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

5. DISCUSSION and recommendations

Introduction

5.1 This section of the report discusses the key findings of the review. It summarises stakeholder views about the ALLIANCE’s impact to date, and its future role and activities. It identifies key insights regarding the current and proposed relationship between the ALLIANCE and the Scottish Government and sets out recommendations for progressing this.

The ALLIANCE’s impact

5.2 Most of those we spoke with felt strongly that the ALLIANCE has had a very significant positive impact on national health and social care policy in recent years. In particular, representatives from across stakeholder groups felt that it had shaped the language and approach to health and social care policy in Scotland, particularly in relation to self management, person centred approaches, and the role of the third sector. Some emphasised the significance of this impact – suggesting that person centred approaches and the third sector would not feature so prominently in the current agenda, had it not been for the ALLIANCE.

5.3 ALLIANCE members who engaged in the review process were very positive about the impact and effectiveness of the ALLIANCE – particularly in terms of representing their views and interests, and those of people with lived experience, at a national level. Members also highlighted the benefits of the Self Management IMPACT fund, and these were supported by outcomes-focused evidence of its impact.

5.4 It is worth emphasising at this stage that this review was largely based on the perceptions and views of those we spoke with, and focused on impact at an organisational level (rather than programme or project level). In order to understand the contribution of specific projects and programmes, we reviewed a large volume of planning and reporting information from the ALLIANCE. While this information provided a great deal of detail about the ALLIANCE’s activities and outputs, it did not reflect the significant impact ALLIANCE stakeholders said it was having. Agreeing a set of overarching strategic outcomes in a new Strategic Partnership Agreement could provide the ALLIANCE with a framework to report more effectively.

5.5 It is also worth noting that we spoke with a relatively small number of policy stakeholders during the review process, and that almost all the information gathered as part of the research was perception based.

The future role of the ALLIANCE

5.6 All stakeholder groups emphasised that there is an ongoing need to have an intermediary like the ALLIANCE. They emphasised that it had originally been established to meet a need (representing third sector organisations with an interest in long-term conditions and ensuring people with lived experience have a strong voice) and this need still exists.

5.7 Stakeholders wanted to see the ALLIANCE build on its key strengths and continue to focus on person centred approaches, and develop the role of the third sector in health and social care.

5.8 The review identified challenges and potential risks for the ALLIANCE in the future, related to its strategic focus and range of activities. A range of stakeholders felt that the ALLIANCE now needs to take stock and consolidate (even sharpen) its strategic focus, and activities. At times we encountered a lack of understanding of the extent of its remit and scope. Some emphasised the need to ensure that the ALLIANCE doesn’t lose touch with its membership base, given their number and diverse interests. Others highlighted the need to avoid conflicts (whether real or perceived) associated with being funded by the Scottish Government on the one hand, and effectively representing its members’ interests on the other. In many cases, such challenges were identified as areas of potential risk – issues those involved felt the ALLIANCE needed to be aware of, and mitigate. Those we spoke with during the review also emphasised the very real strengths the ALLIANCE has – and called for it to build on these, to further strengthen its role.

5.9 The ALLIANCE feels strongly that it has a clear strategic focus and role. Those we spoke with in the ALLIANCE suggested that a new outcomes-focused strategic partnership agreement would further allow it to make clear the links between specific programmes, and its strategic priorities. While key staff recognise the potential challenges in having a diverse membership base, range of activities and close relationship with the Scottish Government, they are also clear that these can be managed. It is our view that while the ALLIANCE has a unique role and remit, many membership organisations operating at a national level in Scotland face similar challenges. We believe the development of a new strategic partnership agreement will offer the ALLIANCE and the Scottish Government the opportunity to clarify the organisation’s focus in terms of Government funded programmes.

5.10 A range of stakeholders welcomed an ongoing role for the ALLIANCE in making the 2020 Vision for health and social care a reality. They wanted to see it continue its influential work around person centred approaches. They also called for it to work with other intermediaries to promote and develop the role of the third sector in health and social care. As part of this, there was support for the ALLIANCE continuing to support joint working between health and social care, particularly at a national level.

5.11 Some strategic and sponsorship stakeholders emphasised the ongoing need for intermediaries involved in health and social care to work effectively together. Furthermore, the review has highlighted opportunities for the Scottish Government better to support joint working at a national level.

The ALLIANCE’s funding relationship with the Scottish Government

5.12 Many of those with a funding relationship with the ALLIANCE clearly viewed it as a flexible and effective organisation. We heard about very positive experiences of how it has worked with the Scottish Government and the Joint Improvement Team to develop new ideas and programmes in response to emerging needs.

5.13 However, the review process has reinforced the need for a more strategic approach to the funding relationship between the Scottish Government and the ALLIANCE. The varied approaches and short term funding decisions are resource intensive to manage and can undermine the ALLIANCE’s ability to plan its business effectively. The lack of outcomes-focused targets and evaluation – both for its core and project funding - make it difficult to demonstrate clearly the impact of the ALLIANCE’s specific projects and programmes on an ongoing basis. A more consistent approach to outcomes-focused planning and reporting could provide clarity and improve understanding of how impacts and funding streams relate to each other.

5.14 In principle, we found broad support for moving towards a more longer term, strategic Partnership Agreement. We also found broad support for improving and rationalising the approaches to core and programme governance, planning and reporting.

5.15 There are a number of internal issues the Scottish Government will need to resolve in order to fully rationalise the underpinning sponsorship processes effectively. The role of wider processes (such as the review of grant processes within the Scottish Government) may influence how this is taken forward, in the longer term. However, we do believe there are a number of practical steps which should be taken to progress a Strategic Partnership Agreement in the short term (November 2014 to April 2015) and build on this in the longer term. Our reco mmendations are outlined here.

Recommendations

A new Strategic Partnership Agreement

5.16 We recommend that the Scottish Government works with the ALLIANCE to jointly draft a new Strategic Partnership Agreement. This should be an accessible, high level document which is in keeping with the spirit of partnership, and actively supports the Scottish Government and the ALLIANCE to strengthen their impact. We recommend it should:

• Set out how the two organisations will work together – The document should provide a narrative, which expresses the shared values and priorities within the partnership.
• Be outcomes-focused – It should clearly set out the key outcomes that the ALLIANCE will focus on delivering, for the funding it receives from the Scottish Government, during the period of the Strategic Partnership Agreement.
• Provide a strategic framework for understanding performance – It should include a small number (about six) high level, outcomes-focused indicators (and potentially targets) to allow impact to be reported.
• Role of the ALLIANCE – The Strategic Partnership Agreement should be clear about the role of the ALLIANCE and how it works with others.
• Provide an overview of activities – It should describe the broad areas of activity the ALLIANCE will deliver to bring about the agreed outcomes.
• Be longer term – It should cover a three year period, and allow a refresh of the outcomes based on experience.

5.17 We recommend that the Scottish Government and the ALLIANCE work to have a draft Strategic Partnership Agreement in place by the end of November 2014. This should include agreed outcomes, outcomes-focused targets and indicators, and proposed activity areas.

5.18 We suggest this builds on the initial draft outcomes map developed as part of this review process and included as Appendix Two. This map could be further strengthened by rationalising the specific outcomes, and perhaps arranging these into ‘intermediate’ and ‘end’ outcomes to demonstrate the logic that delivering some outcomes will lead to the delivery of others. We believe there would also be value in testing the extent to which the agreed outcomes link to the priorities for the 2020 Vision.

5.19 If funding is to be awarded, we recommend that the Scottish Government moves to agree the ALLIANCE’s core grant funding as soon as possible. ^[7]

An annual planning and financial cycle

5.20 We recommend that the partnership relationship between the Scottish Government and the ALLIANCE is underpinned by an annual planning and drawdown cycle. We suggest the two organisations agree broad timescales for each element, including:

the submission and sign off of an annual activity plan – which broadly sets out specific activities and areas of collaborative activity in the coming year, based on the Strategic Partnership Agreement;

meetings to review progress and share learning;

a simple schedule for financial processes – such as drawing down funding, submitting monitoring information, and applying for further funding (while remaining responsive to emerging priorities and opportunities).

Consolidating funding

5.21 We recommend that the Scottish Government explores the opportunities and benefits of consolidating individual programme funding streams into the ALLIANCE’s core budget. Where there is a genuine need for projects and programmes to continue throughout the life of the Strategic Partnership Agreement, we feel there is value in bringing these together. Clearly, the mechanisms for doing this will need to be further discussed with finance professionals within the Scottish Government.

5.22 While we recognise that this process may need to be developed over time, we think the two organisations should work quickly to identify which programmes could be brought together in this way, and (where this is not possible) provide a clear rationale for this.

Rationalising programme governance, planning and reporting

5.23 Whatever decisions are taken about consolidating programme funding into the core settlement for the ALLIANCE, we believe there is a strong argument for rationalising the programme and core governance arrangements, planning and reporting requirements attached to all ALLIANCE funding. We recommend the Scottish Government works to:

• look at the opportunities for one team or group within the Scottish Government to have an overview of all ALLIANCE activity (with advisory and steering functions performed by other boards or groups, where appropriate);
• rationalise funding administration with potentially a single grant offer letter and single payment process for all funding; and
• develop one planning template (such as a Project Initiation Document), and report template to be used for as many funding streams as possible - while these should gather basic financial and output information, they should be strongly outcomes-focused.

5.24 In rationalising and simplifying governance, planning and reporting arrangements, it will be important to take a flexible and practical approach, and respond to individual programme needs.

5.25 At the moment the ALLIANCE is not required to evaluate and report in an outcomes-focused way across its programmes. We recommend that the ALLIANCE and Scottish Government work together to improve this. This doesn’t need to be complex, and could usefully involve self evaluation, feedback from members and other evidence sources. The ALLIANCE should identify a small number of evaluation tools (such as a member feedback form) which can be used to gather information on its progress towards the outcomes agreed in the Strategic Partnership Agreement, or in relation to particular programmes. The ALLIANCE’s methods should also allow it to capture learning about what works and what could be improved in terms of its activities. The ALLIANCE or its funders may wish to commission independent evaluation of its work. It will be important to ensure any such evaluation is appropriate and robust.

A more strategic approach to developing new projects and programmes

5.26 Over the life of any new agreement it seems likely that new needs will emerge in relation to health and social care. The ALLIANCE may be one of a number of organisations with a role in delivering activities to meet these needs. We recommend the Scottish Government continues to develop a more strategic and planned approach to commissioning health and social care activities. We believe this could improve transparency and joint working in health and social care and strengthen the role of the ALLIANCE. We also recommend that the Scottish Government should require funded organisations clearly to set out the specific outcomes to be delivered as part of its funding agreements.