Refreshing the Health and Social Care Alliance Scotland and Scottish Government Partnership Agreement: External Review

1. Introduction and method

About this section

1.1 This section provides introductory information about the ALLIANCE, its role and remit, and its relationship with the Scottish Government. It also includes a description of the methodology for the review.

About the ALLIANCE

1.2 The ALLIANCE is a national third sector health and social care intermediary organisation. Under its original title – the Long Term Conditions Alliance Scotland – it was established in 2006 by a group of third sector organisations with support from the Scottish Government. At that time, the key members were largely third sector organisations which focused on single long-term conditions. Its first major policy responsibility was to develop the Self Management Strategy for Scotland, which was published in 2008 ^[1] .

1.3 Over time, the organisation has broadened its remit, membership and activities. To reflect the changes to its role and the landscape in which it operates, it changed its name to The Health and Social Care Alliance Scotland, and became known as the ALLIANCE, in 2012.

1.4 The ALLIANCE’s current stated aims are to:

• ensure people are at the centre, that their voices, expertise and rights drive policy and sit at the heart of design, delivery and improvement of support and services;
• support transformational change, towards approaches that work with individual and community assets, helping people to stay well, supporting human rights, self management, co-production and independent living; and
• champion and support the third sector as a vital strategic and delivery partner and foster better cross-sector understanding and partnership.

1.5 The ALLIANCE:

• works with a range of people and organisations to influence the development of policy and practice in health and social care;
• delivers a range of specific projects and programmes which relate to disability, long-term conditions, person centred and rights based approaches, and strengthen the role of the third sector in health and social care; and
• manages the £2 million a year Self Management IMPACT Fund for the Scottish Government.

1.6 Since it was established in 2006, the organisation has broadened and increased its membership substantially. It now includes members with interests in long-term conditions, disability, mental health, older people and unpaid carers.

1.7 The ALLIANCE had 728 members in September 2014. The membership base is now very diverse, and includes:

• grassroots and user led organisations;
• health and social care providers;
• disabled people, people living with long-term conditions and unpaid carers; and
• health and social care professionals, academics and policy makers.

1.8 A list of the organisations which are members or associate members of the ALLIANCE is included as Appendix one.

1.9 The ALLIANCE is described as a strategic partner of the Scottish Government and has close working relationships with national health and social care bodies. At a national level it sits on a number of different strategic forums and groups.

Rationale for the review

1.10 The ALLIANCE has had a Strategic Partnership Agreement in place with the Scottish Government since 2008.

1.11 The ALLIANCE has established a wide range of new projects and programmes over recent years, many of which are sponsored by different teams within the Scottish Government. This has created a complex picture of funding streams - and different financial processes, governance and reporting arrangements. Currently, the Scottish Government provides three main elements of funding to the ALLIANCE:

• Core funding – This supports the running costs of the ALLIANCE, including accommodation, and associated overheads. It allows the ALLIANCE to employ core staff to manage its extensive work on: consultation and engagement; events; communications and policy development; membership activities; the Self Management IMPACT Fund; and the Hub. The current Strategic Partnership Agreement provides a basis for this funding.
• Various programme or project funding streams – the ALLIANCE has a number of specific funding relationships with the Scottish Government. These have been developed in response to needs identified by the ALLIANCE or the Scottish Government, or as part of wider funding programmes. In some cases, funding comes from more than one area of the Scottish Government to support a project or programme.
• Self Management IMPACT Fund – the ALLIANCE administers this grant programme on behalf of the Scottish Government. The fund makes £2 million per year available to third sector organisations delivering self management work. The costs of running the programme are met by the core funding provided by the Scottish Government.

1.12 To better support the ALLIANCE activities and long term planning, the Cabinet Secretary for Health and Wellbeing has proposed a move to a refreshed, three-to-five year outcomes-focused Strategic Partnership Agreement. It was proposed that this partnership agreement would be underpinned by consolidated funding that brings a range of currently separate projects and programmes within the ALLIANCE’s core funding grant. The Scottish Government and the ALLIANCE are now undertaking a partnership process to review their relationship, to enable a refreshed partnership agreement and funding model to be progressed.

1.13 In July 2014 we (ODS Consulting) were appointed to carry out an independent review of the ALLIANCE. In particular, we were asked to:

• assess the ALLIANCE’s impact to-date;
• assess stakeholder perceptions of the ALLIANCE;
• provide reflections on the ALLIANCE’s future role in delivering the Scottish Government’s 2020 Vision;
• provide insights on the strengths, weaknesses and challenges of the current and proposed future working arrangements and funding model; and
• provide insights to inform a refreshed outcomes-focused Strategic Partnership Agreement.

Methodology

Our approach

1.14 As part of this review we gathered and reviewed a range of diverse evidence. Our activities included:

• an inception meeting with the Research Advisory Group (RAG) on 4 August 2014, when we discussed and agreed the methodology for the research with representatives from the ALLIANCE and Scottish Government;
• a desktop review of existing monitoring and evaluative information on specific ALLIANCE projects and programmes;
• an online survey with ALLIANCE members ;
• telephone interviews with a number of ALLIANCE members (identified from a short list provided by the ALLIANCE, and based on interviewee categories agreed by the RAG), ALLIANCE staff and Board members, sponsorship representatives from the Scottish Government and Joint Improvement Team, and representatives from strategic organisations involved in health and social care in Scotland;
• a review workshop with the Research Advisory Group on 18 September 2014, where we shared initial findings, and discussed emerging issues and priorities; and
• a workshop with key ALLIANCE staff on 25 September 2014 to identify draft strategic outcomes for the ALLIANCE’s Scottish Government funded activities.

1.15 We developed and consulted with the RAG on the draft survey and a series of semi-structured discussion guides for the interviews. We prepared a covering email with a link to the online survey, which the ALLIANCE issued to its members. This explained the purpose of the research and how information gathered would be used.

1.16 The field work for the review was carried out during September 2014.

1.17 The table below provides an overview of the evidence we gathered as part of the process, and the topics we explored.

Table 1.1 Evidence sources for the review

Review activity	Evidence source	Topics explored
		Impact of the ALLIANCE	Future role	Funding model
Desktop review	Existing monitoring and evaluative material	✓
Online survey of members	Issued to 728 members 99 completed	✓	✓
Member interviews	13 interviews with members	✓	✓
ALLIANCE interviews	5 senior staff and 2 Board members	✓	✓	✓
Sponsor interviews	Discussion group and 3 interviews involving 9 Scottish Government staff and 2 representatives from the Joint Improvement Team	✓	✓	✓
Policy stakeholders	9 interviews with representatives from organisations with a strategic policy interest in health and social care in Scotland: Health Scotland; Coalition of Care and Support Providers in Scotland; Voluntary Action Scotland; Evaluation Support Scotland; SCVO; COSLA; 1 Scottish Government representative and 1 JIT representative (without sponsorship responsibility); 1 Health and Social Care Partnership	✓	✓

Profile of survey respondents

1.18 The online survey of members gathered information about the people and organisations responding. Of those who provided this information:

• Over half (58%) of responses were from organisations, 17% were from ‘Professional Associates’ and 25% were from individual people.
• Almost one third (31%) indicated that they were best described as a ‘professional working in health or social care’.
• In addition, 28% stated they were from ‘a third sector organisation which provides services to people with long-term conditions or disabled people’ and 17% of respondents were from ‘third sector organisations which represent the needs of people with long-term conditions’.
• A very small proportion of respondents were from the private sector (4%) or a public sector organisation (2%) providing services to people with long-term conditions.
• Thirteen percent of respondents were individuals with lived experience of long-term conditions or disability.
• Organisations of different sizes were represented in the survey. We found that 38% of responses were from small organisations (with an annual income of less than £50,000); 26% were from medium sized organisations (between £50,000 and £499,999); and 36% were from large organisations (with an annual income of over £500,000).
• A third of respondents operated across Scotland (33%). The rest operated in specific local authority areas.
• None of the respondents said they operated in either Shetland or in Comhairle nan Eilean Siar local authority areas. Glasgow City was the area where most respondents operated (26%).

This report

1.19 This report sets out the findings from our independent review of the ALLIANCE, which aims to inform the future development of the ALLIANCE’s relationship with the Scottish Government. The review has mainly gathered and analysed stakeholder views on the impact of the ALLIANCE, its future role, and the strengths and weaknesses of the current working and funding model with the Scottish Government.

1.20 This report includes the following sections:

• Section 2 – explores the perceived impact of the ALLIANCE as an organisation, and evidence relating to the impact of the Self Management IMPACT Fund in particular;
• Section 3 – provides an analysis of the views of stakeholders regarding the current and future role of the ALLIANCE;
• Section 4 – considers views relating to the funding relationship between the Scottish Government and the ALLIANCE; and
• Section 5 – discusses the key findings and makes recommendations for the development of the relationship between the Scottish Government and the ALLIANCE.

Considerations in interpreting our findings

1.21 In developing the methodology for this research we aimed to gather and compare evidence from a range of sources.

1.22 To understand the contribution being made by specific programmes, we reviewed existing reports and data to identify evidence of outcomes. The ALLIANCE gathers a wide range of monitoring information, but the different stages of the programmes, variable reporting formats and lack of outcomes-focused evidence have made it difficult to draw conclusions about the impact of its specific programmes from these evidence sources.

1.23 Much of the information, which has informed this review, is perception based. Those we engaged were likely to have had varying levels of engagement with the ALLIANCE – and therefore different understandings of its role, activities and impact. It is also worth noting that we engaged with a limited number of policy stakeholders (nine) who were identified because of their particular interest in health and social care policy.

1.24 In relation to the views of members, we have used both quantitative evidence (gathered from the membership survey) and qualitative data (gathered from a relatively small number of interviews with members). We were able to engage a wide range of different types of members through the survey, and have explored and identified (where relevant) any patterns in the responses of particular types of members. The telephone interviews allowed us to explore key issues in more depth with members.

1.25 These considerations are particularly important when interpreting Sections 2 and 3 of this report, which explore the impact of the ALLIANCE and its role.