Agenda item 3 is a round-table evidence-taking session with representatives of community planning partnerships in Glasgow, Moray and North Ayrshire. I welcome to the meeting Lynn Brown, deputy chief executive and executive director of finance, and Jim Gray, head of democratic services, Glasgow City Council; Laura Friel, executive director of finance and corporate support, North Ayrshire Council; Iona Colvin, director of the health and social care partnership involving North Ayrshire Council and NHS Ayrshire and Arran; Roddy Burns, chief executive, Moray Council; and Pamela Gowans, chief officer of health and social care integration, NHS Grampian.
With the round-table format, which is something that the committee is very familiar with, I will ask one of the witnesses to kick off; in this case, it will be Lynn Brown, who has been forewarned, albeit with only three or four minutes’ notice. Once Lynn has responded to my initial question, anyone who wishes to contribute will be able to do so simply by getting my attention—you just need to raise your hand, nod or whatever—and I will take people in sequence.
You can come in as often as you like, and we can, for example, have cross-discussions in which witnesses ask other witnesses questions. If things start to get bogged down, I might stimulate the proceedings by picking one of you at random and quoting from your submission. That will keep you on your toes.
I ask Lynn Brown to provide an update on evidence that was provided to the Finance Committee in 2010 during its preventative spending inquiry. One witness said:
“We are at the early stages of implementation”
of Glasgow’s early intervention programme
“and we need the results and early indications of how well we are doing before we can determine what to do in shifting resources.”—[Official Report, Finance Committee, 16 November 2010; c 2723-4.]
Another said:
“The intergenerational issue is that we are constantly responding to different pressures in terms of the deprivation in a city such as Glasgow and, to be very honest about it, I am not sure that we will ever tackle it absolutely.”—[Official Report, Finance Committee, 16 November 2010; c 2726.]
What progress has been made in the four years that have elapsed since then?
A significant amount of progress has been made in Glasgow over those four years; indeed, that was reflected in our community planning audit by Audit Scotland, which said that we had made progress. In fact, since the Audit Scotland report was published, we have made more progress on joint resourcing, which I can tell you about if you like.
For us, the key thing happened in 2012. For a start, we completely overhauled our structures. We put in place a board that is chaired by Bailie Aileen Colleran, who has made significant progress, and which includes the statutory organisations that should be involved plus a few others such as the Wheatley Group, which looks after social housing in a large part of Glasgow, and some people from the voluntary sector. The board is very much at the highest level and comprises the board chairs of those organisations. It is underpinned by an executive group that is chaired by the chief executive and which comprises chief executives from those organisations and a few others including the DWP, Skills Development Scotland and the colleges.
We also overhauled our more local structures and put in place 21 area partnerships, which report on community planning in three sectors of the city: the north-east, the north-west and the south. A hard look has been taken at our structures. Our view is that we have to have the right structures and the right people at the right levels in order to make progress. That is reflected in the report.
11:00One thing that came up in the Audit Scotland report—I know that it is a frustration for the Scottish Government as well—is the lack of progress on joint resourcing and budgeting. We have made some progress on that with the national community planning group, which is chaired by Pat Watters. We decided to focus on being more targeted in our community planning. We have the national priorities, but we have been targeting areas in which we believe that we, as a community planning partnership, can make progress. There are three main areas for us: youth employment, alcohol and the vulnerable, which covers two areas—homelessness, which we are looking at first, and in-work poverty. We are looking at joint resourcing there. Before Christmas, I was tasked with setting up a group to look at that, and we have all the directors of finance on the group, which is looking at our budgets. We have already made good progress on youth employment and we have processes in place for the other two areas.
That is a high-level description of how we have been tackling the issues since 2010. Our view is that we have made progress, but there is still a significant amount of work to be done.
I have a question before I let John Mason and then others in. The “Glasgow Community Planning Partnership” report states:
“The Commission is encouraged by the clarity of purpose and direction of Glasgow Community Planning Partnership ... the CPP has made an important shift towards a more long-term, preventative approach to public services that aims to break the cycle of poverty and poor health.”
However, it states that the CPP
“needs to address how it identifies, allocates and redirects resources to fulfil”
the three priorities, noting that
“Only a small proportion”
of the available money is allocated to them.
The first thing is that we are trying to establish exactly what those amounts are. We have worked out that a total of about £148 million has been spent on youth employment by a range of agencies in Glasgow, including those in the voluntary sector. It took a bit of work to get that in place.
What time period is that figure for?
It is for 2013-14.
All partners in the community planning partnership agreed, and we have put it in our budget papers, that we are committed to joint resourcing. We are looking at it, but we are looking at the areas in which we feel that we can make the most progress.
We have just started work on the next area, which is alcohol. The council is leading on the work on youth employment, and the work on alcohol is being led by health. The figure there is quite minimal; it is about £40 million. Again, there is real progress to be made on that.
The third area is homelessness. We can say how much is being spent on that by the council, for example, but at this point we cannot say how much is being spent on it across the city.
On the scale of budgets, I think that, in the report, the Accounts Commission gives a figure of about £4 billion for the spend in Glasgow. It breaks that down, and there is about £1.3 billion for the city itself. A lot of that is DWP spend, loan charges and employee costs. We have decided to take a more targeted approach to the hard-to-reach and hard-to-deal-with areas first of all.
I seek clarification as to what is actually happening, as compared with structures, planning and things.
Paragraph 3.3 of Glasgow community planning partnership’s submission talks about the purpose of joint resourcing activity, which it says is
“to gain a holistic understanding”,
“to analyse and assess”,
“to consider”,
“to quantify”
and
“to consider”,
which all suggests to me that we are still at the preparatory stage. We will hear from other CPPs later, but my impression is that things are beginning to happen on the ground in other areas. Am I misreading the submission?
Maybe the distinction is between calculating the amount that is spent and actual developments on the ground. A lot is happening on youth employment across the city in the different agencies that are involved. We are trying to understand the resources that go into that, where there may be duplication and where we can be more focused.
Youth employment was the first priority and the work on that started about a year ago. There was a summit at which all the agencies in the city came together to talk about what they do and what they want to achieve, and we are now building on that.
As part of the community plan, as well as the national priorities, we are looking at reducing reoffending, early years and the thriving places agenda. In putting in place a process and a methodology that would work for joint resourcing, we are starting with those three priorities. All the partners are on board to support that.
There is no mad rush of people wanting to ask questions—you are a shy bunch—so I will continue. Glasgow community planning partnership’s submission states:
“A further emerging element of the work of the Joint Resourcing working group is around capital planning.”
Will you talk us through that?
This is very much an out-growth of the discussions around joint working and resourcing. To pick up the point that Mr Mason made, it is not the case that nothing was happening before; it is a question of looking at the issue more systematically and making joint working the norm, rather than doing things in an opportunistic way or having them happen by chance. In other words, we are trying to work towards a position whereby the partners share with one another at an early stage the capital project ideas and opportunities and consider what more can be done by coming together, rather than looking at projects in isolation.
So far, we have been in discussion with colleagues in health about the programme to refresh health centres. Some of that work is already in progress in Glasgow—for example, in the Gorbals. We are now looking at other areas of the city where we can take the opportunity to make clear linkages in the integration of health and social care programmes and to plan joint capital expenditure at an early enough stage.
A large part of the problem in community planning over the past 10 years has been the attitude that we do not have time at the moment or that it is too late. We are trying to forward plan and to build that much more into the heart of the budget-setting process at an early stage.
Another example that you give in paragraph 3.13 is
“Housing development between Glasgow City Council and the Wheatley Group.”
Will you expand on that? In a sense, all housing development in Glasgow is linked to Glasgow City Council, is it not?
Absolutely. We are looking for added-value opportunities. It is not that we have not been doing that, but we are looking at what we can learn. There are very good examples from the Wheatley Group, or Glasgow Housing Association. We have a very successful programme that is known colloquially as the environmental janitors programme. It is a job skills training programme. As housing investment happens, we are looking at the potential for social economy developments in local areas. It is a case of integrating the housing investment work into the broader agenda of economic development and social inclusion.
Rather than comment on anything that has been said so far, I want to throw something out for discussion, on which it would be useful to hear from any of our witnesses. We have looked at preventative spending over the past three years. I would find it useful to hear any of our witnesses comment on two things. First, it takes a long time to get results from preventative spend, so we have to be patient. On the basis of what your organisations have done in the past three to four years, can you point to any initial results that you can hold up as evidence of areas in which you have been successful? There might not be a huge amount of such evidence so far, but if there are any examples it would be interesting to hear about them.
Secondly, given that budgets are tight, what are the things that you have done less of? In order to put additional resources into preventative spending, the money would have to come from somewhere. What are you doing less of? What are the results of that so far? It would be useful to hear any tangible examples.
I turn to Iona Colvin. North Ayrshire community planning partnership’s submission says:
“The Family Nurse Partnership is already demonstrating positive benefits”.
That is an initiative that this committee championed. Will you talk about that and other areas?
Family nurse partnerships are certainly beginning to show evidence of improvement; in fact, in the latest health improvement, efficiency and governance, access and treatment targets for Ayrshire and Arran, for the first time we are beginning to see lower levels of teenage pregnancy and an improvement in breastfeeding. That is very welcome. We are not absolutely sure whether one links to the other, given that the family nurse partnership deals with a relatively small number of families.
A couple of weeks ago, I was lucky enough to go along to the partnership’s open day and meet the families. It was inspiring to see the number of babies there, as well as the number of dads who were contributing to parenting. That improvement in the involvement of parents with their children is remarkable. We would encourage people to get involved if they have the opportunity to do so. We are beginning to see some outcomes in that area, which we will evaluate. We know that it is a tried and tested programme and that it has a good evidence base.
We are doing a couple of other, relatively small things. I suppose that the most obvious one is our multi-agency domestic abuse response team. The team is a joint initiative that is based in Kilmarnock police station and which involves the Scottish Children’s Reporter Administration. That initiative has led to an immediate reduction in the number of young people being referred to the panel, particularly younger children, and in the amount of time that people—mainly women—have to wait for a response. That is having a major impact. This year—for the first time—we have seen a decrease in domestic violence. Neither we nor the police would claim that one is linked to the other, but we are tracking that. The results have been encouraging and we have put additional resource into the multi-agency domestic abuse team.
As you will know, the police have moved to concern hubs. We are having discussions with the police on how we jointly resource the concern hubs and join up some of that adult, child and public protection a bit better. The police want to do that on a pan-Ayrshire basis. Through health and social care integration, there has been an improvement in those relationships across Ayrshire. We work across three councils with the health board and we have made significant progress with the partnership. We have had a shadow arrangement for our health and social care partnership since 1 April. I am the chief officer for that, which means that I manage all the health and social care resources in that partnership.
In Ayrshire and Arran, we have agreed to put all health services, apart from the services of the two big district general hospitals, into the partnership. In North Ayrshire Council, we have put all of the health and the social work service—that is for children and for criminal justice—into the partnership.
That is progressing. We have appointed a management team and we have a shadow board. We are about to develop a strategic plan, which will set out the priorities for service development and redesign. In that, we will also talk about what we will do less of. Gavin Brown is absolutely right—we have to do less of something in order to do more.
The council has invested in children’s services, particularly around prevention and early intervention, and has made money available. I think that the figure is about £2.5 million. Is that right, Laura?
Yes.
It does not sound a lot, but in North Ayrshire terms it is a significant amount of money. With that money, we have looked at early years work and combined and integrated teams going into the early years services.
A number of initiatives are going on that are beginning to show results, but we know that it is a case of moving the mainstream. The next iteration, when we produce the strategic plan for the integration partnership, will begin to move the mainstream.
Thank you. I will come back to you in a minute, Laura.
The Scottish Government has commended North Ayrshire Council’s multi-agency approach as national best practice, and I believe that the multi-agency domestic abuse team and the no knives, better lives campaign have also received a number of accolades. I was going to ask about initiatives to make young people more work ready but, first of all, Laura, would you like to make the point that you were going to make?
Thank you, convener. I just wanted to build on what Iona Colvin said about moving resources into early intervention and prevention. Part of the council’s budget strategy is to disinvest in some areas to create the opportunity to invest in early intervention and prevention. Iona Colvin gave a couple of examples of that, and we have also diverted money into economic development for investing in youth employment work with the business sector, because we recognise the importance of that in the council’s overall journey.
11:15The council is starting to look at how much of our spend is reactive and how much involves early intervention and prevention, although we have no historical trend information on that. We will track whether we are doing what we intend to do, which is to shift the expenditure. There is no trend information, but our approach to budgeting includes tracking the early intervention and prevention spend.
How easy is it to split the expenditure into bits? After all, some reactive expenditure might prevent something else.
You are right that what is early intervention and what is reactive spend is not black and white. Each director looked at their spend and split it between being reactive and achieving early intervention and prevention. We then went through a peer-review process to test that and ensure that expenditure was being classified correctly. That gives us a strong baseline from which we can see whether we are making progress in shifting expenditure towards early intervention.
A couple of years ago, Michael McMahon, Jim Johnston and I held an employability workshop in Ardrossan in North Ayrshire, where we took evidence from several organisations. A number of concerns were raised by sectors, particularly by the business and third sectors. It was said that North Ayrshire had myriad policies and schemes in place to deal with employability; that layers of government, including the Scottish Government and local government, all had interests and targets, which were often competing; that there was a lack of common objectives and of funding; and that there was an issue about which partner would get the credit for outcomes.
One employer said that public sector agencies, including the council, were persistent but not joined up. The feeling was that there was less joined-up and partnership working by agencies in 2012 than there had been a couple of years before. What progress has been made to reverse that situation and have much more seamless delivery? I realise that since then significant progress has been made on reducing youth unemployment levels and so on in North Ayrshire, but what progress has been made on cross-agency working?
I can speak at a high level about what is happening in North Ayrshire to improve relationships across the business sector. I do not know whether people have heard of the team North Ayrshire brand, which has been established to deal with the issues that the convener raised, such as knowing who to speak to and knowing which agency is responsible for which aspects.
The brand was launched about a year ago; further work is being done on it and further progress is being showcased. It is very much about the relationship between the council, Scottish Enterprise and Irvine Bay Regeneration Company and about work with Jobcentre Plus, Skills Development Scotland and Ayrshire College. The approach involves being clear about the opportunities for growth in our top 150 businesses and having single points of contact for those businesses, so that they do not have to figure out who they need to speak to. I was going to say that it is very much work in progress, but we are already receiving positive feedback from businesses about the difference that the approach is making for them.
That ties back to employment and youth employment. We must understand what businesses need and ensure that people have the right skills to take up employment opportunities as businesses develop.
The thing that struck me during that visit to Ardrossan and which I took away from it was the frustration felt by many of the agencies that were involved in delivering what were essentially Scottish Government policies. They could tell us how much money they were putting in and they could count the people who were going through the system, but there was a real sense that the outcome was not all that it could have been.
The agencies were ticking all the boxes. They were getting good numbers through and getting the right money to the right places, but there was real frustration among a lot of the agencies in the partnership in that, had they not been constrained by the tick-box aspects of the process, they could have had better outcomes for a lot more people.
For example, people who were placed with firms or on training courses were restricted to 13 weeks. Sixteen weeks might have got them to a position where they could have sustained themselves, but the placement ended after 13 weeks and that was it—they had to move on. Someone else came in, and they were counted as another person who had gone through the system, but the actual outcome was less than it could have been. Does that frustration go beyond Ardrossan?
I will let people respond to that, but Roddy Burns wants to make some comments first.
We are tackling similar issues in Moray. Our community planning board is underpinned by five partnerships, one of which is the economic partnership. It has driven the response to a similar issue about the mismatch between skills and jobs, because the issue in Moray is not just about jobs, but about the skills for those jobs.
The outcome of that is close working with Highlands and Islands Enterprise, Skills Development Scotland and, probably more important, the private sector in the shape of the chamber of commerce and individual businesses, some of which have funded quite substantial programmes, such as those run by Careers Scotland, to give young people an understanding of the world of work and how to prepare for work in all its shapes and forms. That has been a way of taking out some of the frustration.
Some quite challenging discussions have been had. When we spoke to employers, we heard that they were looking for skills in English and the STEM subjects—science, technology, engineering and mathematics. When we look closely at our attainment levels, we see that we struggle in English and maths, so there is an issue about how we deliver the curriculum and how we can improve. That has given rise to some interesting discussions about how we deploy resources in schools and what we need to do in future.
If nothing else, community planning has added to such discussions. The prevention plan is the next logical step in community planning, certainly in the Moray context.
Someone asked about the sharing of best practice. Your submission differs from the others in that it highlights myriad examples of that. Will you talk us through how you are working with other CPPs and organisations outwith them to share best practice?
Broadly, our sharing of best practice reflects two things. First, like Glasgow, we had to refresh the board, the board structure and the community plan quite a bit, and the natural thing was to go and look at best practice in the country and indeed elsewhere. That is part of the explanation.
Secondly, we have to share because of the size and scale of Moray. We look west in relation to enterprise, the college network and the University of the Highlands and Islands and we look east in relation to the health network and NHS Grampian, so it is a natural thing for us to do.
I am not saying that we are doing anything better than anyone else, but such sharing is a natural tendency. We have to look outwith our boundaries—and, often, our skills and resources—to get what we need to address Moray’s particular issues and challenges.
Pamela, what decisions have been taken in Grampian on disinvestment in order to reallocate resources to places where they will have a greater and more positive impact?
I cannot answer that definitively at this point. As others have said, the process is a bit challenging. Future opportunities will involve the relationships between the community planning partnership and the five strategic partnerships, one of which is the health and social care partnership, of which I am the chief officer. It will be all about how we set budgets and the line of sight that we agree on and which we think is possible.
We are doing something similar to what Iona Colvin described, but we are looking at adult and older people’s services in the health and social care partnership first. We will look at which budgets will be devolved from NHS Grampian to Moray, and in Moray we will look at where to focus and what to target. The strategic plan and the relationship with the community planning partnership will be key to getting that right and driving our disinvestment and investment in the right direction.
We are in a transition period in which it is hard to say whether we have truly disinvested from activities. The committee has a nice list of all our activity. One observation from the Accounts Commission’s report on us is that some of that would have happened as a result of preventative spend and perhaps does not represent a disinvestment and transfer of money. That is the task in hand as we develop and mature in the coming months.
We have been talking about this for a long time, so I am disappointed and surprised that there is nothing more concrete. Does Glasgow City Council have anything to mention? In the past, it was particularly concerned about how it would disinvest, so I am keen to know what has been done.
In considering disinvestment, we looked at our budget strategy and decided that we were spending money on things that we did not need to spend it on, particularly in relation to property. We had 19 city centre properties, but we have now reduced that number to six, which is giving us a revenue saving of about £6 million a year. Over 10 years, we will have £60 million, and that financial strategy will allow us to release resources or focus on social work and education. Disinvestment might not happen within a department’s budget; it can be done at a strategic level, and we have done that.
We have set up a customer and business services division, which comprises 2,500 staff, including all the revenues and benefits staff and all the clerical staff who work in schools. The intention is to get synergies of service and deal with peaks and troughs of work.
Perhaps I can add something slightly different to this discussion. The gain from preventative spend is often not to the council but to other agencies, such as the DWP and the police. We have found that one way of achieving preventative spend is through working better with partners, and I will share with the committee a couple of examples of that.
The first example concerns Glasgow’s Helping Heroes, which is based in Duke Street—Mr Mason might be familiar with it. A few years ago, we found out that we had about 200 homeless veterans in the city, which was an issue. We now take a holistic approach. This particular initiative is run by the Soldiers, Sailors, Airmen and Families Association—Forces Help, which employs the staff, and involves Combat Stress, Poppy Scotland and a range of agencies. The key agencies that are involved with regard to housing are the Wheatley Group and Glasgow Housing Association.
We now have a Glasgow veterans programme. The amount of money that the council puts into it is probably not even in six figures, but we now have no homeless veterans in Glasgow, only one veteran has not sustained their tenancy and we have got 300 veterans into jobs. The point is that a certain way of working can be a form of preventative spend. That initiative is preventing health and housing issues from arising.
My second example concerns long-term conditions and involves the health service and Macmillan Cancer Support. The initiative provides social workers, housing support and other agencies to help people with cancer. Apart from people’s health, the main issue to address is that people are in danger of losing their homes and getting into financial difficulties. Since we set that project up in 2010, we have managed to get people about £40 million in benefits, and Macmillan Cancer Support has said that Glasgow is the only city in the UK where people are not at risk of losing their home if they get cancer.
It is not just about major shifts in spend, but about working differently and working with other agencies that are trusted more by the people whom we are dealing with. For example, veterans organisations are more trusted than social work services or the council. We have taken a mixed approach by strategically shifting resources, by not spending money where we spent it before and by being more organic in terms of the organisations that we work with. I should also add that we took a view on youth employment and put 5,000 young people through apprenticeships linked to the Commonwealth games. We worked with the business community on most of that.
There are different levels to take into account. I would say that preventative spend is possible, that there are different ways of tackling it and that we should let different organisations, some of which are more trusted by clients than others, play to their strengths.
11:30
Thank you—that was very interesting. I take it that, with the reduction in the number of facilities from 19 to six, you will have had a capital receipt.
Yes. We had to do a couple of things. We got about £40 million in capital receipts, but we had to agree to invest about £27 million in new facilities because they are all open plan and need to be supported by technology. Over and above that, we are making a revenue saving every year.
I have three quick points. I want to echo what Lynn Brown has said about budget strategy. Everything that has been done in Moray is very similar to what is happening in Glasgow, although clearly on a different scale. For example, we have taken 12 offices out of the main town in Moray—where the population is 25,000—with just one remaining, thus saving £250,000 in revenue and potential capital receipts.
Secondly, there is more ground to be covered in terms of prevention. We can all do a bit more and all the partners recognise that.
Thirdly, and probably more importantly, some of the barriers are often quite disproportionate and indirect in all senses to the possible resolution. For example, the labour market can often be a determining factor in something as simple as the number of carers one might wish to recruit; Moray has a low wage economy and if, say, some of the retailers are on a pre-Christmas drive, that can be the determining factor for many individuals as to whether they want to sustain a job as a carer or whether they want to take something more attractive for the season. That is a driver that is outwith our control. It is important to recognise that there are profound underlying issues in relation to delivering a service, particularly a preventative one.
The Accounts Commission acknowledged the good record that Moray Council has in partnership working, but it noted:
“much of this has been achieved without the leadership of the CPP and as a result of reacting to national policy or specific local initiatives.”
That is fair comment. I take comfort from the fact that the findings of the Accounts Commission recognise that there is now leadership and good partnership working. The comfort for me and, I hope, the assurance for you in your scrutiny work is that, with that leadership and partnership working, the plan that I mentioned earlier is now in place, and the next logical step from that is the prevention plan. That was acknowledged by the controller of audit in his submission to the Accounts Commission earlier this year. Moray is well placed to take that forward.
As someone has said, this work takes time, but we are moving in the right direction. The partnership, along with leadership, will produce the desired outcomes.
My next point is for Laura Friel. In its report on North Ayrshire CPP, the Accounts Commission commented on the linkages between outcomes and spending by CPP partners, noting that:
“Together the main local partners in North Ayrshire spend over £500 million a year, but the CPP cannot yet demonstrate significant examples of sharing resources to achieve better outcomes, or of directing resources towards agreed priorities”.
The report recognised that the
“CPP has developed budgeting processes to manage specific government-funded initiatives between partners, and it has joint commissioning strategies between partners for specific client groups”
but that
“it does not apply this approach systematically, for other CPP activities and initiatives.”
I can say a wee bit about the work that we have been doing to resource map.
We have completed the first phase of the resource mapping, which involved sitting down with our core partners and looking at our spend. That ties in with the neighbourhood planning approach, which Iona Colvin can maybe say a bit more about. We have had a first look at our spend across the neighbourhoods and considered whether it aligns with the need. We have looked at the high-level spend, but we recognise that that information is too high level and that we need to drill down a bit further. For example, we want to know how much per head of older people population we spend across the neighbourhoods and how that fits with what we should spend given the need.
That links in with the significant work that has been done on the areas of family resilience report, which is mentioned in the evidence. We have characterised each of the neighbourhoods and identified the needs across them. The next stage of work that we need to do is to look at the spend relative to need and take a view on where resources perhaps need to shift so that we better align spend to need.
I ask Iona Colvin whether she wants to add to that. Your submission states that
“additional information will support the further development of the resource mapping.”
The neighbourhood approach has been really helpful to us in resource mapping. We know that the resource mapping will probably show that, in some rural areas, particularly areas such as Arran, we spend disproportionate amounts in relation to the population.
North Ayrshire is like many other parts of Scotland in that we have a huge variation in need. In Largs on the north coast and on Arran, we have large elderly populations, with people who live into their 80s or 90s and who basically need health and social care services in their later years. However, in Irvine and the three towns people die 20 years earlier than those in Largs and the north coast—Glasgow has exactly the same challenges in a far more compact geographical area. Those people become sick in their early 40s and 50s.
That is the challenge that we face, and it is reflected in the work that Laura Friel talked about on needs. Our strategic plan for health and social care has a needs strategy underneath it, which has been developed by NHS Ayrshire and Arran and which looks at some of the issues that we have on emergency admissions and outcomes for vulnerable children. We have agreed that those are the priority areas.
We will begin to look at how we address the neighbourhood issue in the strategic plan, which will be available in its first draft within the next month. The plan will set out how we will spend the £200 million that the council and health board have delegated into the partnership, as well as how we will spend the £2.9 million of integration funding that the Government has made available.
We will set that out, but we will not be able to answer all the questions. In year 1, we will probably have more questions than answers, but we will define what we will prioritise in relation to mental health, older people, learning disability, children’s services and criminal justice services; what our redesign projects will be; and how we will integrate the health and social care responses in those areas. We will make better use of the resources that we have.
The elephant in the room is that demand for social care and health services is increasing. Particularly for social work, we need the universal services to take up prevention and early intervention initiatives, which is what we have been working on in North Ayrshire. What can health and education services do that begins to prevent some of the traffic towards social work?
We have more children in care, more children on the child protection register and more elderly people in nursing homes than we have ever had before. I am in charge of mental health services for the whole of Ayrshire and Arran. We have seen a huge increase in the number of people who are acutely ill coming into hospital services and who require one, two, three or four members of staff to deal with them. The issues that we face in providing services are causing real strain.
NHS Ayrshire and Arran has some of the highest figures for emergency admissions to hospital, which is why we have prioritised emergency admissions. A lot of the money is tied up there, but it will not be easy to get it out and move it into community services, although we need to attempt to do that. We are also looking at the outcomes for vulnerable children.
We are considering what we should do and we are looking to use the resource that we have in the best possible way, integrating it across partnerships, so that we—by which I mean health and social work—deliver for children alongside education and the police, and so that health and social work delivers for adults and older people in the community alongside the voluntary sector, in particular.
We can do a lot to look at how we use the resource. We have got better at that, but at the end of the day demand is still increasing. We see the impact of the recession every day, which is why employment is the most important issue in North Ayrshire. We know that having a job is what has the biggest impact on a person’s health—and we have lost more jobs in North Ayrshire than many other local authorities have lost. We see the impact of welfare reform, too, particularly when people lose their benefits. We see the impact of that on vulnerable populations.
We have to cope with all of those issues, as well as moving the money. We are trying to move the money that we can move, but it is a challenge, because we still have to admit people to hospital and take children into care, while providing nursing care placements and care at home and looking after people who have mental ill health. That is the balancing game that we are playing.
CPPs are relatively new and in the early days not everyone was wildly enthusiastic about them. I think that Lynn Brown used the word “trust”, which is important. Given that the process is slow and difficult, do people feel that it is worth while, in spite of the huge difficulties? Michael McMahon said that there is frustration about tick-box systems. When discussions take place, do people generally trust one another to get over the problem? Do you bend the system to make it fit what you want to do?
Community planning is important. In Glasgow, it has really helped to have an overhaul of the structure and to have political support behind the process. It is not just about support from the council; there is board-level support from health, the police, fire and so on.
Part of the issue is the reduction in resources throughout the public sector as a result of the economic downturn. That means that we just have to work together. There is also much more appreciation that what we are doing is about the citizens of the city. That is becoming more important. The move away from inputs and towards outputs and outcomes can change the mindset. Progress is slow, but we are firm believers in the process.
Our approach has been to consider priorities, which we think is manageable. We felt in Glasgow that it would have been difficult to look at the whole budget of £4 billion and break it down. If we can show success quickly on the areas where we think that we can do that, people will gain confidence about going forward, because they will have achieved something—they will not be just going round in circles.
We see community planning as really important. Private and public sector organisations have to work together to achieve what they want to achieve.
11:45
I echo what has already been said: the value of community planning is that it has created trust. The value of the outcome approach is that, when they saw the scale and nature of it, everyone recognised that some way of trying to resolve some of the issues would be found only by working collectively and collaboratively. There are still some profound issues in Moray, for all its relative affluence, with the way that people’s lives are blighted by alcohol, for example.
I will give one simple example to illustrate that value. We have been proofing our objectives. All the partners have to give each of the objectives a confidence rating and one of the low-scoring objectives was having confident young people. That is all about attainment, and the score was low because, as is reported in The Scotsman this morning, we have real difficulty in recruiting and retaining teachers. There is an issue in that because, however well we might aspire to achieve that objective, we will not do that if we cannot recruit and retain teachers. However, the exercise sparked off a very constructive discussion between Skills Development Scotland, HIE and others about how we could work towards finding a solution. That type of discussion would not have taken place before.
That is a simple example and I know that it is highly anecdotal, but it illustrates for me the value of having the right people around the right table discussing the right issues.
I have a question for Jim Gray. The Christie commission found considerable evidence of serious shortcomings in the capacity of public services as presently organised to deliver better outcomes. Some years have elapsed since the commission reported. The committee took a lot of evidence on that report. What bottlenecks remain in delivering better outcomes?
There is probably an emerging consensus that some of the barriers to joint working between public bodies in Scotland that we face concern issues such as data sharing. We have wrestled with that in the youth employment mapping exercise that we have been doing. We have made some progress with finding ways of working round it. I have to say that there are perfectly legitimate data protection and confidentiality issues, but we have to find more ways of getting more information in something resembling real time to share it.
I will give the example that is in our submission, which relates to reoffending. We have found that, by bringing together a team that can access the databases of their respective agencies, we can work around some of the data-sharing issues. However, for the longer term, particularly on youth employment, we have been having discussions with the DWP about how it can better share the crucial information that it holds about claimants and former claimants. We think that we can progress some of that, but some aspects may require primary legislation.
That is one of the biggest barriers. Another one that comes up quite a lot is that, although we as partners are trying to work more collectively and in an integrated way where we have agreed a joint priority, we are still required to report individually to different departments of the Scottish Government. We have had dialogue with colleagues in the Scottish Government about how we can simplify some of the reporting arrangements and find some way of ensuring that, if we have agreed to work together on a preventative approach to alcohol, colleagues in health, the council and the police do not have to report separately on exactly the same issue.
The flexibility introduced by the general removal of ring fencing has been extremely helpful. The degree of flexibility, particularly on employment issues, will greatly assist in, for example, the progress that we have made on the Glasgow and Clyde valley city deal. We would be interested in considering equivalents in other areas of work.
As Lynn Brown said, it may well be that partner A has to spend more in the short run to help make savings for partners B and C. How can that be levelled out over time so that partner A is not taking the financial hit? Otherwise, there is a perverse disincentive to resist change. That problem is not unique to Scotland; it is obviously a problem in other jurisdictions, specifically England.
Colleagues will have other examples, but those are the barriers that we have been discussing in Glasgow and have picked up on in discussions with colleagues from throughout Scotland.
I am keen to hear more from the witnesses about any other bottlenecks and barriers.
My experiences of data sharing are similar to what Jim Gray has described. That can be the case even just within the health and social care arena. It is a time stealer: at a time when we are discussing capacity challenges and trying to make the shift, a lot of energy and time can be stolen, because the lack of proper infrastructure does not allow the systems to function easily.
Linked to the point about reporting, and taking more of a health perspective, there is also an issue with competing demands. Iona Colvin was speaking about this. When it comes to the initiatives and targets for planned care and waiting times, resources can end up being very much concentrated and targeted away from the prevention and community end of business towards acute hospitals. That represents a real challenge. People might want to make the shift, but the task can almost be dwarfed by the need and pressure to meet particular targets.
Returning to the previous point, the value of community planning is critical, for reasons of capacity. We see a proportion of the population who would be far better served elsewhere, rather than entering health and social care services. With the right level of resilience and support within the community and the right options available, there will probably be better responses to people’s issues there compared with what they would get from entering a general practice surgery, for instance.
You say that “community planning is critical”, but the “Improving community planning in Scotland” report, which was produced by Audit Scotland on behalf of the Accounts Commission, concluded that CPPs had not met the ambitious goals that were set for them, were seen as council-driven exercises and were
“not able to show that they have had a significant impact in delivering improved outcomes across Scotland.”
Furthermore, that report said that
“Community planning has had little influence”
over the use of public money.
I can understand why that statement and those observations were made. However, it is important to consider the journey that the mechanism is on and its maturity.
I am fairly new to Moray, but I have seen how things function in Moray and I have experienced a couple of the boards and the underpinning structures. I know from discussions about the progress that has been made that the process is not there yet, but trust and cohesion are starting to be demonstrated. The self-assessment—as it almost is—and confidence ratings that are being discussed across the partnership are creating a better arena for developing more of a recognition of what it is possible to do together.
The use of alcohol, which is one of our big issues, is a cross-agency, public problem, which is often deferred to health services. The issue is about the maturity of the partnerships, the journey that they are on and the expectations that people have of them.
I emphasise the importance of information and information sharing. We have heard about reducing resources and increasing demands. There is a real need to shift resources, and having the information helps to provide the evidence to substantiate any shift in those resources. That is really important. It is also important to ensure that information is available from all agencies so as to see the whole picture locally. For example, Jim Gray referred to DWP expenditure, and there have been particular challenges in getting local information about that.
The way that Ms Gowans was talking has got me thinking. We have used words such as maturity and trust, and those are quite hard things to measure. As someone who was originally an accountant—maybe Audit Scotland is the same—I would like to see a certain amount of money going into a box and going down a route, which is nice and easy to measure. However, I accept that, if the health board, the council and other partners are working together, it will be more effective but it will be harder to measure, even if they are still looking after their own pots of money. Is that where we are going, or is it a mixture of the two?
I hope that it is a mixture of the two. There will always be a tension and a point where it is hard to be definitive.
We could say that we expect some sort of prevention activity to be evident every time a health or social care practitioner has the opportunity to interact with somebody, but it would be difficult to extrapolate that from such an intervention. However, we know that we spend a lot of time with people in situations where a more proactive approach, maybe in the community, could have an influence.
We have seen examples of that in employability schemes, particularly in mental health. Perhaps we can prevent the use of medical and nursing models, which can medicalise things that do not need to be medicalised. If we can understand the workloads and the spend on that work, I would like the challenge of trying to disinvest in those areas and invest in more community activity.
We have had experience of that approach with other structures, such as the alcohol and drug partnerships—previously known as drug and alcohol action teams—where the commitment of the partners and their willingness to be accountable in a way that was not completely authoritative was evident. That was needed to get a really good outcome: there is an element of maturity and an element of commitment.
We are fortunate in Moray, partly because of the size of the area. Although it presents its own dilemmas, one of the fortunate things is that there is a fairly small pool of people who have to work together if we want to make an impact. The layers are therefore less challenging, although the Accounts Commission’s report shows that there are some things that we need to improve.
Of course, it is not just about inputs, as we discussed last week. It is about the outcomes that we get from those inputs.
I would like to wind up this session, as the committee still has a lot of work to do this morning, but I would like to give each of our guests the opportunity to make final comments. Because Lynn Brown started us off, I would like to give her the final word.
There has been some discussion about maturity, and that is a real issue. I have been in North Ayrshire for four and a half years, and the difference in the partnership is tangible and is beginning to come through in the outcomes under the headings of safe, working and healthy. The numbers of young people in police custody, in secure accommodation or in Polmont are reducing, and part of that is because of partnership working.
We are now on the precipice of the next step, and the partnership and the way in which we have worked have allowed the council to feel confident about moving forward with its model for the integration of health and social care. The council took the decision 18 months ago to put all its social work resources into the partnership, and the relationship with the health board at that point was so positive that it could do that. It was not like that four and a half years ago, so there has been a huge move forward. It is a matter of feeling confident and trusting one another, but it is obviously helped by the legislation in this case. That will be a major step for us. What Pamela Gowans says is right: we will be able to do some intervention, and much earlier intervention than is possible with preventative work, but we must remember that the partnership works across the whole of primary care as well as acute services.
There are a lot of opportunities to do things differently from how we currently do them and to use the resources better in areas such as longer-term care for Scotland’s citizens. I am thinking particularly about elderly care, where two thirds of the money is spent on emergency care. One of the challenges for me and for Pamela Gowans is to make sense of that and to have a systematic look at what it means across communities as well as within hospital services, which is where we tend to look at it. We need to ask how we can reduce some of that spending and transfer the resource to make such services better for our communities. All of us across health, social work and the private and voluntary sectors need to look at the kind of care that we want to provide in future.
We have not been in that position before. We have had umpteen initiatives looking at joint futures, but we have not been in the position that we are in now, where we are able to say, “Here is all the money that is on the table; let us think seriously about what the citizens of North Ayrshire will need in future.” That is where we are just now.
It was always going to be difficult to work voluntarily in a world of statutory bodies. I am slightly paraphrasing the controller of audit, so I do not necessarily disagree with that comment and I think that it is a fair reflection. I hope that the new Community Empowerment (Scotland) Bill will address some of those issues in the fullness of time, but the cohesion and maturity that have been referred to point to prevention planning as the next logical step. We all hope for the benefits that have been well articulated by North Ayrshire.
The health and social care initiatives that have been referred to will take community planning another step—in fact, a huge leap—forward, because it is such an important part. Other agencies are involved as well, and the real prize for us if we can make it work is to show that public services are worth while and are of value and that we can do things right.
I thank everyone for their contributions.
12:02 Meeting suspended.