1. Community Health Partnerships Angela Canning

2. What we do 227 February 2012Community Health Partnerships

3. 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 327 February 2012Community Health Partnerships

4. 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 427 February 2012Community Health Partnerships

5. 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 527 February 2012Community Health Partnerships

6. 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 627 February 2012Community Health Partnerships

7. Good governance principles for partnership working BehavioursPersonal commitment for the joint strategy from partnership leaders and staff Understand and respect differences in organisations’ culture and practice ProcessesNeed 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 measurement & management Clearly defined outcomes for partnership activity Partners agree what success looks like and indicators for measuring progress Partners implement a system for managing and reporting on their performance Use of resourcesIdentify 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 727 February 2012Community Health Partnerships

8. 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 827 February 2012Community Health Partnerships

9. 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 927 February 2012Community Health Partnerships

10. 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 1027 February 2012Community Health Partnerships

11. 1127 February 2012 Current work programme Community health partnerships (June 2011) Transport for health and social care (August 2011) Scotland’s public finances: addressing the challenges (August 2011) Overview of Scotland’s criminal justice system (Sep 2011) Modernising the planning system (Sep 2011) Telehealth (Oct 2011) Role of community planning partnerships in economic development (Nov 2011) Reducing greenhouse gas emissions (Dec 2011) National health service – annual overview (Dec 2011) Cardiology services (Feb 2012) Commissioning social care (March 2012) Commonwealth games – 2 nd position statement (March 2012) Reporting in 2011/12 Community Health Partnerships

12. Future work programme Mergers of public bodies – lessons learned Outsourced contracts Justice – Reducing reoffending Health inequalities GP prescribing Protective consumer services in local government Stroke services NHS annual overview Managing major capital investment in local government Scotland’s public finances – workforce planning with reducing budgets Renewable energy Reporting in 2012/13 1227 February 2012Community Health Partnerships

13. More information www.audit-scotland.gov.uk acanning@audit-scotland.gov.uk 1327 February 2012Community Health Partnerships