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

3. The ROLE OF the ALLIANCE

Introduction

3.1 This section provides an analysis of the views of stakeholders in relation to the current and future role of the ALLIANCE. This includes information from the member survey (completed by 99 members). It also includes information from qualitative interviews: with members (13); sponsorship representatives from the Scottish Government and the Joint Improvement Team (11); and policy stakeholders (9).

A valuable intermediary role

3.2 During interviews we explored the need for a national third sector organisation which represents the views of the people and organisations represented by the ALLIANCE. Members, policy stakeholders and sponsorship representatives clearly valued the role of the ALLIANCE. They particularly emphasised its value as an intermediary in terms of:

• bringing together smaller third sector organisations to engage in health and social care policy developments;
• creating opportunities for policy makers to understand the views of people with lived experience; and
• providing expertise in relation to long-term conditions, self management and person centred approaches.

“It’s certainly important to have an umbrella organisation.”
Small sized member organisation

“There is strength in third sector organisations coming together and harnessing a purpose like health and social care. It makes sense for them to pool resources and to collectively sharpen lobbying activity.”
Policy stakeholder

“If we didn’t have the ALLIANCE we would need to invent [a body like it].”
Sponsorship representative

3.3 Some policy stakeholders and sponsorship representatives felt strongly that without the ALLIANCE, there would not be such a strong emphasis on self management, person centred approaches and the role of the third sector in health and social care policy in Scotland.

Unique strengths

3.4 The research asked for feedback on what the ALLIANCE does particularly well. Stakeholders readily identified strengths – which generally reinforced points discussed elsewhere in this report, including:

• skills and expertise around person centred approaches;
• being well connected to its members and responding to their needs;
• the ability to identify opportunities to influence decision making;
• providing a voice for people with lived experience and the third sector organisations The ALLIANCE represents;
• the ability to bring diverse groups of people together;
• a high profile and partnership relationship with the Government; and
• its strong focus on, and integrated approach to, health and social care.

“It puts itself out there; it is very good and influential and is using its influence.”
Policy stakeholder

“The ALLIANCE brings together specific services and it has a strong voice, and a collective voice for long-term conditions.”
Large sized member organisation

“Its policy and Government links are excellent. It influences real things for real people.”
Professional associate

Stakeholder views on future strategic focus, role and activities

3.5 The ALLIANCE has expanded its focus in recent years, to reflect its changing role and the landscape in which it operates. While its diverse membership base and approach were viewed as key strengths, there was concern across stakeholder groups that in broadening its remit, activities and membership base, the role and focus of the ALLIANCE was now less clear than it had previously been. Some suggested that the wide range of (what appeared to them to be) quite different projects and programmes adds to this impression. Such views indicate there may be an opportunity for the ALLIANCE to further communicate its strategic focus and how individual projects relate to this.

“I sometimes find it confusing to work out what the ALLIANCE does. . . they could communicate better.”
Large sized member organisation

3.6 Generally, those we spoke with wanted to see the ALLIANCE broadly continue in a similar intermediary role, building on its unique strengths. They felt there was an ongoing need for its influential role in relation to long-term conditions, person centred approaches and (along with other intermediaries) developing the role of the third sector in the design and delivery of health and social care.

3.7 During interviews we asked stakeholders about the types of activities the ALLIANCE should undertake in the future, and whether there were any new areas of activity it should explore. Many of those we spoke with expressed the view that the ALLIANCE should broadly continue with similar types of activities. However, a number of policy stakeholders and members suggested that the ALLIANCE’s current range of projects needed to be refocused.

“They have developed and grown, which is a testament to [the Chief Executive] but they need to consolidate and focus.”
Professional associate

“They are getting bigger and they should realise that there are maybe two or three things that they do very well and where they can have the best impact.”
Policy stakeholder

The 2020 Vision

3.8 During the survey and interviews we explored views about the future role of the ALLIANCE in relation to the Scottish Government’s 2020 Vision for Health and Social Care ^[5] in particular. This vision sets out that by 2020 everyone will be able to live longer and healthier lives, at home or in a homely setting and where:

• we have integrated health and social care;
• there is a focus on prevention, anticipation and supported self-management;
• if hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm;
• whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions; and
• there will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

3.9 Stakeholders felt that the ALLIANCE has an ongoing role in supporting the delivery of the 2020 Vision. In particular they felt it should:

• Support the development of the third sector in health and social care - A number of sponsorship representatives and policy stakeholders highlighted this potential role. They also emphasised the importance for the ALLIANCE and the Scottish Government to engage with other intermediaries in reforming health and social care delivery.
• Strengthening the voice of its members in policy development - Members strongly emphasised the ongoing role the ALLIANCE has in representing third sector views and ensuring the views of its members are heard at strategic levels in relation to the 2020 Vision and associated developments. Those who commented on this felt that the ALLIANCE should maintain its current role as a ‘link’ between the Scottish Government and its members.
• Strengthening the voice of people with lived experience – Sponsorship representatives, policy stakeholders and members emphasised the need for an ongoing voice of people with lived experience in relation to the 2020 Vision, and suggested the ALLIANCE was well placed to provide this.
• Further promoting person centred approaches - Others highlighted that the ALLIANCE could drive progress towards the 2020 Vision, and work to ensure person centred approaches were truly adopted and embedded. This was perceived to be a key area of expertise.

“The ALLIANCE could influence the way health strategy is delivered. That should be their role. It should be the vehicle by which third sector organisations can deliver services.”
Policy stakeholder

“The future could embrace and enhance current ALLIANCE work practices by being a conduit between Scottish Government and third sector organisations who will all be working towards the 2020 aims.”
A person who cares for or supports

someone with a long-term condition or disability

“. . . ensuring that views of all members representing long-term conditions are included. There is no one size fits all approach to self management or services for different long-term conditions.”
Small sized member organisation

“So that the 2020 Vision doesn’t just become another strategy, so that it is actually actioned.”
Large sized member organisation

3.10 The ALLIANCE has had a Strategic Partnership Agreement in place with the Scottish Government since 2008. However, some members and policy stakeholders felt it was important to ensure that the ALLIANCE did not become, or be perceived to be, just a “delivery agent” for the Scottish Government. They wanted to see it continue to represent member interests, and influence policy.

Supporting integrated health and social care partnerships

3.11 We specifically asked members, policy stakeholders and sponsorship representatives about the potential role for the ALLIANCE in supporting integrated health and social care partnerships. A range of stakeholders reinforced the role the ALLIANCE could play in supporting the development of person centred approaches and providing a strong voice for its members as integration develops further.

3.12 Members responding to the survey were particularly keen for the ALLIANCE to maintain its ‘seat at the table’ of Government and to continue to represent the views of third sector organisations in discussions with health and social care partners at a national level.

“It has a major role to play in making the Public Bodies Joint Working Act a reality.”
Sponsorship representative

“The ALLIANCE has strong connections at a policy level in Government on how to address long-term conditions. It can give an independent perspective.”
Large sized member organisation

3.13 Some of those we spoke with identified challenges for the ALLIANCE in influencing the activity of individual health and social care partnerships. They felt that the ALLIANCE would need to either develop a stronger local presence; or continue to work through existing structures to influence change.

Representing a diverse membership base

3.14 Our research suggests that the ALLIANCE’s connection with its membership is a key strength. However, members and some others suggested the ALLIANCE may face challenges in effectively representing what is now a large and diverse membership base. They highlighted the need to maintain relationships with its members. They also emphasised the potentially diverse and conflicting agendas of (for example) people with lived experience and service providers.

“The ALLIANCE has not lost touch with those it represents – yet, but this is a big risk.”
Policy stakeholder

“My worry is that it is too much of an umbrella organisation”
Member organisation, size not recorded

“[Its challenge is] to ensure that the range and spread of organisations it aspires to represent feel they are genuinely influencing.”
Sponsorship representative

Stakeholder views about working with or alongside others

3.15 During interviews with policy stakeholders and sponsorship representatives, we discussed how the role and activities of the ALLIANCE relate to those of other organisations. We also gathered views about the ALLIANCE’s approach to partnership working.

3.16 The ALLIANCE is clear that it strives to work collaboratively with a wide range of organisations involved in health and social care in Scotland. Its publications and reports suggest it is working with a wide range of organisations at a local and national level, including other third sector intermediaries – both in terms of policy development and programme delivery. Examples of specific work can be seen in Section 2.

3.17 Many of those we spoke with who had experience of working with the ALLIANCE were positive about this and highlighted that there had been mutual benefits from the relationship.

“We have no complaints. We have an open and good relationship with them.”
Policy stakeholder

“They can offer knowledge and networks which is the same as [my organisation] and is extremely helpful.”
Policy stakeholder

3.18 A number of policy stakeholders and some sponsorship representatives emphasised that the ALLIANCE is one of a number of intermediaries involved in health and social care. Some highlighted the increasingly competitive nature of the third sector and identified perceived tensions between organisations as a result of this. There was also a perception among some that the ALLIANCE has at times been presented as the main intermediary for all stakeholder groups involved in health and social care.

3.19 A range of stakeholders emphasised the important role the ALLIANCE has played in promoting the role of the third sector in health and social care. Policy stakeholders and sponsorship representatives made suggestions about how the ALLIANCE could further strengthen its partnership working in order to further develop the role and voice of the third sector, and its members.

3.20 In particular, some reiterated that the ALLIANCE could be clearer and more specific about its strategic focus and skills. This would enable it to distinguish itself from other intermediary organisations.

“It is important in the sector for there to be clarity over who does what and this includes skills, abilities and expertise.”
Policy stakeholder

“There is a risk of overlap between the ALLIANCE and other organisations. There needs to be clarity about what the ALLIANCE and others do.”
Policy stakeholder

3.21 Others emphasised their view that the ALLIANCE and other intermediaries need to work together – particularly when developing new programmes and on important policy developments. In this sense, potential overlaps were also opportunities to work together.

“More joint working is needed – maybe not on all issues, but they need to come together on joint common issues. This would increase their political force.”
Policy stakeholder

“[It needs to be] collaborative. No single part of the voluntary sector or health and social care can do this on their own.”
Policy stakeholder

3.22 The review process has also highlighted the important role of the Scottish Government in supporting organisations to work collaboratively. There was recognition that Government approaches had contributed to competition and tensions within the sector. There are opportunities for the Scottish Government to support collaboration and ensure relevant interests are taken into account.

Summary

3.23 Members, policy stakeholders and sponsorship representatives feel that the ALLIANCE has a valuable ongoing role as a national intermediary. It was viewed as being particularly strong in representing the interests of third sector organisations which focus on long-term conditions, and people with lived experience.

3.24 Stakeholders identified what they saw as the ALLIANCE’s key strengths – its expertise in person centred approaches; its strong connection with its members; its ability to provide a strong voice for its members and people with lived experience; its high profile with Government; and its strong focus on health and social care.

3.25 There was support for the ALLIANCE to broadly continue in the same role as it has to date, undertaking the same types of activities. However, a range of stakeholders suggested that the ALLIANCE has to clarify (and possibly sharpen) its role, and the narrative about its role, following a period of growth and development.

3.26 A range of stakeholders spoke of very positive experiences working with the ALLIANCE. They valued its unique skills and innovative approach.

3.27 Some policy stakeholders and sponsorship representatives suggested there is an ongoing need for close working between national third sector organisations and others involved in health and social care. The Scottish Government has a potential role in supporting appropriate joint working at a national level.

3.28 A range of stakeholders believed the ALLIANCE was well connected to its members – and this was valued by members responding to the survey. However, it was suggested that the ALLIANCE needs to work to maintain this, following a period of significant expansion.

3.29 The Scottish Government, policy stakeholders and members agreed that there was an important role for the ALLIANCE in supporting the delivery of the Government’s 2020 Vision for Health and Social Care – particularly in ensuring that person centred care becomes a reality and that people who access services have a strong voice in policy. Those we spoke with also called for the ALLIANCE (with others) to strengthen the third sector voice and develop the role of the third sector in health and social care.

3.30 There was recognition that the ALLIANCE could support person centred approaches and the development of the third sector role as health and social care integration continues.