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

2. THE IMPACT OF the ALLIANCE

Introduction

2.1 This section of the report considers the changes that the ALLIANCE has brought about, and the impact it has had as an organisation. It mainly provides an analysis of the views expressed by stakeholders. These were gathered through the member survey (completed by 99 ALLIANCE members) as well as qualitative interviews with: members (13); the Scottish Government and Joint Improvement Team (11); and policy stakeholders (9). This section also provides a high level analysis of existing evaluation in relation to the Self Management IMPACT Fund (the grant programme which the ALLIANCE manages on behalf of the Scottish Government).

Gathering and representing member views

2.2 The ALLIANCE strives to ensure that its members’ views are gathered and heard, and our research suggests that the ALLIANCE is doing this very well.

Members are involved in a range of ways

2.3 Respondents to the member survey indicated that they have been engaged by the ALLIANCE in a range of ways, with the vast majority feeling the ALLIANCE gathered views from all its members effectively. We found:

• Forty-four per cent had contributed to consultations and research carried out by the ALLIANCE.
• Seventeen per cent said that they had participated in an ALLIANCE reference group.

There are differences in the way different sized organisations participated. Those participating in reference groups were most likely to come from medium sized organisations: 52% of them said they had engaged in this way compared to only 12% of large organisation and 14% of small organisations. Whereas, large and small organisations were more likely to be involved in consultations and research - with 52% of small organisations and 57% of large organisations saying they had been involved in these, compared with 35% of responding medium sized organisations.

• The ALLIANCE was highly rated by members for its ability to collect the views of all its members on relevant issues. Eighty-nine percent of respondents felt that the ALLIANCE was effective in this area.

Effectively representing member views

2.4 As well as collecting their views, members felt strongly that the ALLIANCE represented these effectively. Almost all survey respondents (95%) felt that the ALLIANCE effectively ‘presents the views of members to the Government and others’. Of these, the majority (57% of respondents who rated this area of activity) indicated the organisation was very effective in this area.

2.5 This finding was further supported by the comments individual members made during the survey and interviews.

“The ALLIANCE . . . helps by raising awareness of long-term conditions, and lobbying for organisations.”
Professional associate

“The ALLIANCE has argued a good case for our sector. It has encouraged government to invest in the third sector.”
Large sized member organisation

2.6 Also important was the promotion of self management, which survey respondents felt the ALLIANCE had successfully placed on the Government agenda.

“The promotion of self management as a tool that can empower people with long-term conditions.”
A person with lived experience of long-term conditions

Providing a voice for people with lived experience

2.7 Members were extremely positive about the ALLIANCE’s ability to provide a voice for disabled people and those with long-term conditions. Ninety-five per cent of respondents to the survey said that the ALLIANCE was effective at providing a voice for this group. Smaller member organisations highlighted that they have become known to the Government through ALLIANCE activity and this has raised their profile and benefited them and their service users.

[What does the ALLIANCE do well?] “Communicating people's needs to the Government.”
Medium sized member organisation

Shaping policy

2.8 Critically, all stakeholder groups felt that the ALLIANCE had gone beyond effectively representing member views, actually to influencing and shaping national policy – particularly in relation to self management, person centred approaches and the role of the third sector in health and social care.

2.9 Members felt strongly that the ALLIANCE had strengthened the voice of disabled people and people with long-term conditions in the development of national policy: 96% said they had at least some impact in this area, with 54% indicating a significant impact.

2.10 When asked what had been the ALLIANCE’s biggest achievement in recent years, members were most likely to comment on the role it had played in strengthening the voice of the third sector in national policy making.

“Giving a voice to people living with long-term conditions and disability. Focus is on the members' experiences and views which hopefully influence national policy.”
A person with lived experience of long-term conditions or disability

“They strengthen the voice of disabled people and people with long-term conditions in the development of national policy.”
Member organisation, size not recorded

2.11 Policy stakeholders and sponsorship representatives also emphasised the significant impact the ALLIANCE has had in strengthening the third sector voice in policy making.

“The ALLIANCE provides an ability to work with the third sector and have their views heard.”
Policy stakeholder

2.12 All stakeholder groups emphasised the significant impact the ALLIANCE has had in raising the profile of long-term conditions, and self management in national health policy. In particular, they suggested the ALLIANCE had actively shaped the approach and language associated with long-term conditions and self management in Scotland.

2.13 In addition, several policy stakeholders and a number of sponsorship stakeholders felt the ALLIANCE had had its most significant impact in raising the profile of person centred approaches with policy makers.

2.14 Policy stakeholders and sponsorship representatives identified key characteristics in the ALLIANCE’s approach which they suggested had enabled it to have had such a significant impact in policy terms. In particular, they suggested the ALLIANCE had:

• effectively provided mechanisms and spaces to consult with its members on health and social care developments;
• readily identified emerging needs, priorities and opportunities for influence;
• developed strong working relationships with policy makers – particularly in health, but also in relation to social care; and
• taken an integrated approach to health and social care policies.

“They (the ALLIANCE) have been successful in getting among the health policies as well as social care policy and fighting for the rights of individuals.”
Policy stakeholder

“ALLIANCE work has led to light bulbs going on.”
Sponsorship representative

Information sharing

2.15 A key area of impact the ALLIANCE has had on its members relates to sharing and disseminating information. We found that:

• More than nine out of ten respondents (92%) to the online survey indicated that they received updates and information from the ALLIANCE and over half (56%) indicated they had attended training and information sharing events run by the ALLIANCE. The survey suggests that large and small organisations were most likely to attend events.
• Members were very positive about the effectiveness of the ALLIANCE’s information sharing activities. Almost all those who commented on this during the survey felt that the ALLIANCE was effective at keeping members up to date with relevant policy developments (98%), with 67% of them indicating it was ‘very effective’.
• When offered the opportunity to provide feedback on the ALLIANCE’s approach and achievements during the survey and interviews, members emphasised the ALLIANCE’s strengths in this area. They highlighted the quality and accessibility of information. They also welcomed its open communication with members, and signposting to other information sources. Events hosted by the ALLIANCE were found to be useful.

“It keeps everyone informed at all times.”
Small sized member organisation

“The ALLIANCE is always ready to answer any questions, information is readily available and it is very accessible.”
Small sized member organisation

Providing learning opportunities and support to members

2.16 The ALLIANCE was praised by members for providing support which allowed members to develop their skills, knowledge, and organisational capacity. We found:

• When asked to rate the ALLIANCE’s impact in relation to ‘improving knowledge, understanding and skills’ almost all respondents (96%) felt it had had at least some impact, with just over a half (54%) indicating the impact had been significant.
• Nine out of ten respondents (90%) said that the ALLIANCE was effective at providing ‘support to develop skills and knowledge’, with 46% saying it was very effective at this.
• When asked about its effectiveness in providing capacity building services, 83% of those who responded suggested the ALLIANCE did this effectively, with 57% saying it was very effective in this area.
• Our telephone interviews with members highlighted that information and advice provided by the ALLIANCE relates to areas such as funding applications; overcoming operational issues; and working with other organisations.
• Only a small number of members indicated that they had received support relating to operational matters such as recruitment, employment practices, policies, procedures and staffing issues (3%).

“The support that the ALLIANCE provides its members and those who are funded by them is invaluable.”
Medium sized member organisation

“In my opinion the ALLIANCE does an excellent job of supporting third sector organisations like mine with support in a multitude of different ways.”
Member organisation, size not recorded

Providing accommodation (the Hub)

2.17 The Hub is a resource for use by ALLIANCE members. It is located in the ALLIANCE offices in Glasgow city centre and provides meeting and training rooms for hire, computing equipment, hot-desking facilities and PA systems.

2.18 Members can book the facilities and are charged according to the size of their organisation. Members were generally positive about the Hub. We found that:

• Just under a third of survey respondents (31%) said that they had used the Hub facilities. Given the broad geographic spread of members who responded to the survey, this seems relatively high.
• Members who used the Hub were very positive about the facilities, with 87% of survey respondents saying that the ALLIANCE was effective in ‘providing good value, accessible meeting and event facilities and hot desks’. More than half (57%) rated the ALLIANCE as very effective in this area.
• Some members highlighted the high quality, good value facilities and support staff at the ALLIANCE as key strengths.
• For some survey respondents, the charge for use of the facilities was not a welcome introduction as they had previously used the facilities for free. However, others we spoke with highlighted that the charges were small in comparison with other venues.
• Some suggestions for improvements were made, which mostly related to improving the accessibility of facilities for disabled people. Other members commented that the Hub was not accessible to them because it was situated in central Glasgow.

“I think the Hub is an incredible resource and I am very grateful for it.”

A person with lived experience of long-term conditions or disability

Impact of specific programmes

2.19 This review has primarily focused on gathering views from stakeholders about the impact of the ALLIANCE at an organisational level. The diagram below sets out how ALLIANCE programmes, activities and reports directly relate to its aims and the Scottish Government’s 2020 Vision for Health and Social Care.

2.20 The following sub-sections provide information on the intended impact of the ALLIANCE’s key programmes, evidence on the impact of the Self Management IMPACT Fund, and recent reported achievements.

Key programmes

2.21 Here we provide an overview of the main intended impacts of key ALLIANCE programmes.

2.22 The ALLIANCE now operates a number of projects and programmes supported by the Scottish Government. The table below lists the projects, funding amounts and timescales, and gives a brief overview of their focus.

Table 2.1 Overview of the main programmes supported by the Scottish Government ^[2]

Project or programme	Agreed funding	Focus
Allied Health Professionals	£188,451 Jan 2013 – Jan 2015	The appointed post holder is working with national partners to develop strategic interventions that improve outcomes for people through closer collaboration between the Allied Health Professionals and third sector organisations.
ALISS (A Local Information System for Scotland)	£471,000 Jul 2012 – Jun 2015	ALISS aims to make information about local sources of support easier to find. ALISS has been designed by and developed with people with long-term conditions and professionals from multiple sectors involved in signposting people to support, and aims to offer a technology solution and a means of communities working together to gather, maintain and share information.
The Third Sector Health and Social Care Support Team	£540,000 Jan 2012 – Mar 2015	A team of six ALLIANCE staff provide third sector coordination and support at a strategic level to secure effective engagement of the sector in the Reshaping Care for Older People programme.
Dementia Carers Voices	£307,097 Dec 2012 – 2016	The ALLIANCE is funded to host this awareness raising project which highlights the importance of family carers being enabled after diagnosis. It focuses on the importance of building and sustaining networks of support, preventing crisis situations and feeling enabled to ask for additional help when it is needed. It also involves capturing the experiences of carers across Scotland with a view to informing future policy and service provision.
GIRFEC awareness raising project	£177,271 Nov 2011 – 2015	The ALLIANCE is developing and delivering awareness raising sessions for children and young people who are disabled or living with long-term conditions and their parents or carers. It is also delivering ‘training for trainers’ so that the sessions can be cascaded or delivered by other organisations.
Health and Social Care Academy	£210,000 Oct 2013 – 2015	The Academy will support transformational change in health and social care based on lived experience. It will do this by supporting all sector leadership, thinking, development and sharing of learning, evidence and practice.
House of Care	£210,000 Apr 2014 – Mar 2015	“House of Care” seeks to improve the relationship that people have in their day-to-day interaction with the NHS and social care to ensure it is organised around what matters to them. The ALLIANCE is also hosting a post holder for three years to develop the “House of Care” model in Scotland.
Links Worker Programme	£1,350,000 Aug 2013 – Jul 2015 [3]	This programme aims to explore how primary care teams can support people to live well in their community, by connecting GPs with local assets.
My Skills, My Strengths, My Right to Work	£285,000 2012 – 2015	The ALLIANCE was awarded funding from the Scottish Government Equality Fund to improve access to the labour market for people with long-term conditions, including by promoting self management approaches. The programme explores and develops good practice, and raises awareness around employability. This is being achieved by working with the ALLIANCE members and forging partnerships with key employability organisations.
People Powered Health and Wellbeing	£1,414,360 2013 - 2015	The aim of this programme is to enable people to influence their own health and wellbeing and contribute to the design, delivery and improvement of support and services, including peer support. The ALLIANCE is working closely with Healthcare Improvement Scotland, NHS Education for Scotland and the Joint Improvement Team to support local health and care teams to make their services more person-centred.
Practice and Partnership Development Programme	£450,000 April 2014 - Mar 2017	The aim of this programme is to ensure that self management is central in the support and services available to disabled people, people living with long-term conditions and their unpaid carers in Scotland.
Primary Care Development Programme	£125,893 Jul 2012-2015	Project to improve access to information and promote health literacy for people living with long-term conditions.
SDS project	£172,000 (consortium of IRISS and SCLD) and £214,504 (Policy and Outcomes Officer), 2011-2015	The ALLIANCE works with IRISS and SCLD to deliver this programme. It also hosts a Senior Policy and Outcomes Officer post, to build the capacity of care and support providers and particularly to support people to make sense of self directed support in the context of health and social care integration.
Self Management Awareness Raising project (MCMTML)	£75,000 Jul 2012 - Jun 2015	The ALLIANCE is delivering this social marketing campaign to increase awareness of self management.

Key achievements

2.23 The ALLIANCE undertakes a very wide range of work, as part of its core activities. Here we highlight some of the key achievements the ALLIANCE has recently reported ^[4] .

2.24 The ALLIANCE has been actively involved in the development of national and European policy. In collaboration with others, it has worked to represent member views, and improve approaches and legislation. Reported achievements during 2013 included:

• working alongside the Scottish Government, Healthcare Improvement Scotland and NHS Education for Scotland to promote the strengths of third sector partners;
• representing member interests on the 2020 Route Map Ministerial Programme Board and the Quality Alliance Board;
• influencing legislation on health and social care – particularly regarding human rights based approaches;
• helping shape the Public Bodies (Joint Working) (Scotland) Bill;
• influencing the Social Care (Self Directed Support) (Scotland) Act and Children and Young People Bill;
• being actively involved in the expert panel to inform the development of Scotland’s Second National Dementia Strategy and participating in the Dementia Forum;
• participating in the Ministerial Task Force on Health Inequalities;
• being appointed Patient Lead and Chair of the European Patient’s Academy on Therapeutic Innovation UK - which brings together patient groups, industry and academia to support public involvement in medicines development and research;
• playing an active role in the development of Scotland’s first National Action Plan for Human Rights, and jointly convening the action group focusing on human rights approach in health and social care; and
• participating in the European Innovation Partnership on Active and Healthy Ageing’s Action Group on Age Friendly Environments.

2.25 The ALLIANCE regularly works with other organisations at a national and local level to develop support and resources to inform those who provide services and those who use them. In addition to managing the Self Management IMPACT Fund, reported achievements during 2013 included:

• reaching over 2,000 health and social care professionals and students, in order to share the lived experience of people who are disabled or living with long-term conditions;
• producing a range of new resources, in collaboration with its members and people with lived experience – these included a learning resource with NHS Education for Scotland, new Quality Services Values for Allied Health Professionals, new guidance for Lymphodema in partnership with people living with the condition, and specific materials for MSPs in advance of a Parliamentary debate on person-centred approaches;
• delivering high profile events – including the ‘Life, Letters and Love Stories’ concert, in collaboration with Celtic Connections and Regular Music, which celebrated the role of carers in Scotland;
• working to build the capacity of the third sector at a local level – with Third Sector Interfaces, national third sector organisations and Housing Associations on the Reshaping Care for Older People agenda;
• delivering the fourth annual Self Management Week which celebrated the power of community and peer-led activity in self management;
• coordinating a website to help people make connections and work better across the third and statutory sectors;
• as part of the ‘What Matters, What Counts’ programme, the ALLIANCE produced a series of publications exploring how personal outcomes approaches can be embedded in the design and delivery of social care;
• publishing think pieces including “Being Human, A Human Rights Based Approach to Health and Social Care in Scotland “ and ‘Health and Social Care in Scotland – Integration or Transformation’; and
• in partnership with the Joint Improvement Team, publicised ‘In Good Faith’ – which highlighted good practice of faith communities in supporting vulnerable people.

The Self Management IMPACT Fund

2.26 The ALLIANCE administers the Self Management IMPACT Fund on behalf of the Scottish Government. This grant programme covers the period 2013-14 to 2015-16. It builds on the learning of the previous Self Management Fund which ran during 2009-10 and 2010-11 and invested £4 million in 81 self management projects across Scotland.

2.27 The Self Management IMPACT Fund allows third sector organisations and partnerships to develop and strengthen new project ideas that support self management as well as building on existing approaches.

2.28 The ALLIANCE provides support and advice to organisations receiving funding. It has worked closely with Evaluation Support Scotland to support projects to evaluate their impact in an outcomes-focused way.

2.29 During the survey and in interviews we explored member views about the impact of the Self Management IMPACT Fund, and the ALLIANCE’s associated support activities. We engaged with seventeen funding recipients through the survey and four during telephone interviews.

Effectively managed

2.30 Members we spoke with about the fund were positive about the ALLIANCE’s approach to managing the fund. When asked during the survey to rate the extent to which the ALLIANCE performed this role effectively, the majority of members responding to this question indicated it was very effective (63%) or effective (27%).

2.31 In addition, the support provided by the ALLIANCE was viewed positively by the small number of selected members we spoke with. They told us about how supportive the ALLIANCE had been during the application stage and the ease with which the application could be submitted. Members also spoke of an open dialogue between themselves and the ALLIANCE in relation to their funding options. Some members talked about having worked directly with staff at Evaluation Support Scotland. They received advice and support with monitoring and evaluation – and this was highly valued.

“The ALLIANCE is unlike other funders. They will sit down and meet with organisations and discuss the suitability of the fund. It’s a very open process and not many funders do that.”
Small sized member organisation

“By undertaking the evaluation with support from Evaluation Support Scotland, we were able to evidence the impact of our service.”
Large sized member organisation

The impact of the fund

2.32 A number of special reports have been prepared which demonstrate the impact of the Self Management IMPACT Fund on the individual organisations or groups it supports. These special reports set out outcomes-focused case studies. They suggest that the fund has:

• Generated health and wellbeing outcomes for individuals – The special reports identify a range of examples where individuals have improved knowledge, skills and confidence as a result of funded programmes. There is also good evidence that this had led to improvements in their health and wellbeing, and wider benefits for organisations and services.
• Supported the development of new self management programmes – Organisations and groups have been able to establish new approaches and programmes, often targeted at specific groups.
• Strengthened existing programmes – As a result of the fund, organisations have been able to build on their existing staff skills and capacity, and develop volunteers.
• Enabled organisations to develop and strengthen their business models – For example, the funding led one smaller organisation to tender to deliver activities for Alcohol and Drug Partnerships. This organisation has also worked with Community Outreach Teams to explore social enterprise possibilities. The Self Management IMPACT Fund has acted as leverage for some smaller members to engage with other funding sources and partnerships.
• Developed an evidence base about the impact of self management – For example one organisation had developed a self-management and life-coaching programme. This organisation was able to evidence a subsequent decreasing demand on NHS services and an increase in positive emotional and mental health. A national organisation was able to demonstrate positive mental health and wellbeing outcomes (including increased confidence and self esteem) as a result of their physical and sport activities. Another organisation was able to show that increases in mental health and wellbeing resulted in increased attendance at appointments.
• Supported collaboration and joint working in the field of self management – For example, a national organisation has worked in partnership with a wide range of health practitioners, other specialists, and people with lived experience to develop a programme of support.
• Offered opportunities to learn from lived experience – For example, one organisation had created a library of short films to share experiences and raise awareness of issues relating to caring. Others developed programmes which allowed people with lived experience to support others with similar conditions, or to shape the development of services.

Other views about the fund

2.33 During telephone interviews members reinforced the impacts explored through the existing evaluation work. In particular, small organisations spoke of being able to ‘grow and develop’ as a result of the fund.

“It has acted as leverage for other funding and partnerships because of the credibility of being linked with the ALLIANCE. It stands you in good stead.”
Small sized member organisation

“It has made a tremendous difference, and allowed us to concentrate on the organisation.”
Small sized member organisation

2.34 The fact that the Self Management IMPACT Fund covered three years was welcomed by some members we spoke with. In comparison to other funding streams, this fund has allowed organisations to develop and deliver their projects in a more ‘reasonable’ time frame.

“Prior to the ALLIANCE, funding was at best bitty....this allowed us time for project development and delivery.”
Small sized member organisation

2.35 Some members who responded to the survey suggested that funding awards should be linked to more specific outcomes.

Summary

2.36 Our research suggests that the ALLIANCE has been successful at ensuring its members’ views are gathered and heard.

2.37 Members felt able to contribute their views to the ALLIANCE through different methods, such as consultations, reference groups and research. They thought that the ALLIANCE was effective at collecting the views of its members on relevant policy and delivery issues.

2.38 The ALLIANCE was thought to have a particular strength in raising awareness of long-term conditions and being able to communicate these needs to the Government.

2.39 Members, policy stakeholders and sponsorship representatives were generally very positive about the ALLIANCE’s ability to provide a voice for people with lived experience. Ninety-five percent of respondents to the online survey said that the ALLIANCE was effective at providing a voice for this group.

2.40 All stakeholder groups felt that the ALLIANCE has had a very influential role in shaping policy – particularly in relation to self management, person centred approaches and third sector involvement in health and social care. It was viewed as having supported policy discussions at a national level and taken an integrated approach to health and social care policies.

2.41 Members felt that the ALLIANCE has effectively offered a range of opportunities to hear about policy developments, engage in discussions and consultation processes, and develop knowledge and skills. The members we engaged who used the Hub were generally positive about its facilities.

2.42 The ALLIANCE carries out a very wide range of work to support the development of effective policy and legislation in Scotland and beyond. It has participated in a wide range of forums, and has actively influenced a range of policy and legislative developments.

2.43 The ALLIANCE has also delivered a range of activities to support people who deliver services and those who receive them. This includes working with a range of other organisations to develop publications, resources, events and direct support programmes.

2.44 Existing evidence and the views of members suggests that the Self Management Impact Fund has provided opportunities for organisations to develop new and existing programmes, and to demonstrate the value of these.