Local Government and Regeneration Committee

Meeting date: Wednesday, March 14, 2012

Official Report 459KB pdf

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Public Services Reform and Local Government: Strand 1 (Partnerships and Outcomes)

Item 3 is oral evidence in our inquiry into public services reform and local government, strand 1 of which concerns partnerships and outcomes. We have two panels of witnesses. I welcome our first panel. Bob Jack is chief executive of Stirling Council; Gavin Whitefield is chief executive of North Lanarkshire Council; Hugh Robertson is assistant chief executive of Angus Council; and Stuart Crickmar is strategy and performance manager of Clackmannanshire Council. I thank you all for coming along.

We will go straight to questions. We are well aware that councils across Scotland have been working hard to ensure that partnership working is under way. How are witnesses managing to integrate that partnership working with the community planning partnerships? How well are you doing? If there is still work to do, what needs to be done to achieve that integration?

Who wants to kick off?

We are working well in terms of community planning. The evidence that we submitted should be seen in the context of trying to add value to partnership working. We are seeing real improvements through the single outcome agreement and a real commitment to partnership working during these difficult financial times. There is always room to add value and to make further improvements. In the evidence, we set out ways in which we think we can achieve that in North Lanarkshire, with some general lessons—which could apply across Scotland—based on our experience.

I very much agree with that. There is quite a way to go. I hope that the various on-going reviews will not change the system fundamentally, but will perhaps encourage more progress in the same direction. If we look just at SOAs, their first two iterations had a one-year focus. The iteration that we are about to go into has a five-year focus. We should be looking towards a longer-term focus because it takes somewhat longer than a year to demonstrate real progress in respect of many outcomes. That will get us further along the road. Sticking with the same direction of travel, there are a number of things that can be improved and the pace can be picked up a bit. Rather than constantly reinventing documents, we should focus on the longer-term outcomes and the local partnership should be left to work out how best to achieve that.

We are making good progress within the Angus community planning partnership and I hope that the evidence that we submitted to the committee shows that. Integration is well developed through the processes and the governance arrangements that we have in place. What that has required, and what is still required, is good leadership and joint commitment from all the partners.

As the question suggests, there is still work to do. I was at a conference yesterday where it was said, “We’re winning the battles, but not the war.” Much of the integration and the work that is taking place is project based, rather than about integrating services per se, which will take a longer term focus and approach.

I agree with pretty much everything that has been said. We are making good progress on the partnership working side of things, but we need to focus on engaging with communities and getting them much more involved as equal partners at the table. There is also work to do on the ground and at the operational level, but there is a huge commitment among partners to come together and work collaboratively.

Are there any major barriers, either legislative or on the ground, to your continuing along the road that you are on?

The experience to date is that there have been no showstoppers in the way of partnership working. Clearly, there are areas—as highlighted in the evidence and as I mentioned earlier—that we could identify that would add value to the approach that has been adopted to date.

One danger is the perception of the need to start with an outcome that is about a structure, or about a single or pooled budget. Our approach has been to look at the partnership’s priority outcomes and to work back from that. If there is a need for and value in service integration and there being a single management approach to services—such as the joint equipment store, which we developed in conjunction with Lanarkshire NHS Board—or if there is value in there being a pooled or single budget, we will pursue that approach.

The important thing is to have that local flexibility to operate. A major factor in securing that positive operation is in the relationships between the community planning partners. One thing that has been cited as having the potential to add value is the making of the community planning duty consistent across the public sector so that there is a way to deal with partners that are not engaging effectively.

Along the same line, it was highlighted previously that there are barriers to the fulfilment of HEAT—health improvement, efficiency, access and treatment—targets by national health service boards in relation to integration. Also highlighted was the problem of different budget cycles when dealing with some of the integration work. It seems that in certain areas—Mr Whitefield mentioned the North Lanarkshire equipment store—such initiatives are not unusual. However, with the big picture items and the areas where radical change is needed to fulfil the preventative agenda, folk are saying that those are difficulties. Will you comment on that please, gentlemen?

10:00

It would perhaps be interesting to take up that question with the chief executive of an NHS board.

It is often asked whether people are managing to the priorities of the partnership or to the performance measures to which a cabinet secretary holds them to account. That is inevitable, and the situation is similar in local government. We are managing a range of services against a range of statutory performance indicators, but that does not prevent there being a focus on the partnership objectives. There has to be balance, although there is undoubtedly something in what Mr Stewart said.

Sometimes, other priorities and being held to account on other measures are diversions from partnership activity. As Gavin Whitefield said, it is down to how seriously the relationships at political and senior executive levels take partnership working. If there is commitment at those levels in a partnership, it is possible to respond to the different agendas—to the partnership agenda and the various measures that require that attention be given to service delivery.

I will certainly be asking Dr Farquharson the same question later. However, the issue is often highlighted by people from local authorities, rather than by folks from the health boards, which is why I am asking you, gentlemen, whether it is a barrier.

I want to pick up on the point about budget cycles. Within the current arrangements, which have operated for a number of years, we have been able to work through budget cycle issues. However, a consistent budget cycle that was linked to a financial plan that was as long term as possible—a minimum of three years—would facilitate and ease partnership working and improve how we plan jointly for major capital investment.

It is recognised that there is a lot of good shared asset management planning work going on across community planning partners, but because of different budget cycles we are at different stages of firming up in capital programmes, which can create difficulties that we need to work around. Consistent budget planning across the sectors that are involved in community planning would be an improvement.

I see lots of nodding, so I will not hear everyone else on that question.

I do not know whether I need to declare quite the same interest as John Pentland did. I do not have the same history of having a working relationship with Gavin Whitefield, but I write to him regularly, so I should perhaps declare that.

You have talked about the partners that you work with within your jurisdictions and boundaries in community planning, but there will be communities around the edges of the areas that you represent. How much do you view one another as partners in the planning process when an application pertains to a community that is right on your geographical periphery, where you bound with another local authority? It is fortuitous that we have Bob Jack here who represents Stirling, which bounds North Lanarkshire and Clackmannanshire, so we have at least three chief executives—with respect to Mr Robertson—who can comment on that.

That is an important point. The basic building blocks of community planning are the 32 local authority areas, and so a number of issues arise when partners operate across larger areas. We have that situation in the Forth valley, where the health board and police and fire services are pan-Forth-valley agencies, so if we insisted on everything being dealt with at local authority area level, huge overheads would be placed on authorities. There are also Scottish partners, including Scottish Enterprise and Skills Development Scotland, and there are issues with how they tie in to the community planning process.

It would be a mistake to look for a perfect community planning model that can apply in every local authority area. The system is much more untidy than that, and the model must be flexible enough to allow us to deal with, say, Stirling issues in a Stirling context, while also acknowledging the need to operate across local authority boundaries if there is to be proper engagement with partners—in our case, they are primarily the health service and, with regard to the public protection agenda, the police. It should be more of a framework than a model.

You are right to highlight the fact that certain bodies operate more widely than your local authority area; nevertheless, they still operate within your local authority area. We have representatives from North Lanarkshire, Clackmannanshire and Stirling here this morning. Mr Jack’s jurisdiction might end at Stirling, but what would happen if an application were to be made for something in North Lanarkshire right next to that local authority? The people who live in that area might have an interest and want to use the service to which the application pertained. How do local authorities interact with each other in that respect?

Perhaps Stuart Crickmar can answer that question. Given that Clackmannanshire is right next to Stirling, both authorities will have to work with some of the bodies we are talking about.

To a certain extent, partnership working is a state of mind; it is a mentality. It is all about trying to understand how to maximise benefit for stakeholders through working with whomever you need to work with, whether that is the neighbouring local authority or another agency. In our approach to strategic and policy development we are, from what I can see, looking more and more beyond our own boundaries.

Good morning, gentlemen. The North Lanarkshire submission raises an issue that is reflected in the other submissions. It says:

“decision making, performance setting, governance and accountability arrangements should be reviewed to provide greater flexibility and autonomy to CPPs.”

I have two questions. First, have the councils and their community planning partners ever considered incorporation of CPPs? Secondly, how much of a barrier are the different governance and accountability arrangements to effective partnership working and how realistic is it in practice to change them?

On the first question, I honestly do not think that Clackmannanshire Council has considered incorporation—but I do not really know. However, as I said, it is all about having leaders who have the mentality for collaboration and who see and seize the opportunities for working with others. I am not convinced that the kind of structural approach that you suggest would necessarily bring about the collaborative partnership working that we want; it is more about having the right leaders with the right mentality.

Stirling Council has not considered incorporation. If the question is whether such a move would solve some of the governance issues, I have to say that I think that it would create more. You might create another entity with its own governance, but what would be ceded to that entity by the various constituent bodies? We will certainly get into that area with the proposals to integrate health and social care and to formalise health and social care partnerships. Will they sit within the community planning framework or will they be separate entities?

At the end of the day, what you have in CPPs is a consensual collaborative partnership, each constituent part of which is required to get decisions through its own governance machinery. The system is a little clunky at times, but I agree with others that if the political level—by which I mean elected members in local authorities and board members of other agencies—and the senior executive level are committed to the partnership process, we can have the parallel governance and accountability that are required to get decisions through.

The provisions for incorporation were in the base legislation, but I am not aware of any area that has taken that forward in any meaningful sense.

The straight answer to the first question is no; we were aware in the early days of community planning that incorporation was a route that we could go down, but we chose not to. I was not around at the time, so I cannot expand on the reasons for that.

I would not say that the fact that different partners have different governance arrangements is a barrier to making progress with community planning partnerships, but the arrangements could be improved to merge more effectively with the community planning arrangements. Everyone is at the table, but the only partner at the table that has a duty to make best value work is local government—that duty does not rest with the other partners, so that could be looked at.

We considered incorporation a number of years ago, but we decided not to pursue it. As with the other authorities that are represented here, the feeling was that it would not add great value to the structures that were already in place and that we would spend an enormous amount of time working through governance issues, rather than spending the time on focusing partnership activity and programmes on delivery of positive outcomes.

At strategic level, the structure that we have in place involves the partnership board and themed working groups to deal with each of the priorities in the community plan—health and wellbeing, lifelong learning, regeneration, environment, community safety, transport issues and community engagement. At local level, we have six local area partnerships. We are trying to get at local level the same commitment to delivering on community planning that exists at strategic level. To date, we have had good participation from the other partners in the local area partnership structure.

In relation to governance and accountability, it is a case of further streamlining the process along the lines of the principle of ensuring that we devote maximum resources and time to delivering outcomes as opposed to managing governance, producing reports and dealing with scrutiny and regulation.

Many of the CPP structures seem to be quite complex. Could they be simplified? If so, what would be the advantages and disadvantages?

As I have outlined, we have tried to set out a fairly streamlined approach at strategic, operational and local levels. We constantly review the structures. You are right that it can appear that they are quite complex, but we are dealing with complex issues. One of the challenges that we have in community planning is that we need to be able to adapt structures to deal with the issues that arise. The solution that is required to address health and wellbeing issues could be different to one that is required to address a community safety issue. When it comes to how the structures are developed, it is horses for courses.

Now that we have the backstop of the single outcome agreement, we have a much clearer picture of what the partnership is delivering on. We have an annual report that shows the extent to which targets have been met and, when they have not been met, the reasons for that. It is important to view the structures in the context of the fact that a much more effective performance management and reporting system is now in place, thanks to the single outcome agreement.

10:15

The structures can look fairly complicated, but community planning is a complicated area. We continually review our structures—we last reviewed them last year, when we changed them in order to streamline them more. We have an annual planning day with all the partners at which we look at our structures. Although we try to ensure that we have appropriate governance arrangements and structures in place, the main focus of all the partners is on improving outcomes; the purpose of the structures is to help to achieve that.

As I am sure members of the committee know, we recently went through an audit of best value and community planning. One of the points that the audit report makes is that our community planning structures are complex and opaque. If members wish to see it, there is a wiring diagram in that report, which shows that the structures are undoubtedly quite complicated.

As others do, I think that it is of necessity complicated, but my question is whether we need to show all the internal workings and whether there is a better way of simplifying community planning for the community and for those to whom the partnership is accountable. That is an issue at the political and strategic levels.

In the future, acting on the recommendations of areas for improvement that are highlighted in the best-value audit, we want to take community planning into the area of simplification, perhaps not of all the internal workings but of how it is reported to the public, and we want to address the multidimensional issue. Some things will be better done at the pan-Forth-valley level, because that is the level at which some other key partners operate, and some of it will be done at local level.

I agree that one thing that is often missing in community planning is the community. If you focus on structures, accountability, governance and all the rest of it, you tend to talk about the organisations, but community planning is really about the engagement of the community to drive the partners to the desired outcomes.

You have made a crucial point about the engagement of the community and helping it to understand the objectives of the CPP.

In Clackmannanshire, community planning was quite traditionally structured, so it was divided into, for example, community safety and health improvement teams. Over the past year or so we have put in place intermediate priorities around job creation and skills development—which are focused particularly on 16 to 24-year-olds—community engagement, prevention and early intervention.

We found that looking at community safety or health improvement within the theme teams sometimes created a silo mentality. To reflect our intermediate outcomes, we have decided to move from seven teams to two. One is focused on jobs and economic development and the other on early intervention and prevention, with community engagement being a cross-cutting issue.

Another theme that has emerged is communities getting panned by various agencies coming at them for community engagement time and again; there is almost engagement overload. We are therefore trying to join up our community engagement, so that we understand a community’s needs and aspirations and can work collectively with the community to realise them.

We have undertaken a fundamental review of our structure. The point was made previously that the approach needs to be flexible and adaptable and must fit in with the strategy.

It is nice that we have started to talk about the community’s role in the community planning partnership.

Stuart Crickmar has started to answer this question, but to what extent do the councils consider that their current CPPs are focused on outcomes-based and preventative approaches?

We are on a journey. There is a huge commitment to moving towards those approaches. It is easy to make a statement, but it is about getting things to happen on the ground. It is not always the public agencies that are best placed to get behind the doors and deal with the issues that we are trying to tackle. Communities and the third sector often know how to get underneath the skin of problems.

In Clackmannanshire we have said that prevention and early intervention are intermediate priority outcomes, so we are looking to see that priority come through in operational planning and projects. Essentially, projects that can demonstrate that they are focused on prevention and early intervention are the ones that will attract funding.

On paper, given that we have all signed up to a single outcome agreement, the partnership is focused on outcomes. The question is whether those are the right outcomes, whether they are clear enough and whether we are clear enough about what success looks like so that we can track progress. Those are the areas in which there is scope for improvement. We do not want a single outcome agreement with 1,001 outcomes that we are trying to achieve, because that gets us into the sort of issue that Mr Stewart raised about HEAT targets conflicting with outcomes. If the outcomes are few enough, big enough and clear enough and we are clear about what success looks like, we will be better able to design interventions that take us towards success.

That is where we need to go in the next iteration of the single outcome agreements. As I said, the single outcome agreements should be longer term, because some outcomes are not achieved in a year. With preventative work in the early years, some outcomes will not be achieved until a generation moves through the system. Therefore, we need fewer, clearer and smarter outcomes in which success is more clearly defined. That will allow us to be clear about the actions and interventions that will take us towards that. Everybody is signed up to outcomes, but the question is what actions and interventions will take us there. That is the area in which we need to be a lot smarter and a lot better.

I concur with the majority of what has been said. Our single outcome agreement concentrates on outcomes, although we accept that there is still a learning curve and that they can be improved, and we must accept that there is a long way to go before we achieve the outcomes. Sometimes, there is conflict between the need to wait to achieve outcomes and the demand or push for shorter-term inputs. However, our SOA is certainly based on outcomes.

Most community planning partnerships and local authorities, and national Government, are at the start of trying to move towards preventative spend. The Christie review and the Government’s response to it have given added impetus to that. We have heard about issues with project-type preventative spending. However, in our submission to the Finance Committee, we gave evidence on a more integrated preventative service that we provide in Angus. With our health, social work and housing partners, we provide enablement measures for older people to try to reduce the number of people who go into residential homes and allow people to stay in their own homes and be independent for longer. That type of preventative spending is starting to produce good outcomes in our area.

I agree with all that has been said. On both issues, we are on a journey. We are closer to the end of the journey towards being outcome focused. We have had four or five years of developing single outcome agreements and we have clear outcome measures, targets and indicators that we can use to measure progress. However, we are further away from making the progress that we all want to make on preventative spend.

A key challenge in the short term that we have been considering is the exceptional financial challenge that we face. The council and health, police and fire services are all dealing with that challenge, but we are trying to do so as a partnership so that we avoid compounding some of the issues by cost shunting between organisations. The council has shared the approach to our savings strategy with the community planning partnership—that has been a standing item at the community planning partnership board for some time. That issue is as important to address in the short term as the issue of how we get the drive and commitment to move to preventative spend.

How do you sell the benefits? In Glasgow, there is a perception—although I am sure that it is not held by everybody—that the CPP and the organisations that are involved in it tick boxes rather than affect their communities. Before you get to the stage at which you can say that you have achieved the outcomes, how do you sell the message of the positive work that you do? How do you ensure buy-in from the partners to outcomes-based and preventative measures?

Getting buy-in is not just about structures, processes and systems; it is about relationships and people showing commitment to a shared vision for the area while not being precious about organisational boundaries. That is about building up trust between the different players, not just through the meetings of the partnership board and the other structures but through meetings outwith those structures and through people getting to know and trust one another. We work hard at that in North Lanarkshire. We are alert to the change taking place in the organisations taking part in community planning and we are trying to maintain those relationships.

We have an excellent opportunity to sell the benefits of community planning now that we have the single outcome agreement. We have a much sharper focus on performance and we can report at a strategic level on what the partnership is delivering across North Lanarkshire. We are also seeking to make that more meaningful at the local area partnership level and, ultimately, at a neighbourhood level. We have all the information, but we could do more to publicise the areas in which we are and are not making progress, the reasons for that and how we are addressing them.

On selling the message, it is essential that we communicate with the public in a clear and understandable way and avoid a lot of the jargon. I would question whether words such as “community planning” and “community planning partnerships” are meaningful to the public. We need to talk about improving the environment in which the public work and live, and their outcomes for educational attainment and health. We need clear, understandable measures and targets that the public can relate to. We also need to report those in a way that is meaningful to the public, whether that be through newspapers, the web or any other medium.

As Gavin Whitefield has said, a lot of the work to get partners to buy in is about the relationships between them at all levels of the organisations, particularly leadership level, and about a shared commitment to the community.

To return to an earlier answer that I gave Margaret Mitchell, when it comes to selling the message, a focus on structure and process is not really going to connect with the public. That may be what we need to obsess about to make the partnership work better, but it is not relevant to selling it to the public. The public need to see, feel and touch a tangible outcome from all the partnership working.

For example, the health board and the council recently agreed to a project based on the after-use of the site of the Stirling royal infirmary, now that we have the Forth Valley royal hospital. The project will develop a care village with a range of integrated health and social care. The public can engage with that project, which will help us to meet our needs, from sheltered accommodation to fairly intensive care. The partnership has signed up to the project and we are now on to the next stage of getting it through the approval machinery for funding and so on. Getting it through that machinery is our problem, but the connect with the public is the vision for the end product and what it will do to improve the lives of older people in the area.

We have to be a lot smarter on the narrative of community planning and not focus on the barriers and the processes that are for us on the council to solve.

10:30

I agree with what has been said. The big word for me is “relevance”. This is about making it relevant to communities. I often tell my colleagues that community planning should have a small c and a small p—it is about planning with the community, for the community. If it is relevant to the community, we will get buy-in. Even in a small county like Clackmannanshire, folks in Tillicoultry or Alva are not necessarily interested in what is happening in Alloa. It has to be relevant to Fishcross and Coalsnaughton. To return to a point that I made earlier, one of the challenges that we still have to overcome is to get the community element into community planning and really make it relevant for local communities.

I have a question for Mr Whitefield and Mr Jack. Both gentlemen talked about spending and cost shunting, and Mr Jack gave us the example of integration at the Stirling hospital. The submission from NHS Lothian describes the integrated resource framework that exists between that board and the four councils on a pan-regional basis, which identifies the activity and spend across health and social care for adults. I believe that that information is now being used for future planning processes. Is that the way forward? Do integrated resource frameworks represent a more transparent approach to community planning?

They have their place. As I mentioned, it is important to start by considering the key outcomes that we want to secure, and work back from that. If integration and shared or pooled budgets are features that are required to achieve that, we will pursue that approach. In North Lanarkshire, we have adopted that approach in the integrated management of day care services and addiction services. I mentioned the single management approach for equipment and adaptations, which certainly has its place.

As community planning develops, and given the continuing drive to ensure that we are making the best use of all our resources across the community planning partnership, every avenue has to be pursued. The council is looking at its savings strategy not in isolation but as part of a team. We are looking to see where we can get better value through shared services approaches and integrated service management. However, the approach should not be seen as a panacea or a solution for every problem.

Apart from the equipment store, can you give us an example of where North Lanarkshire Council has joined-up budgeting with the NHS board in your area?

I mentioned the integrated addiction and day care services. They operate with an NHS budget and a council budget, but a single manager has oversight of them to ensure that they are used effectively. We recognise that more can be done to achieve the best use of resources.

A number of years ago, we did an exercise to quantify the total resource that was going into public services in the area. That was a challenge and it was a complex process, but the purpose was to ensure that we were looking at the full picture of all the resources so that, at a strategic and operational level, we could use community planning to make the best use of them. The need for that approach is even more critical now, given the financial challenges that we face.

I will cite two examples. In Clackmannanshire, there is an integrated mental health service between the health board and Clackmannanshire Council, which won a Convention of Scottish Local Authorities excellence award a year or so back. It has a fully pooled budget with a single manager who operates an integrated service. Through the joining together of Stirling and Clackmannanshire social services, we are looking to extend that across the whole Stirling and Clackmannanshire area as one of the early priorities for the integration.

In Stirling, we have a partnership in the north-west, rural part of the area, which recognises the particular challenges that rurality brings. We are trying to minimise the waste that is involved in different visitors going to particular households, so we have a single manager who manages resources across both health and social care in order to better integrate service provision and eliminate wasteful duplicate visits from different sides of the health and social care partnership.

Those are small examples of work on the ground. The resource framework that Kevin Stewart mentioned is about the bigger picture of how we transfer resource from one agency to another, how we pool it and how we shift to early intervention and prevention work. There are huge challenges in there, because the world goes on while we are trying to shift more resource into prevention. The change funds will help, but the challenge will be dealing with the disinvestment and, as Gavin Whitefield says, identifying sufficient efficiencies to maintain the preventative spend beyond the end of the life of the change funds. At the end of the day, the issue is not just about money; it is also about human capacity and using the professionals in a more flexible way, which is what underpins health and social care integration. There are many issues to do with terms and conditions and the transfer of people from one thing to another. If we focus on the structures and the governance, we will not get anywhere. If we focus clearly on the outcomes, if people are flexible and prepared to work across barriers, and if we put in place the local management that can make that happen, we can go further, and a lot of the other stuff will follow behind.

The integrated resource framework is a useful piece of work. A lot of learning comes out of that, but there are many other things that help the approach move forward on the ground.

What would you say on Mr Stewart’s point about transparency?

That is one of the useful aspects of the issue. We need to understand where resource is tied up in each other’s organisations. I have heard a health chief executive—not my own—talk about the problem that they have with insatiable and growing demand. If better outcomes for older people, such as preventing their admission to hospital and getting them out of hospital and into care settings earlier, can be used to free up beds in the acute sector, there will be plenty of other demand that will soak up that efficiency. The question is how we capture those efficiency savings and ensure that they do not just go to meet the insatiable demand but are moved to invest further in the preventative approach. That is the challenge. The work that is being done on the integrated resource framework helps us to see what is being done in that regard and helps us to keep track of what is happening as our interventions change things.

I recognise that good progress is being made in CPPs and that some of the barriers that were there previously are slowly but surely disappearing. One of those barriers, which was highlighted by Mr Whitefield and others, concerned the sharing of budgets. I think that you suggested that it would be better if there were a single budget line, with all partners committed to the partnership. What benefits would come from that arrangement?

Many submissions have suggested that it would be useful to do a mapping exercise to determine how public sector investment meets the strategic priority needs. Do councils have any plans to undertake such an exercise? How would the outcomes from that exercise be used in practice?

Common sense pushes us in the direction of saying that, yes, there would be benefits from having a single-line budget. However, I would not like to guess the complexities that would be involved in getting there. I think that some work was done by the Improvement Service in Fife, with Fife Council and the NHS, to try to identify the costs of joint services. However, I think that they gave up the task, as it was too complex to unravel the NHS budget and find out how much was being spent by the NHS on a particular service. It might be that, instead of taking budgets on a service-by-service basis, we should consider them on an outcomes basis and try to put money into outcomes rather than into the service silos.

Could you repeat the second part of your question?

A number of submissions suggested that a mapping exercise could be done to determine public expenditure on meeting strategic priorities and needs. Do councils have any plans to do such a mapping exercise on meeting demands?

I do not think that that was in our submission, so we have no plans in that regard. However, reference to a mapping exercise on expenditure brings me back to the work that the Improvement Service was trying to do in Fife to map how much is spent. It found that to be very complex and it ran into difficulties. My understanding is that it just could not be done.

We have no plans to do a mapping exercise. However, an area that probably needs to be explored is understanding what the cost of failure is when we get it wrong and what getting it right first time might save us.

I am not sure whether not having a single-line budget is a barrier or whether having such a budget would make a difference. However, I agree with points that were made earlier about having much more closely integrated financial planning and understanding collectively the challenges of financial resilience not just in the council but across all partner agencies. Having a collective understanding of that and closer financial planning would certainly be a step forward.

Gavin Whitefield and Bob Jack have talked about single-line budgets, but it would be interesting to hear their thoughts on the mapping exercise suggestion.

They are related issues. For me, they approach the question of the success of community planning from the wrong end—from the inputs end. The approach is to say, “Let’s identify where all the inputs are at the moment and aggregate them.” What that gets us to is the realisation that the resources that are available to the agencies are far from sufficient to meet all demand.

The better approach is to ask what things need to change in order to better the lives of citizens and communities in Stirling—to use my area as an example. It is about what we need to change in Stirling over the period of time that we are talking about, what actions and interventions will make that change and how we will collectively resource them. We peel away from the existing spend by prioritising and focusing on the actions and interventions that take us to the agreed outcomes.

If we start at the end of pooling budgets and mapping all the resources, we are really looking at the existing situation. What that throws up is all the reasons why we cannot stop doing what we already do, because everything that we do has some importance and priority. The point is to look at things from the other end.

We mentioned earlier an exercise that we did a number of years ago to quantify the total resources going into community planning across all the partners in North Lanarkshire. That is a challenging but worthwhile exercise because it should improve accountability. A number of years ago, we were accounting for so many different funding streams, but there were very few if any attempts to look at what the total budget was delivering. We have the potential for that now because we have the single outcome agreement, which shows the outcomes, and the total budget of that at the strategic level, so we can compare the two.

In our experience, the challenge is to move beyond that and map and analyse budgets with regard to strategic priorities at a more local level, which is very complex and challenging. There may be a place for doing that on a manageable pilot basis and learning from the exercises, rather than biting off more than we can chew, given the current priority of focusing on actions and outcomes, as Bob Jack said. There is a danger that we could lose a lot of time in doing analyses that would not provide much benefit. There is a need in the current financial climate, though, to look at every way in which we can manage resources better to get better outcomes.

The use of data is important and it has been referred to a few times. However, is there a general concern about the difficulty of obtaining comparator information, given that organisations are not measuring like for like? Is there any concern about the reduction of Audit Scotland’s role in collating and publishing data on strategic performance indicators?

10:45

That was a problem in the past whenever we looked at comparative information. When I challenge my local authority and ask why we are where we are in the unit cost league table, for example on domestic refuse collection, I am told that we are not comparing like with like; that is the immediate answer to benchmarking. We need to get better at that and accept that it will never be a perfect exercise. It is, however, the can opener that gets us into some of the issues.

For the past year or so—for far too long—the Society of Local Authority Chief Executives and Senior Managers, the Chartered Institute of Public Finance and Accountancy and the Improvement Service have been doing a piece of work across the 32 councils on benchmarking unit costs and service delivery and one or two highlight performance measures. Every time that work has been near to publication, we have been told that we are not comparing like with like and that some local authorities do not like where they happen to be in the league table. We have committed to publishing that work in June and we need to get on and do that. Only by getting that information into the public domain and having the debate about the questions around it will we perfect the benchmarking. We need to handle that in a mature way. As you will appreciate, there are sensitivities to consider, especially if a local authority is 32nd out of 32 in a particular service league table.

The point of doing it is to drive improvement and increase efficiency across the board. If we handle the data in a mature fashion, we will get better and better benchmarking data, but if we do not, we will never start the journey because people will be afraid to put that kind of information into the public domain. We are committed to publishing that report and if we get on with it and deal with it in a mature way rather than focusing on who is at the bottom of a particular league table, we will get better and better at benchmarking, and that will drive up performance and efficiency across the board. Local authorities will want to know how to move from where we are to being average or better; that is what benchmarking is for.

What about Audit Scotland’s role in collecting data on SPIs?

When Audit Scotland was in charge of that, there was more consistency in the data collection. However, there were several hundred SPIs. The benefit of the work being done by SOLACE, CIPFA and the Improvement Service is that it focuses on the things that really matter in relation to services. What is needed is a unit cost measure that can be collected in the same way across the 32 councils and that can be checked for consistency, and a performance measure that really matters as a yardstick of how well that service is doing. We do not need 1,001 indicators; we need to look at the things that matter.

We are getting a bit tight for a time. Does Gavin Wakefield want to add to that?

It is important to consider the purpose of the benchmarking. The benchmarking that Bob Jack has mentioned will be of real benefit, but it deals with service performance, cost of service and efficiency measures that will provide good benchmarks across Scotland and within family groupings of local authorities. Beyond that, we have talked a lot about outcomes. Every community planning partnership will draw on a menu of outcome indicators. When the single outcome agreements were being introduced a number of years ago, it would have made sense to have a core set of indicators so that we were all measuring against the same outcomes. That would have helped with benchmarking. At the time, it was felt that that was not the way to proceed but, as we have said in our submission, we still believe that it would be beneficial. In practice, we have got pretty close to that.

In the performance reports, about 70 or 80 per cent of the indicators are fairly consistent throughout Scotland. If we moved to 100 per cent consistency for that core set of indicators—not a massive number but a manageable and meaningful one—it would add value, as long as we take into account the different family groupings and compare like partnerships with like partnerships rather than areas that bear no resemblance to each other, which would have a significant influence on the outcomes that are delivered.

I have two quick questions on the issue of keeping community at the heart of community planning partnerships. I realise that we are tight for time, so not all panel members need to answer. You could put your fingers on the buzzers and be dead keen and eager. How do councils ensure that the third sector and communities are fully involved, and what difficulties face councils and those groups in improving engagement? Don’t all rush!

Earlier I mentioned partners working together on a cohesive community engagement strategy, working with communities and understanding their needs and expectations. The difficulty is that not all communities want to come to the table. Some communities are better geared up than others to engage, particularly in the case of communities that do not have community council representation. We are working in partnership with colleagues in health on an asset-based approach, which has also been used in Onthank in Kilmarnock. It is about getting the community involved using community assets and building community engagement. It is not a one-size-fits-all approach. Some communities are well geared up for engagement and for linking into the community planning structure, but others are not. It is about ensuring that we target our support and that the third sector—particularly through the third sector interface—is an equal partner at the table.

We have to ensure that the third sector is at the table as an equal partner. It has a massive role to play in adding value to services that are delivered, and indeed delivering some of the services itself through service level agreements with other partners.

As Stuart Crickmar says, it is down to our community engagement strategy. We need to realise that there is not one community out there; there are different communities. There are communities in a geographical sense and there are communities of interest, and we have to engage with them all. We try to do that through our community planning partnerships, but it is hard to get full community engagement. It is a matter of plugging away at it and putting stuff forward in a way that is meaningful to the community. If it is meaningful to the community and the community has an interest in it, the community will come.

We have spoken a great deal about local government’s role in the structure of community planning partnerships. Do you foresee a role for MSPs or MPs in the structure of CPPs?

That is not something that we have considered as a partnership, but we have reflected over the years that, if we are serious about getting better alignment between the different tiers of government—the United Kingdom Government, the Scottish Government, local government and local community planning—there could be merit in having that involvement.

In recent years, we have seen a welcome development in which senior civil servants from the Scottish Government are represented on community planning partnerships. That has added value; making the political links as well could be of equal value. It is worthy of consideration.

In the early days of community planning, when Stirling was one of the five pathfinders, we had something called the Stirling assembly, which involved MSPs and MPs and operated at a pan-Stirling level. It was an opportunity for community councils, communities of interest and anybody from the public to come together to debate bigger issues in the Stirling agenda. That fell by the wayside for a number of reasons.

In response to your prompt, though, how do we engage MPs and MSPs and so on? They will not want to commit to particular community planning structures and related meetings. However, we have experience that MSPs and MPs very much wanted to be part of wider engagement on the big issues that affect an area.

I thank panel members for their evidence.

10:56 Meeting suspended.

10:58 On resuming—

We move on to our second panel, which is Dr David Farquharson, medical director of NHS Lothian. We will have a session in which we will hear from more representatives of NHS boards, but it was impossible to get everyone in the room at the same time today. We promise not to give you a full grilling.

It feels a bit like a job interview.

You are the only candidate, so congratulations.

Thank you for making it along today. How are NHS Lothian and other partners integrated into the community planning process?

We see the community planning process as an important function, particularly in relation to the changing demographics in NHS Lothian and throughout Scotland, with people living longer. We ignore our local authority colleagues at our peril, so it is extremely important to have the appropriate people with the delegated authority to ensure that meaningful discussions and actions come out of the process.

We have had further discussions about the integrated resource framework and we have done a lot of work on integrating health and social care, which I was here to discuss last week. From the point of view of transparency and giving confidence to those who are in operational roles, we feel that this is valuable work, which needs to be supported.

There is a degree of scepticism about whether the benefits of transferred resource from healthcare to social care will be realised. Judging by the earlier discussion, a lot of it is about prevention. We are talking about the long term; we will not see an outcome in three years, particularly when it comes to some of the work on the early years. We are investing in the children of the future and we will not see immediate results from that investment.

It is terribly important for the viability of the NHS that we invest in what we do for young people so that they do not have to use the NHS in the way that we may have had to do in our time.

11:00

My questions are on the same lines as previous questions. Some folk see HEAT targets as an impediment to the health service’s involvement in community planning partnerships. The different budget cycles have also been thrown up as posing a difficulty at times. Can you comment on that?

A lot of it is cultural—where there is a will, there is a way—and the single outcome agreements should be the strategic priority as we move things forward. Likewise, in finances, the integrated resource framework is a template and a model that we should be using. I stress that, if we all have the same shared vision, we should be able to overcome the barriers and obstacles that we see.

Thank you for that concise answer. The integrated resource framework seems to be working very well where it is being used. For transparency, is it much better to go that way? Is it more transparent?

I probably have to say yes, because NHS Lothian has invested a lot of resource in the IRF. As I said, it is important to give the NHS confidence about where activity and spend has gone, particularly in terms of the budget that is now available to the NHS. As times get hard, I see it as an important part of moving forward.

The committee recently visited the Borders to look at some of the integration work that is being done there, which seems to be moving on apace. The health board was completely honest in saying that there were some difficulties, but it has always managed to get through them. Is a change in governance required, or just a change in culture?

It is more a change of culture that is needed. As I have said, we must have a shared vision of what we are trying to achieve. I would not want us to spend a lot more time on process or governance, the arrangements for which are satisfactory; it is important that we look for real and tangible benefits, as has been mentioned previously. For me, it is important to demonstrate the benefits that can be achieved so that people can be confident that this must be the way forward. Given the changing demographics and an increasingly elderly population, we ignore combined work at our peril.

To what extent are third sector and community representatives fully integrated into the community planning process? Are those groups seen as consultees or as full partners?

I hope that they are seen as full partners. The third sector is extraordinarily important in the delivery of healthcare in other health settings, and I do not think that we make full use of it.

How could communities and third sector organisations be better engaged in the community planning process?

They need to be involved at an earlier stage. NHS Lothian is formulating its clinical strategy for the next 15 years, and we see early involvement of the third sector as a stakeholder as extremely important. Those groups and organisations need to be involved near the beginning of discussions.

CPP structures seem to be quite complex. Could they be simplified? What would be the advantages and disadvantages of that?

CPP structures have to be fairly complex to some extent, because they deal with many different areas of work. I find it difficult to see how they could be simplified, although perhaps I do not have expert knowledge to answer the question. They must have a degree of complexity by necessity, simply because of the challenges that they face. A number of areas require to be addressed and, from where I sit in the NHS, I do not see an easy way of simplifying that.

In the earlier evidence session, it was suggested that the structures still need to be in place, but that there could be a simplified model to sell to the community to make it understand what CPPs are all about and encourage community engagement. Is that suggestion worth looking at?

Absolutely. I am not sure that communities necessarily appreciate the benefits and workings of community care partnerships, what they are up to, and what their purpose is. That might be more to do with a public relations exercise being required, but you are right. I do not think that communities understand the value of that bit of the organisation.

Do you have a view on the key ways in which arrangements around the governance and accountability of CPPs could be improved?

It is important to ensure that we have the metrics to judge success. Outcomes need to be tangible and real. People can have confidence that the approach is the right way forward only by that means. From a clinician’s point of view, we would like to see real evidence of where the arrangements can be effective in the transfer of care from the hospital setting, in the broadest sense, back into people’s homes. In the future, the way forward must be to deliver more care in patients’ homes with the best use of technology. I am referring to telehealth, telemedicine and all the other bits of technology out there that we use in our everyday lives. Perhaps we do not make full use of those technologies in healthcare. We will need to look seriously at that area in the future.

Is there an issue around the data evidence base for those outcomes? Is there a problem in NHS Lothian with collecting comparative data and finding its sources?

There is a great challenge with data. Recent articles in the British Medical Journal have said that there is no good evidence that some of the technologies that I have mentioned prevent readmissions to hospital, but I still think that they will almost certainly be the way forward. There is certainly evidence that telehealth can reduce readmission rates for chronic obstructive airways disease. We need to promote work pilots to see what the real benefits and disadvantages of such an approach would be. All the evidence suggests that elderly people—not only the younger generation—can access the internet effectively. We need to make full use of that ability. People want to manage their health, get their prescriptions and make general practitioner appointments online, and I do not see why we should not be able to do that. We all do similar things in our everyday lives, so why should healthcare be behind?

In overcoming the main challenges in engaging communities with the voluntary sector, how should partners share their budgets? Do you have a view on a mapping exercise being carried out?

Perhaps we should look at bundles of care and, in particular, we can look at the elderly or the frail elderly. We can map that through. That would be a useful exercise to break down silos, and it could be done for specific disease problems or entities. The vast majority of care for people with certain specific diseases can be delivered in the community, so I would go for looking at specific disease bundles and seeing how the budget for them could be looked at throughout the healthcare setting and in local authorities. That approach could be used as a model to consider how resource transfer can take place.

What about the sharing of budgets?

I would want that to happen along the same lines, on the basis of disease models and bundles of care. There could be shared budgets for specific parts.

To what extent does the NHS consider that the CPPs in which it is involved are focused on outcomes-based and preventative approaches?

As I have said, the preventative approach is extraordinarily important. The NHS cannot work in isolation and needs to get involved in supporting and investing in the early years, in particular, to promote good health among the young population.

How focused are the CPPs in which you are involved on those outcomes?

We have been doing some good work with them. Lothian, for example, has piloted family-nurse partnerships, which support early intervention in young families. That sort of approach might be a long-term investment, but surely we should be aiming to give everyone a good start in life to ensure that they do not hit the NHS system in the future.

How does the NHS see the CPPs ensuring buy-in from all partners to these outcomes-based and preventative measures?

I hope that we have a shared vision of how we want to move forward. I do not think that legislation or budgets are the whole answer, and I hope that, if the appropriate senior staff are involved in the discussions, the CPPs will have the overall vision of what we are trying to achieve, particularly with regard to prevention. After all, the NHS’s future will depend on prevention, anticipatory care and so forth rather than on the current reactive approach, in which we simply treat patients coming into accident and emergency. We certainly need to look at very different models of care.

At the moment, the community planning duty is restricted to local government. What are your views on the suggestion that has been made by a number of witnesses that it be extended to other partners, including the NHS?

I would be in favour of such a move. As I have said, the scope of CPPs is immense and I do not think that we are necessarily realising the full benefits of the approach. Anything that helps to facilitate that would be an improvement.

I am hesitating slightly, because I am trying to think of the disadvantages. They might come to me in due course.

Thank you very much for your evidence, which will slot into the evidence that we will take in our longer session with other NHS boards.

I suspend the meeting for five minutes.

11:13 Meeting suspended.

11:20 On resuming—