four year research project on reducing families' exposure to second-hand smoke in the home. Academic leads in the study were extremely positive about the outcomes of the work, and were complimentary about the role of ASH Scotland both in enabling the funding and in contributing policy expertise to the research:

"the research community need to work with policy and advocacy. [This sort] of partnership is very beneficial... It is a two way conversation which stimulates research ideas which are grounded and linked to practice and the work of the STCA."

4.7 Close working relationships with academia beyond the specific REFRESH project also have a value in ensuring that there is a sound evidence base for developing policy. This is particularly valuable in ensuring that arguments are sufficiently robust to provide challenge to the tobacco industry and those who oppose tobacco controls and that evidence can stand up to scrutiny, including potential legal challenge.

4.8 The partnerships can in themselves lead to new alliances and co-operation. For instance a relationship is being developed with Age Scotland and Alzheimer Scotland to look at the links between dementia and smoking, and the STCA's and ASH Scotland's Youth and Tobacco Forum has brought in new groups representing young people, which enable the forum to make links with local youth networks.

4.9 External stakeholders, including the Scottish Government, see ASH Scotland as very effective at partnership working. Several commented that it manages to retain good relationships with different partners, even in a context where they may be competing for funding. It is seen as a very active lead organisation, but without dominating the sector, and as offering "an open house for partners and the wider tobacco control community". The wider sector working on tobacco control seems to appreciate the coordinating and supporting role that ASH Scotland undertakes.

4.10 Through partnership working ASH Scotland is able to offer good value for money on three levels. Its work with the STCA and the SCOT group enables it to access free meeting rooms and other facilities provided by partners, saving it direct costs. At a second level, the combined expertise of partners can be costed, and valued as a contribution to campaigns, policy and research work. ASH Scotland has already begun to undertake a costing of some of its partnership work that estimates the value of members' inputs, which shows how partnership can leverage in value. At a third level, the products of partnership activity achieve a national impact and local spread and increase the sustainability of activities so that it provides very good value for money for ASH Scotland and its funders.

4.11 Working in a potentially more constrained future financial context, a more strategically focussed approach to partnership working may become necessary. With possibly fewer resources available to support alliances, partners will themselves need to invest more resource in ASH Scotland's work. ASH Scotland will need to prioritise partnerships according to its understanding of which ones contribute most effectively to its overall objectives and add the most value to its work.

Governance arrangements for partnerships

4.12 Both SCOT and STCA have clear governance arrangements and structure. For SCOT, this is light touch, appropriate to a small group. The STCA has more formal arrangements for its structure, communications and election of officers and members for its coordinating and sub groups, consistent with its wider membership and more complex role. There were specific financial and governance arrangement for the REFRESH project to ensure compliance with funder requirements. However, most partnerships are informal, often time limited, with no funding attached and do not require formal governance arrangements. Interviews with stakeholders indicated that where there are no formal partnership arrangements, partnerships were generally still perceived as having fair and transparent decision making processes.

The balance between local, national and international work

4.13 Currently ASH Scotland works at the local, national and international levels and sees a clear link between them. National work is supported by local activity which provides both an opportunity to spread good practice and to build alliances of local voices to support campaigning. International work builds on the good practice developed by local and national implementation of tobacco control initiatives and allows the organisation both to learn from best practice and to disseminate its own learning. Knowledge and activities at all three levels contribute to the strength of ASH Scotland's profile and effectiveness. The question as to what balance the organisation should set between local, national and international work was raised by a number of people interviewed for the review, who expressed a variety of views. Below are set out some of the findings and the questions they raise.

4.14 At the local level ASH Scotland works with alliances such as the STCA to act as a catalyst and vehicle for achieving change in local communities. Links have also been made with individual NHS Boards through the provision of training for professionals involved in smoking cessation services, and with local government (for instance in encouraging the inclusion of local tobacco control issues in their Single Outcome Agreements). Another example of local partnership working is the development of a Tobacco Policy Support Guide for organisations, groups and youth workers that work with young people in community settings with NHS Greater Glasgow & Clyde Smokefree Services. This guide was drafted in consultation with local third sector youth organisations. ASH Scotland also provides some direct local services, such as the cessation training to practitioners, and Tobacco Awareness Raising Sessions (TARS) to community and voluntary sector groups, REFRESH training, and there are examples of direct engagement in relationship to tackling inequalities.

4.15 A wider question was raised by stakeholders in relation to how ASH Scotland engages at local level. It is not seen as a grass roots organisation; its expertise is in policy, influencing, informing, and it may be most effective in using those skills rather than concentrating on extensive local activity. Its engagement and the remit of its activities at the local level need therefore to be considered and clearly articulated to stakeholders.

4.16 ASH Scotland's local engagement across geographic areas is not always consistent. Some NHS Boards require more input, whereas larger boards may require none; rural and urban areas have different requirements. A point raised by a minority of stakeholders, is the tendency to be Edinburgh-centric, with less or little engagement further afield in Scotland. Some stakeholders perceived that ASH Scotland is sometimes less willing to engage with smaller and more distant events or training courses. However, it is important to recognise that ASH Scotland has provided training and tobacco awareness raising sessions across Scotland, including Orkney, Shetland and Inverness, and makes considerable effort to ensure it does hold and contribute to events in different locations. There is however, an inherent financial challenge in achieving wider spread in a cost effective way. ASH Scotland needs to balance carefully budgetary and time demands with its remit to work across Scotland, a challenge of which it is mindful.

4.17 At a national level ASH Scotland is widely seen by stakeholders to be effectively contributing to the reduction of smoking through its information and advocacy work within Scotland. It plays a vital role by linking national policy with local implementation, and in bringing together key players in academia, local government, the NHS, the community and voluntary sector and national government. This is a unique role which allows it to influence wider debate and policy on tobacco control from a position of independence and credibility. The organisation is able to work as a catalyst, promoting the flow and use of policy and information through its networks, and helping translate it into action. Its strong voice and effective management of media, together with its function in promoting and disseminating research help ensure that it has wide credibility. ASH Scotland provides a clear, well-informed voice in Scotland which consistently and persistently pursues the reduction of harm from tobacco use. From an assessment of stakeholder interviews and of ASH Scotland work and strategy, it is clear that its national role is clearly one that it plays very well, and is widely recognised for. It is also a role which could not be provided by any other organisation in Scotland. As one stakeholder commented: "[It's] worth every penny for what ASH does, if it didn't exist, you'd have to invent it."

4.18 At the international level ASH Scotland contributes to UK level work on the WHO Framework Convention on Tobacco Control and is a member of the Framework Convention Alliance and the Smoke Free Action Coalition. It meets regularly with ASH in London and ASH in Cardiff, the Northern Ireland ASH hosted by Cancer Focus Northern Ireland, and ASH Ireland to discuss policy. These meetings of the ASH organisations in the five nations were instigated in 2008 and now take place regularly. Academic and government stakeholders both made the case that increasing its international profile further would both be beneficial to ASH Scotland's efficacy through learning from other countries, and serve as a platform for publicising good practice and successes from Scotland. It was understood that increased international participation would have associated costs, but stakeholders thought that these were relatively low and would be outweighed by the benefits. Increased cross-UK participation in terms of coordinating work with ASH in London and ASH in Cardiff to ensure a collaborative approach to avoid potential duplication on policy will also help strengthen ASH Scotland's value for money and overall impact on tobacco policy in the UK as well as Scotland. It seems sensible to continue with the international activity: it has a high profile, requires relatively little time and resource, and adds value to Scotland's international profile, building on the strong national commitment to tobacco control.

4.19 There were broadly three views expressed on the local/national balance of work. A number of people interviewed thought that ASH Scotland gets the local/national balance about right, recognising that there are limited resources, and that the organisation needs to prioritise. However there was a second view, expressed mainly by local organisation stakeholders, that there is a need for more locally based work, with both statutory and voluntary groups. This was largely framed either as doing more with local health boards, local government and the third sector to develop tobacco policy to support implementation of the national policy; or to do more work specifically connected with the inequalities agenda. No respondent was very specific on quantifying what this would look like; there were also no suggestions that ASH Scotland should do less at the national level. A third view was that ASH Scotland is particularly effective at the national level, and that while the local relationships are important, the national role is one that no other organisation could fulfil.

4.20 ASH Scotland is mindful of the need to achieve the right balance, and has identified its approach to local work as an area to reconsider for its 2015 - 2018 strategy, particularly in relation to tackling inequalities and increasing direct engagement with local groups. However, this will require resource and increasing organisational focus on local activity would require changes in funding use and/or fund raising policy. If there is a decision to increase local working, the impact on national (and international) work will need to be fully assessed.

4.21 These different views on the balance of local/national/international work implicitly raise questions about what stakeholders see as ASH Scotland's main purpose, and which level of work offers most value for achieving that purpose. It is clear from the findings above that it is the local role that needs to be reviewed and given a clearer direction for the future. If there is a planned increase in local activity it will be necessary to demonstrate how it helps ASH Scotland (and major funders such as the Scottish Government) achieve their objectives in relation to tobacco control, and make clear the contribution of local work to intended strategic outcomes.

4.22 A review of the local activity may also benefit from considering the ways in which ASH Scotland works locally. Much of its activity work is explicitly through work with and support to alliances. It is widely seen to be effective at this. Stakeholders and ASH Scotland itself have both recognised, however, that it is not necessarily the right organisation to work directly with some disadvantaged and excluded groups and individuals, which can be better engaged with by local voluntary or community groups or specialist professionals, but does work well with intermediary groups. Potentially it can be most effective by continuing its role of supporting professionals and alliances to undertake local work and providing expert advice and assistance, particularly in relation to inequalities. The organisation may want to consider how it works through alliances, including local authorities and NHS Boards, to promote tobacco control strategies and activities to optimise use of total available resources. Partnerships will need to be selected strategically to maximise the resources available.

4.23 It will also be beneficial for ASH Scotland to maintain strategic partnerships with NHS Health Scotland and COSLA to ensure that its planned activities are well coordinated with the work of NHS Boards and local authorities. The integration of health and social care and work with community planning partnerships provide excellent opportunities for ASH Scotland to revisit how it collaborates with the public sector in Scotland at locality levels.