Angela-Canning by lanyuehua

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									Community Health
Partnerships

Angela Canning
What we do




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Community Health Partnerships



                                To examine whether CHPs
                                 are achieving what they
                                 were set up to deliver,
                                 including:

                                •   their governance and
                                    accountability
                                    arrangements
                                •   how well they are using
                                    resources




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Audit of CHPs – our methodology



• Analysis of published national statistics
• Analysis of CHP information held by ISD Scotland
• Collected information directly from CHPs (eg
  structures, budgets, staffing)
• More detailed work in 6 CHPs about specific issues
• Desk-based review of documentation
• Interviews




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Main findings (1) – Partnership
working in the public sector

• Long history to partnership working in the public sector
• Cluttered landscape:
    • Risk of duplication between groups
    • Lack of clarity on distinct roles and responsibilities
    • Opportunities to streamline and achieve
       efficiencies




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Main findings (2) – CHP structures



• Two types of CHP structure (health-only CHP and
  integrated CHP) but no evidence that one structure is
  better than the other
• Partnership working is challenging and requires:
    • clarity of purpose
    • strong, shared leadership
    • commitment
    • good relationships




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    Good governance principles for
    partnership working
Behaviours                Personal commitment for the joint strategy from partnership leaders and staff
                          Understand and respect differences in organisations’ culture and practice


Processes                 Need or drivers for the partnership are clear
                          Clear vision and strategy
                          Roles and responsibility are clear
                          Right people with right skills
                          Risks associated with partnership working are identified and managed
                          Clear decision-making and accountability structures and processes

Performance               Clearly defined outcomes for partnership activity
measurement &             Partners agree what success looks like and indicators for measuring progress
management                Partners implement a system for managing and reporting on their performance

Use of resources          Identify budgets and monitor the costs of partnership working
                          Achieve efficiencies through sharing resources, including money, staff, premises
                          and equipment
                          Access specific initiative funding made available for joint working between health
                          and social care


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  Main findings (3) – Governance
  arrangements in CHPs
• Governance arrangements are complex and not always clear:
    • CHPs set up over 5 years ago and have evolved over time
    • Schemes of establishment (SoEs) are out-of-date or
        incomplete
    • Other governance documents are inconsistent with SoEs
    • Lack of clarity about CHPs’ devolved functions and other
        responsibilities
    • Added complexity for integrated partnerships
• Lack of clear, joint vision and strategies for health and social care
• Performance arrangements are complex and not always aligned
  with strategies
• Joint workforce planning and management arrangements for joint
  posts are underdeveloped


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Main findings (4) – Use of resources

• Few CHPs influence how resources are used across the whole
  system
• Joint planning and resourcing is generally underdeveloped:
    • Need better information about how resources are used
    • Pooled budgets are beneficial but only one in Scotland
    • Need better engagement with GPs and other clinicians
    • SG is leading Integrated Resource Framework project and
       Change Fund
• £13 billion spent on health and social work services in 2009/10:
    • CHPs managed about £3.2 billion but responsibilities vary
    • Management and administration costs are unclear
    • Gaps in community-based activity and workforce information
       at a CHP level


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Main findings (5) – Impact on health
and quality of life of local people

• Scotland has long-standing health issues
• Difficult to attribute change in people’s health to any
  single body
• No large scale shift in the balance of care
• CHPs have contributed to some improvements, eg
  support for rehabilitation, anticipatory care, training for
  carers, self-management




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Current work programme




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Future work programme




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More information




                            www.audit-scotland.gov.uk

                       acanning@audit-scotland.gov.uk




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