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 staffUnderstand and respect differences in organisations’ culture and practice

Processes Need or drivers for the partnership are clearClear vision and strategyRoles and responsibility are clearRight people with right skillsRisks associated with partnership working are identified and managedClear decision-making and accountability structures and processes

Performance measurement & management

Clearly defined outcomes for partnership activityPartners agree what success looks like and indicators for measuring progressPartners implement a system for managing and reporting on their performance

Use of resources Identify budgets and monitor the costs of partnership workingAchieve efficiencies through sharing resources, including money, staff, premises and equipmentAccess 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

Community Health Partnerships

Future work programme

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More information

www.audit-scotland.gov.uk

acanning@audit-scotland.gov.uk

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